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2. "We must look to the nursing process for guidance in nursing care."

A change in nursing care delivery system is being considered by hospital administrators. Which information should the nurse executive add to this discussion?

2. As a medical-legal incident

A client has been told that chemotherapy must be postponed until he is hydrated. The client refuses the intravenous hydration and demands to go home. How would the nurse best categorize this situation?

4. The hospital with the highest performance ratings for this procedure

A client needs a high-risk surgical procedure. According to the Leapfrog Group, the client should choose which hospital for care during this procedure?

4. Home health agency

A client who is being discharged from the hospital will need follow-up for wound care. The client's spouse is not capable of providing bed baths for the client. The nurse case manager who is planning care for this client should contact which agency?

4. Ability to inspire the others to commit to the team's goals

A nurse is working in a unit with several less-experienced nurses. Which attribute displayed by the senior nurse would make her leadership of the less-experienced nurses most effective?

2. The staff nurse

A nurse manager and a staff nurse are in conflict. The nursing supervisor has decided to use mediation to arrive at a solution. The supervisor should be most concerned about which person's level of comfort when choosing a place for the mediation meeting?

3. Develop a work plan with interim deadlines.

A nurse manager has been appointed leader of a large task force charged with a complex assignment. What strategies should the manager use?

3. "Your most important role is to ensure client care accountability."

A successful nurse manager is mentoring a newly promoted nurse manager. Which comment by the mentor reflects the most important consideration of all nurse managers?

3

A tornado destroyed 65% of the businesses and homes in a small midwestern city. Aid would be requested based on categorization as a level ______ disaster.

3. A high RN-skill mix

A unit requires a great deal of staffing flexibility. To fill this need, the manager should use which strategy?

2. The nurse should get medications more quickly because the robot can work more consistently without breaks.

Hospital administration is considering the purchase of a robotic pharmacy system. What would be the advantage of this system to the nurses who work in the hospital?

3. The Institute of Medicine has proposed residency programs for nurses.

Hospital administration is working with a university school of nursing to establish a nursing residency program. Why is this a desired action?

2. A normative-reeducative strategy

Hospital administrators are considering changing from the traditional method of creating work schedules to a system in which the nurses will choose their own workdays. Choices will be made according to seniority. Which change strategy would likely be best for this endeavor?

1. Follow the nursing process.

How can a nurse best influence policies in an organization?

2. Information power 4. Expert power 5. Referent power

Leaders and managers often exercise power differently. Select the powers most frequently used by leaders. Select all that apply.

2. A person cannot be promoted to the role of leader.

The health care organization's monthly newsletter has a headline reading "Nurse Promoted to Leader of Specialty Care Units." What is the error inherent in this headline?

4. Conjunctive

The nurse manager has been asked to assemble several groups to work on tasks to improve the unit's performance and client satisfaction scores. This manager would put the fewest people in a group working on which type of task?

1. The budget is a fixed one.

The nurse manager tells the staff that this year's budget numbers will not change, even if census drops over the rest of the year. How should the staff interpret this information?

4. Current research

The nurse manager's expected outcome is to increase evidence-based practice on the nursing unit. To meet this outcome, the manager encourages nurses to base their practice on which technique?

2. None of the methods are designed to place blame on an individual.

Which statement reflects a characteristic common to all methods of quality management?

1. The RN asks the LPN to assist with admissions by assessing the clients as they get to their rooms.

Which statement represents a situation is which delegation is ineffective or inappropriate?

3. Vision statement

"We want to be the hospital of choice in the Midwest" is which type of statement?

1. By being educated 3. With training 4. Through life experiences

According to the behavioral view of leadership, how are leaders formed? Select all that apply.

3. Empirical-rational model

Computerized charting will be initiated on select units of the hospital. Orientation to this new system will be provided to each nurse by a team of nurses educated in nursing informatics. This is an example of which type of change strategy?

1. Conflict draws attention to an issue. 3. Conflict can stimulate new ideas about how to manage the high-acuity unit. 4. Conflict about the unit will help to identify the compromises necessary to make it a viable part of the hospital system. 5. Conflicts about staffing may make current staff members reexamine their own performance.

Conflict has arisen within the hospital regarding who will staff a proposed high-acuity unit. The nurse executive and other administrators have purposefully not intervened in this conflict. Why is that strategy appropriate? Select all that apply.

1. "The day shift just wants to shift work onto the evening shift." 2. "Everyone likes to bathe right before bed." 4. "The physician staff will be upset if we change our morning routine." 5. "If we let them change this, they will want to make lots of other changes, too."

Currently clients on a unit are bathed in the morning between 8:00 am and 11:00 am. The nursing staff is contemplating changing that routine to bathing clients in the evening between 7:00 pm and 9:00 pm. Which statement reflects an underlying assumption that might affect the staff's ability to think critically about this change? Select all that apply.

3. Dependent

During a discussion of how to proceed on a project, a team member says, "I don't care how we do it. Just tell me what to do and I will get it done." What kind of followership is this nurse exhibiting?

1. The nurse will have to choose a provider from within the HMO.

During a nurse's interview for a new job, the health benefits are described as being provided by a health maintenance organization (HMO). What should the nurse expect from this coverage?

2. The nurse manager may have too many staff members to manage.

During a performance evaluation the nurse manager states, "My span of control is just too large." How should the unit supervisor interpret this statement?

1. Metacommunication

During an evaluation conference, the nurse manager observes nonverbal messages, including nodding in agreement and smiling. These behaviors are examples of which aspect of communication?

2. "The night shift differential is 10 percent."

During an interview with a potential employee, the nurse manager tells the individual that an additional 10 percent of the hourly rate will be paid for working the 7:00 pm-7:00 am shift. What is another way the manager could have described this difference in pay?

3. The administrator is worried about the hospital's ability to respond to a large influx of clients from a disaster.

During discussion about the hospital's disaster plan, the administrator says, "I am concerned about our current surge capacity." How should the members of the group interpret this concern?

4. Forming

During the first meeting of a newly created task force, the nurse manager notices that individuals tend to cluster with members of their specific nursing units. The nurse manager begins the meeting with an explanation of the focus of this group. These behaviors are characteristic of which stage of Homans's group process?

2

Fire departments from a three county area have responded to a wildfire that has threatened several homes and a hospital in a wooded area. The fire is now under control and the fire chief is completing paperwork on the response. The disaster should be classified at level ______.

3. The regulations of the state nurse practice acts

For the nurse to effectively and legally delegate, which document must be consulted and followed to reduce the likelihood of liability?

2. As a pandemic 3. As a health disaster 4. As a natural disaster

Health care providers are preparing for a worldwide outbreak of H1N1 influenza. How would this outbreak be classified in planning literature? Select all that apply.

3. "You can expect additional efforts to help us keep on track."

Hospital administration has elected to use TeamSTEPPS as a method of team building. What should the nurse manager tell staff about this training?

1. Develop a caring relationship with staff during normal times.

Hospital administration is aware that staff may be reluctant to be called back to work in a disaster. How can the hospital be proactive in encouraging staff to make the decision to serve?

3. Procedure complication

Immediately following a barium swallow, a client noticed hives and a feeling of shortness of breath. Although there were no known allergies to food or drugs prior to this incident, the diagnosis was allergic reaction to the preservatives in the barium. Which is the correct risk category for this incident?

2. Procedural technician

In a group meeting, one of the members always arrives early and places the chairs in a circle so all members can interact. This person is responsible for confirming that the room is available for the monthly meetings. Which person does this describe?

3. "Relationship building is essential to successful leadership."

In a leadership training class, which statement by a student indicates learning has been successful?

4. Win-lose

In order to come to a solution for an ongoing conflict among several nursing units, the nursing supervisor says, "Your managers will meet to create a voting form representing both sides of this issue. Each of you will vote and the majority will rule." What kind of a solution is the supervisor seeking?

1. Accountability for the assignment on the part of the delegate 2. Accountability for the assignment on the part of the delegator 3. Authority by the delegator to assign the task to the delegate 5. Authority of the delegate to accomplish the task as assigned

In order to delegate, which must be present? Select all that apply.

3. Case management

In order to organize services needed to achieve specific client outcomes, hospital administrators should consider what type of client care delivery system?

1. Check with the assistant to see how the assignment is going during the time breakfast is served.

In the morning care conference, the nurse instructs the assistant to feed breakfast to the clients in beds 2234, 2230, and 2241. The assistant indicates understanding of the assignment and repeats the bed numbers back to the nurse. What is the nurse's next step?

4. The emergency nurse receives a client who was transferred via ambulance for confusion.

In which situation should the nurse be most concerned that communication was distorted?

1. "There is no time to worry about using personal protective equipment, just try to be safe."

Multiple casualties have arrived at the emergency department following a tornado. Which instruction from the manager to staff is incorrect?

3. The unit has just adopted combined staffing patterns.

On two recent occasions, the experienced nurse manager has found it nearly impossible to discuss upcoming events with all the staff on the unit. What is a common reason for this problem?

1. The nurse commits a medication error and reports it to the charge nurse.

One of the nurse competencies of the synergy care delivery model is "moral agency." Which action is an example of that trait?

1. Coercive power

One of the nurses often fails to attend educational offerings available to the staff. The nurse manager who implies the nurse may receive a negative evaluation is using which type of power?

1. "I am not following the policies and rules well." 2. "I should review the procedure manual." 3. "I'm good at using my previous experiences to guide my decisions."

Part of the facility's performance evaluation is based on the nurse's strength in the three types of decisions. During a nurse manager's performance evaluation the supervisor says, "You are very good at adaptive decisions, but you need to be more precise in routine decisions. When the situation calls for really innovative decisions, you do not seem sure of yourself." How should the manager interpret this information? Select all that apply.

2. Nurse manager

Procedural changes are being planned on the unit as a direct result of client satisfaction surveys. Which person is most strategically placed to handle how these changes are initiated?

2. "I hope to be as good a manager as he is someday." 4. "His example has encouraged me to get to know people in other departments in the hospital."

Staff nurses have been asked to comment on the work of a nurse manager as part of the manager's performance review. Which comments by the staff nurses would indicate to the supervisor that the manager is also a leader? Select all that apply.

3. Nurses routinely interact with multiple disciplines.

The CEO of the hospital approaches the chief nurse with a request that the nurse act as the primary change agent in the implementation of a new hospital-wide policy. Why would the nurse be a good choice for this assignment?

4. Patient classification

The OB manager is looking at staffing for the night shift. The postpartum unit is busy and the labor-delivery unit has four clients in labor. The manager collects data from the nursing staff regarding the acuity of their clients. These data assist the manager in determining the staff for the next shift. This is an example of which type of system?

2. As a common disadvantage of the team approach to nursing

The RN leader of a team overhears one of the UAPs on the team say, "I'll sure be glad when I get my RN license. All they do is sit around doing paperwork." How does the RN interpret this comment?

3. Team nursing

The RN receives reports on eight clients in the morning. Client assignments are then delegated to an LPN and two nursing assistants. The morning is busy, with physician visits and new client orders, and the RN communicates these new orders to the LPN and nursing assistants. The RN also meets with the case manager to discuss nursing home placement for a client. What type of nursing care delivery system is in place in this hospital?

2. RNs will be required to accept flexible schedules that might require the nurse to practice on any unit in the facility. 5. When low census occurs the unlicensed assistant category will be first to be furloughed.

The administration of a health care organization has proposed a new client care area staffing system. Which components of this system do not meet the American Nurses Association (ANA) requirements? Select all that apply.

1. The client may have multiple primary nurses if transfers within the facility are necessary. 3. Staff nurses cannot be held legally liable for care provided outside their work hours. 5. All persons caring for the client must have excellent communication skills.

The hospital administration is considering adopting primary nursing as its model of nursing care delivery. Disadvantages of this method are that: Select all that apply.

3. Total patient care

The hospital is opening its first intensive care unit. The nurse executive should plan to staff this unit according to which model of care?

2. Nurses are doing both the old work and the new work. 3. A nurse says, "I guess everything we've done for years is wrong." 5. Nurses are doing parts of the old procedure and parts of the new procedure.

The staff is transitioning to a major change in the provision of nursing care in a large hospital. Which behaviors should the nurse manager watch for that would indicate possible problems? Select all that apply.

3. The assignment will be time limited.

The staff nurse has been appointed to a task force. What can the nurse expect regarding this group?

1. Intersender conflict

The staff nurse is unsure of the correct protocol for calling in sick to work. The nursing supervisor told the nurse to call the nursing office; however, the nurse manager told the nurse to call the unit. This issue is likely the result of which distorted communication?

4. Attend the hospital-based communication training.

The staff nurse would like to improve personal communication with peers, patients, and the medical staff. Which strategy would be most effective for this nurse?

1. Negotiation

The staff nurses and nursing administration are attempting to construct a method of scheduling that meets the needs of both the clients and the nursing personnel. Because nurses and nursing administration have experienced conflict about the issue, their intent is to arrive at an agreeable solution between both parties. Which option does this process best exemplify?

0.12

The unit employs 35 FTEs (full-time equivalents) based on an 8-hour shift. The average benefits for these FTEs are 12 vacation days, 10 holidays, 6 sick days, and 4 personal days. Based on these figures, the FTE required per employee to replace benefit time is _____ FTE. Round to the nearest hundredth FTE.

2. The agency nurses are costly.

The unit has open shifts even after staff members have signed up for overtime. The chief nurse officer (CNO) does not want to hire agency nurses to cover these shifts. The nurse manager does not understand why the CNO is offering staff an incentive versus hiring agency nurses. Which would be a reasonable conclusion?

1. Block staffing

The unpredictability of the labor and delivery area requires a set staff mix for every shift. Which type of staffing pattern should the manager use to ensure this mix?

1. There is little training available for nurse management positions. 2. Entry-level educational programs for nurses do not contain sufficient managerial content. 3. Management techniques are often learned "on the job." 5. Nurses often experience poor supervision in their own careers.

The vice president for nursing services of a large teaching hospital has been aware that many of the problems in the nursing staff result from poor management at the unit level. What are reasons that nurse managers are sometimes ineffective in their role? Select all that apply.

4. Reward power

There is a shortage of nurses on weekends. The unit manager asks nurses to work every other weekend in return for an additional 8 hours of paid vacation per month. Which type of power is this manager using?

4. Establishing a standard of total participation

This is the first meeting of a task force. What should be the leader's primary objective of this meeting?

2. "Thankfully we can treat this with an antibiotic."

A 70-year-old client develops a catheter-induced urinary tract infection. Which statement by the nurse would indicate to the nurse manager a need for additional understanding of this situation?

2. The client can indicate dissatisfaction on the survey often sent to clients after discharge. 3. The client can call the hospital administration. 5. The client can make a public report through the Agency for Healthcare Research and Quality.

A client who was discharged yesterday is very upset about the quality of care received during hospitalization for gastric surgery. What options for reporting concerns does this client have? Select all that apply.

4. Medicare will pay based on a set amount for the specific condition for which the client was hospitalized.

A client's spouse is concerned about the cost of hospitalization. The nurse says, "Since your spouse is on Medicare, the hospital will be paid according to the DRG." What does the nurse mean by this statement?

4. Transformational leadership

A community hospital has been purchased by a large health care conglomerate. Nursing administration has the task of changing the nursing practice model that has been followed for 50 years. To best achieve this change, administration should appoint a nurse executive whose leadership style follows which theory?

3. "If this new company is based on systems theory, there will be a lot of focus on how much work we can produce."

A community-owned hospital has been purchased by a health care conglomerate. The staff is aware that the organizational theory governing the hospital is likely to change. Which statement indicates a lack of understanding of organizational theory on the part of a staff nurse?

2. Make a timely decision regarding if and when to intervene.

A conflict has arisen between two staff nurses who work on the same unit. Which strategy is most important for the nurse manager to consider?

3. A nurse from a decentralized internal float pool

A critical care nurse has reported off because of an illness. Which choice of replacement for this nurse would provide the best continuity of quality nursing care?

2. Collaboration

A difference in opinion has arisen regarding methods to care for clients who are on mechanical ventilators. The nurse manager asks a group of nurses to meet and review evidence-based practice related to this client care situation. Each nurse volunteers to gather data prior to the next meeting. This is an example of which type of problem solving?

1. Allow some time to pass to see if the situation resolves. 2. Support both nurses as they work through this issue. 3. Provide any resources the nurses may need to help solve the problem. 4. Intervene if the problem begins to impact client care.

A disagreement has arisen between two staff nurses. Both have discussed the situation with the manager. The manager feels that that problem is likely self-solving. How should the manager approach this situation? Select all that apply.

2. Be certain to maintain the client tracking system.

A disaster planning task force has been asked to focus on communication. Which instruction should this group provide to nursing staff?

3. Geriatric nursing

A graduating nurse student is deciding which nursing specialty would be a good place to begin a nursing career and ensure long-term stability. Which specialty is most likely to have the greatest growth in need?

1. The remaining group members may begin to use manipulation to get the tasks done. 2. The other group members may attack the noncompliant member. 4. The remainder of the group will ignore the noncompliant member.

A group member has failed to complete assigned tasks for three of the last four meetings, despite reminders that incomplete work slows down the entire team. At each meeting the noncompliant member promises to complete tasks for the next meeting. What group actions are likely to occur? Select all that apply.

4. Unit clerks have made 10 transcription errors in the last 6 months.

A group of nurses has been convened to solve a problem. As the first step in this process, the group leader asks for a definition of the problem to be solved. Which statement reflects the best problem statement?

3. Total patient care

A group of nurses is developing a poster presentation titled "Nursing Care Delivery Through the Ages" for the hospital's annual Nurses' Day celebration. What form of nursing care delivery should they depict as occurring prior to 1930?

1. "This system will allow nurses to spend more time with those clients who need us the most." 2. "We expect that using this system will help us improve client outcomes."

A health care facility has adopted automated scheduling across all client care areas. When presenting this decision to nursing staff, the nurse executive should include which information? Select all that apply.

2. Nurse executive 3. Staff nurses

A health care organization has just achieved Magnet status. During the award ceremony the organization's chief executive officer should give primary praise for this achievement to which employees? Select all that apply.

1. Good delegation helps to reduce overtime. 2. Absences decrease when delegation is used correctly. 4. Patient satisfaction scores increase when care is efficient and effective. 5. Good delegation increases productivity.

A health care organization has provided intensive education to staff regarding benefits and correct methods of delegation. Why has the organization spent the time and money to sponsor these sessions? Select all that apply.

3. Outcome data will be analyzed to identify successful interventions. 5. Previous quality improvement efforts may or may not be discarded.

A health care organization is using the quality concepts of lean thinking and decentralization as part of their redesign efforts. Which initiatives would this organization undertake? Select all that apply.

14

A health care system is considering applying to the Magnet Recognition Program. The leaders of this health system should prepare to address ________ qualities or "Forces of Magnetism."

2. Obtain research material to provide reasons why routine nursing visits at night are not as effective as during the day.

A home health agency has a policy requiring nurses to make routine visits at night. How might politics be used to change this policy?

1. Follow the EOP to deactivate the plan.

A hospital administrator initiated the emergency operations plan (EOP) after being notified that a tornado struck a nearby community. Thirty minutes later law enforcement calls to report that while significant damage was done, there were only minor injuries. What should the administrator do now?

3. The hospital could have liability for the volunteer's performance and for his or her safety.

A hospital administrator on a disaster planning team says, "I am worried about our liability in using volunteers to provide care during a disaster." What should this team consider?

1. Mobilize the hospital incident command system. 2. Notify other administrators and order a rapid needs assessment in all critical areas. 3. Authorize the implementation of the hospital's disaster plan.

A hospital administrator receives a call that mass casualty shootings have occurred at several different locations within the city. Early information indicates that up to 50 victims may be arriving at the hospital starting within minutes. What action should the administrator take? Select all that apply.

3. Open shift management

A hospital has open shifts on its medical-surgical unit. The manager has listed open shifts on the hospital's intranet. This is an example of which type of scheduling?

1. The Federal Emergency Management Agency (FEMA)

A hospital has sustained massive destruction after being struck by a tornado. The disaster plan has been activated. The administrator would expect help from which agency to coordinate the disaster efforts?

2. If clients on the manager's unit require the use of this equipment, a portion of the cost will be charged to the unit.

A hospital has used capital funds to purchase a new piece of diagnostic equipment. The hospital's chief financial officer (CFO) says, "The cost of this equipment will be expensed out across all units that use it." How should the nurse manager interpret this statement?

1. Employees may be unwilling to come back into the disaster. 2. Employees may be personally affected by the disaster. 4. There may be no way to contact employees for call-back. 5. The employee may not physically be able to return to the hospital.

A hospital has written a well-defined surge call-back system for employees to use in case of a disaster. What are key vulnerabilities of this system? Select all that apply.

2. There has been a decrease in client deaths. 4. The overall quality of care has increased. 5. The nosocomial infection rate has dropped.

A hospital increased its RN-to-client ratio 1 year ago. What effects is the hospital likely to see as a result of that choice? Select all that apply.

4. Patient-centered nursing

A hospital is concerned about low customer satisfaction ratings and poor evaluation on quality indicators. The nurse managers are asked to implement a nursing delivery system that is cost-effective and improves both customer satisfaction and quality of care. Which nursing delivery system should the managers implement?

1. "If we use critical pathways, we won't have physical therapy to help us ambulate clients." 3. "The critical pathway lists discharge outcomes but won't help us with day-to-day guidance of care." 4. "Once the client is on a critical pathway, we must follow it until discharge."

A hospital is considering implementing the use of critical pathways and case management. Which statements by a nurse would indicate to the nurse manager that more education should be provided? Select all that apply.

1. Flooding 2. Hurricane 4. Tornado 5. Industrial accident

A hospital on the Gulf Coast of the United States would list which situations among its top vulnerabilities? Select all that apply.

3. The hospital will absorb the additional costs.

A hospital successfully implemented its disaster plan to manage providing care during a massive 3-day snow storm. What is the most likely way additional costs for this service will be paid?

1. "The finance department sent me the budget worksheet with last year's expenses." 2. "We have $1,000 left in our education account that we need to spend before the year is over. Who has an idea for a class to attend?" 4. "I like this type of budget preparation because it is fairly simple and straightforward."

A hospital's budget is incremental. Which statement by the nurse manager reflects use of this type of budget? Select all that apply.

1. "What are our current capabilities for evacuation?" 2. "Do we have sufficient resources in any other areas to continue operations if this happens to us?" 3. "Are there physical training needs that we have not filled?" 4. "What education should we provide to the staff and community?"

A hospital's disaster management team is reviewing the disaster plan after reading about a hospital that was destroyed by a tornado's direct hit. What questions should team members ask themselves? Select all that apply.

3. The nurse is going to call a physician who cares for inpatients.

A hospitalized client is complaining of abdominal pain that has developed since admission. The nurse says, "I am going to call the hospitalist." How should the client interpret this statement?

2. Educational level 3. Experience 4. Nurse preference

A large metropolitan hospital uses differentiated practice as part of the structure of nursing services. Following this plan, nursing responsibilities are assigned based on which criteria? Select all that apply.

2. "I'm so sorry, but your husband's injuries are very severe. We have to take care of the others first."

A level III disaster has occurred and the hospital is receiving clients by ambulance and those who have walked in to the emergency department. The wife of a man who is critically injured screams, "Why doesn't someone do something for my husband? He is dying!" How should the nurse manager respond?

1. The nursing department is responsible for writing the client's comprehensive care plan.

A long-term care facility's organization reflects a functional structure. Which facility practice reflects a basic weakness in this organizational strategy?

1. Enough RN staff to provide all the care to the residents

A long-term-care facility is considering implementing total patient care. Prior to implementing this system, what must be available?

1. Disperse information about the change as quickly as possible. 3. Remind staff that change is part of the health care environment. 4. Talk about the change in positive terms.

A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change? Select all that apply.

4. "I have information to share with you about the new IV pump we are considering for the unit."

A new IV pump has just been purchased by the facility. Which statement by the nurse manager reflects Rogers' first step in making the change to this new equipment?

3. "You need to look at the policy and procedure manual for the organization, not the Joint Commission manual."

A new nurse manager asks to see the Joint Commission manual in order to determine adequate staffing for the next shift. How should the supervisor respond to this request?

1. The complaints motivated the nurse manager to make the change to increase unit effectiveness.

A new triage area has been built in the emergency department causing conflict between the nurse manager and the nurses who think the design is not "user friendly." After repeated complaints the nurse manager asks maintenance to change the arrangement of the room. What is the most important reason this change occurred?

1. Status incongruence

A newly hired nurse is asked to join a group working on unit protocols. This nurse is verbal and dominates the conversation of the group. The group leader identifies the disruption this nurse causes as being from which phenomenon?

2. "First you must become familiar with the classification system we use."

A newly hired nurse manager is being mentored in this new role. How should the mentor advise this manager regarding staffing for the next shift?

4. Practice partnerships

A newly licensed RN is beginning a job search. This nurse would be best served by working in an organization that provides which nursing care delivery system?

3. Does this task involve nursing judgment?

A newly licensed nurse is concerned about the legal aspects of delegation. What is the most important question for the nurse to consider prior to delegating a task?

3. A manager who can help with skills transfer from school to work

A newly licensed nurse received specific knowledge of management skills while in nursing school. What does the nurse need now?

2. This nurse is learning to be creative.

A newly licensed nurse working on a unit committee challenges every detail of a proposal the committee is developing. How should other committee members interpret this behavior?

3. Transparency

A newly promoted nurse manager is fearful that previous coworkers will undermine her efforts to succeed in this new position. The new manager does not share information with these coworkers even though they may need the information to understand changes that are going to occur in the organization. Which emotional intelligence self-management competency is this nurse most clearly violating?

3. Demonstrate a genuine desire to find our why there is dissention.

A newly promoted nurse manager would like staff to solve problems without relying on preconceived ideas. How should the manager role-model this ability?

2. "This client needs an additional day to learn how to care for a complex wound." 3. "It will help this client manage her diabetes more effectively if she is assigned a diabetic educator." 4. "Research has shown that early ambulation helps to reduce the likelihood of pulmonary embolism."

A nurse and a physician are in conflict over the treatment of a client. Which statements by the nurse reflect the best way to handle interprofessional conflict? Select all that apply.

2. Delegation would have been more effective had the nurse been more specific about which clients and when it should be completed.

A nurse asks an unlicensed assistant to help with discharging clients since so many are going home at one time. The nurse states, "Can you help get these clients ready to go home by helping them pack?" Which option best describes the statement with regard to effective delegation?

2. An underlying assumption

A nurse believes that milk is part of the healthy adult's diet. The nurse frequently offers milk to adults as a between-meal beverage. This action is based on which concept?

3. As part of the capital budget

A nurse educator is asked by the chairperson of the department to submit a list of equipment that could be used to meet the department's goals. The list includes projectors, computers, office supplies, and computer-assisted programs. How would the educator categorize the materials?

2. Supplies 3. Physical space 4. Management infrastructure 5. Personnel

A nurse executive is assigned to a task force working on a surge system for the hospital in case of a disaster. This group should write strategies to cover which procedures? Select all that apply.

1. Open access to the blog may damage recruiting efforts. 3. Users of the blog must be very careful not to divulge any information that would violate client confidentiality. 4. The organization's reputation may be altered by a blog.

A nurse executive is considering initiating a blog to enhance communication among staff nurses, managers, and supervisors throughout the organization's different campuses. What serious considerations should the nurse make prior to starting a blog? Select all that apply.

3. "Even though we don't agree on much, I do think you are correct about enforcing the length of lunch breaks."

A nurse has a longstanding conflict with another nurse working the same shift. Over the last few days the first nurse has made an effort to smooth over the conflict. Which statement would the nurse manager evaluate as an example of a "smoothing" comment?

1. There may be lack of coordination of services across the different departments in the organization. 2. Senior nursing managers may be overwhelmed with work and decisions. 5. Managers have limited knowledge of general management techniques.

A nurse has accepted the position of vice president in charge of nursing in an organization that has a functional structure. What issues should the nurse be alert for? Select all that apply.

1. A 12-hour shift on Saturday 5. Shifts every weekend

A nurse has agreed to work on the Baylor plan. The nurse should arrange day care for which shifts? Select all that apply.

3. The United States spends more money on health care than any other country.

A nurse has been invited to discuss health care costs at a senior citizens' club. What information should the nurse plan to include in this discussion?

2. Many nurses view power as oppressive.

A nurse is overheard saying, "I just don't want to be involved in this power struggle. I don't want power; I just want to do my job." What is a common reason nurses may feel power is not desirable?

2. A method to recognize that a disaster is imminent or occurring with plans to reduce the disaster's impact 3. A plan whereby policies and procedures as well as equipment and personnel are in place to handle disasters 4. Policies and procedures that operationalize actual activities during the disaster 5. Policies and procedures describing what will occur immediately after the disaster

A nurse is working with a hospital team to create an emergency response plan that will meet Joint Commission requirements. Which sections should be included in this plan? Select all that apply.

1. "I agree it was not effective years ago, but other units have now had success with it." 2. "What were your specific concerns about the 12-hour shifts?"

A nurse manager approaches the nursing supervisor with a request for approval to incorporate 12-hour shifts into scheduling. The supervisor denies the request, stating this staffing pattern was used previously with poor outcomes. Which responses by the nurse manager may positively influence the supervisor? Select all that apply.

4. Chaos theory

A nurse manager encourages nursing staff members to assist in developing a new creative staffing pattern that can respond quickly when staff resign or go back to school. This is an example of the use of which organizational theory?

1. Nurse who each have 7 to 8 years of experience 3. Staff nurses who are interested in learning about the task of the group 4. Staff nurses who work with one another on a daily basis 5. Staff nurses who are all between 35 and 40 years of age

A nurse manager has just completed a difficult assignment managing a group that was not cohesive. Which group should the nurse identify as likely having good cohesiveness? Select all that apply.

3. "This is certainly an interesting choice of people to put together."

A nurse manager has just posted the membership list for a newly formed quality management task force. Which statement, overheard by the manager, indicates the most potential for problems on the team?

1. "We should treat as many clients as possible as quickly as possible."

A nurse manager has provided education to emergency department nurses regarding disaster management. Which statement would the manager interpret as indicating understanding of this education?

41

A nurse manager has received the following e-mail from the finance department: "Your unit's budget for travel is $1,500 for the fiscal year. The unit's actual expenditures have been $2,120." The unit is over budget by _____ percent.

1. The information may be rapidly disseminated. 2. The information may be altered as it moves across the grapevine.

A nurse manager is aware that there is a strong "grapevine" communication system on the unit. The manager elects to use this grapevine to distribute information about an upcoming change in unit policy. In making this decision, the manager should consider which possibilities? Select all that apply.

1. Provide opportunities for staff to interact with nurses from outside the facility. 2. Give the nurses freedom to design their work environment. 5. Be receptive to ideas even if they seem strange at the beginning.

A nurse manager is committed to establishing an environment that supports critical thinking and creativity. What strategies would help in this effort? Select all that apply.

2. Make eye contact with the secretary when explaining the task. 3. Talk to the secretary in person rather than by telephone or in e-mail. 5. Discuss the importance of the task to the organization.

A nurse manager is delegating a new, complex task to the unit secretary. Which strategies should the manager use? Select all that apply.

3. "The studies we want are built around the scientific approach to solving problems." 4. "Our focus should be on studies that use both experimental and control groups to determine intervention effectiveness."

A nurse manager is directing a team of staff nurses working to solve a clinical problem using evidence-based practice (EBP). Which manager statements would direct these nurses to the forms of strongest clinical evidence? Select all that apply.

1. "I don't care what they say; I'm not giving care that way." 4. "I bet I can make it very difficult for this change to occur."

A nurse manager is faced with the task of introducing an unpopular change to a staff that includes several nurses who have acted as rejecters to previous changes. The manager expects resistance but hopes to identify these rejecters early in the process. The manager should be particularly alert to which statements? Select all that apply.

2. "What are the group's current goals?" 3. "How have the members organized the group?" 4. "What is the general culture of the group?"

A nurse manager is focused on team building activities with a group chosen to write new unit policies. As a beginning step in this process, the manager should ask which questions to assess the group's context? Select all that apply.

2. "Your triage system will be reversed during a disaster."

A nurse manager is leading an education session regarding disaster triage for emergency department nurses. Which statement should the manager include in this instruction?

2. Can the manager find two or more research studies that support the use of the intervention? 5. Is the research study that recommends the intervention rigorous in design and execution?

A nurse manager is looking for evidence-based information regarding wound care. Which criteria should be used to evaluate the usefulness of an intervention? Select all that apply.

1. Newly hired radiology technicians 4. Nurses who have worked at the facility over 5 years

A nurse manager is orienting newly hired staff nurses to the organization's total quality management program. As part of orientation, the manager has assigned the nurses to interview the organization's internal customers. Which group would the nurses interview? Select all that apply.

1. Cost of care

A nurse manager is participating in the health care organization's strategic planning committee. Which factor is the primary driving force and controlling factor in new initiatives this committee might recommend?

3. Labeling the cost of each item in the clean supply closet

A nurse manager is trying to educate the staff regarding efficiency and how it affects the unit's costs. Strategies to increase efficiency could include which of the following?

3. "I stopped the conversation frequently to have the parties summarize what was being said."

A nurse manager is trying to manage a conflict between a staff nurse and a medical student. Which statement by the manager would the nursing supervisor interpret as following the rules of basic mediation?

1. Observe group member behaviors during a meeting. 2. Listen to how group members interact with one another. 5. Ask a team member how the work of the group is proceeding.

A nurse manager is using Homans's framework to evaluate the need for team building in a group appointed to work on accreditation issues. Which strategies should the manager use as part of this evaluation? Select all that apply.

4. "We should only focus on arson fires."

A nurse manager is working on a task force to develop policy for man-made disasters. There is some discussion in the committee about whether fire should be included in the policy. Which suggestion by a task force member would be most useful?

4. Agency nurse

A nurse manager needs to supplement the staff for the next schedule. Which option would be the most significant drain on the unit's staffing budget?

1. There is a higher turnover rate of nursing staff on the medical unit. 4. The critical care manager is a better manager than the medical unit manager. 5. More staff on the medical unit received premium pay this year.

A nurse manager of a medical unit and a nurse manager of a critical care unit are discussing their personnel budgets. The medical unit budget is higher than the critical care unit budget. What are plausible reasons for this difference? Select all that apply.

1. Conflict can stimulate more people to become involved in a situation, thus creating more innovative solutions to the issue.

A nurse manager states, "I cannot stand all these conflicts in my department. Nothing good can come out of it." Which indicates the best reason the manager's statement is untrue?

2. The alternatives are known. 3. The conditions of each alternative are clear.

A nurse manager who is retiring is helping the new manager learn about the position. As part of this education, the current manager has the new manager make all decisions that can be made under certainty. What conditions will these decisions have in common? Select all that apply.

1. It will help the manager create the budget for the next year.

A nurse manager writes the following note: "Over personnel budget by $1,250 in April due to late snowstorm. Nurses unable to get to work. Overtime wages paid." Why is this note important?

1. The manager has historically used trial and error as a decision-making strategy. 4. The manager uses old ways of thinking to solve the day-to-day issues of the unit.

A nurse manager's supervisor reports that many staff members have complained about the manager's rigidity. What situations reflect this rigidity? Select all that apply.

1. Electronic medical records (EMR) technology 3. An understanding of the complexity of multiple-need clients 5. A plan for compensation for the primary care provided

A nurse practitioner and a physician are considering establishing a medical home. For this venture to be successful, these health care providers should ensure which resources are available? Select all that apply.

4. Joint venture

A nurse practitioner and a physician have opened an office together. The nurse regularly collaborates with the physician in client care and is a general partner in the business of the office. This is an example of which diversification method?

21.78

A nurse recruiter is developing a handout to take to nursing schools in hopes of recruiting graduating seniors. The salary for a newly hired nurse is $18.15 per hour with shift differential of 20 percent for working the 7:00 pm to 7:00 am shift. The salary for those who would like to work this shift would be $______ per hour.

4. "As long as you follow the five rights of delegation, your liability is minimal."

A nurse says, "I am always worried that I will be liable if someone I delegate a task to does something that hurts the client." What is the manager's best response to this concern?

1. Much of the care provided is based on standard operating procedure. 3. There is a well-defined chain of command in the organization. 5. The facility's organizational chart reveals departmentalization.

A nurse who works for an accrediting agency is reviewing the structure of a health care organization. Which situations would the nurse interpret as indicating the agency is based on classical theory? Select all that apply.

2. Asking all employees to write down their ideas about a solution

A nurse working in a rehabilitation center notices clients frequently asking for something to drink. Which response indicates the use of creativity in finding a solution to this problem?

1. "I know that suggesting this change may backfire on me." 3. "I see an opportunity to make a difference in the way this facility provides nursing care." 5. "This change is certainly going to be a challenge, but that's okay."

A nursing administrator overhears nurses conversing during a break in a seminar on change. The administrator would interpret which statement as meaning that the nurse who made it is ready to become a change agent? Select all that apply.

2. The assistant should use personal time, not sick time for this situation.

A nursing assistant tells a nurse, "I am going to have to call in sick tomorrow because I don't have a babysitter." How should the nurse respond to this information?

1. Where will the service be housed? 3. When will the service begin? 4. Who will provide the services?

A nursing committee has been organized to help plan a new intensive care service at the hospital. Which questions are essential for this committee to consider? Select all that apply.

3. "Our emphasis must change to improving students' clinical reasoning skills."

A nursing curriculum includes integrated content on critical thinking. Which statement reflects movement toward designing the curriculum to meet Carnegie Foundation recommendations?

2. Environmental services is a non-revenue-producing cost center.

A nursing executive is comparing the entire hospital financials for the month and notes that the medical laboratory's revenue is higher than environmental services. What is a possible explanation?

2. Sequential interdependence

A nursing group cannot complete a task assignment because information from another group has not been provided. Because the nursing group cannot complete its task, a group from physical therapy will not be able to complete its task. This is an example of breakdown in which task format?

3. "What evidence supports that statement as accurate?"

A nursing leader wishes to maintain an image of power on a multidisciplinary committee. In a meeting, a committee member makes a statement that the nurse believes is in error. How should the nurse respond?

1. Meet with the supervisor and discuss modification of the proposed change. 2. Slow down the change process. 4. Work together to identify strategies to overcome resistance. 5. Proceed with the change.

A nursing supervisor has introduced a needed change in policy to the nurse managers. The managers have met maximum resistance when attempting to gain support for the change. Which options reflect valid strategies for the nurse managers? Select all that apply.

4. There is no difference in the full-time equivalents (FTEs) required.

A nursing supervisor is setting up a new unit and must make a blanket decision about whether the unit will be staffed on 12-hour shifts or 8-hour shifts. What should this supervisor keep in mind when making this decision?

1. If schedules are posted online they are open for all to see. 2. Posting schedules online will promote fairness in shift assignments. 5. Open shift scheduling is easier to maintain if all schedules are online.

A nursing supervisor requests information technology support for posting all nursing scheduling online. What justification can the supervisor provide for this request? Select all that apply.

1. "Well, we don't want to rock the boat too much." 2. "Do you think we can get enough support from the nurses to make this change?" 3. "We tried making a change like this before and it didn't work out well."

A nursing supervisor would like the nurse manager to serve as change agent for a needed revision to unit policy. Which statements would alert the supervisor that this manager is not the best choice for this assignment? Select all that apply.

2. Critical thinking

A nursing task force has been created to determine whether a new model of differentiated practice would be more effective than the current model. The task force analyzes data as a basis to examine alternatives. Which activity does this represent?

1. Reviewing the client's plan of care with the UAPs 2. Discussing the client's increasing shortness of breath with the LPN 3. Updating the care plan of a client who will undergo surgery tomorrow 5. Calling the physician to discuss the client's response to a new treatment

A nursing team consists of an RN, two LPNs, and two UAPs. Which work would be completed by the RN? Select all that apply.

1. There are problems with delegation. 4. Communication on the team or with the nurse manager is flawed.

A nursing unit has just completed a 6-month trial of using team nursing to provide care. The overwhelming opinion of the staff is that the experiment was a disaster. What are the most common reasons team nursing is not successful? Select all that apply.

2. The nurse avoids the physician in the hallway. 4. The nurse is no longer as careful in caring for this physician's clients. 5. The nurse is apathetic about the care of clients.

A physician criticizes the care provided by a nurse in an area where others are present. Which actions by the nurse would the manager interpret as a covert conflict behavior resulting from this situation? Select all that apply.

2. Post a notice on the bulletin board explaining the issue. 3. Ask nurses individually for input.

A problem has arisen on a unit whose nursing staff is composed primarily of members of Generation X. Which strategies should the nurse manager employ to get staff input into solving this problem? Select all that apply.

2. Normative-reeducative

A proposed change in a health care organization is controversial and will require cooperation from all parties involved. Which change strategy should the change agent use?

2. The nurse will meet with other disciplines to agree on the choice of critical pathways for each client. 3. The nurse will work to build consensus with the physicians caring for the clients on the team. 4. The nurse will define the expected nursing outcomes for the clients on the team. 5. The nurse will collect and analyze data regarding the clients on the team.

A registered nurse will be the case manager of a group of ten clients. What will the nurse expect as part of this assignment? Select all that apply.

1. There is disagreement over the cause of the incident. 2. There are insufficient resources to make needed changes to prevent similar incidents.

A risk manager generally uses root cause analysis to investigate incidents. What are the likely outcomes of this action? Select all that apply.

2. Withdrawal 3. Avoiding

A serious conflict between a nurse and a nursing assistant erupted into a shouting match in the hallway. The nurse attempted to slap the nursing assistant. What conflict responses are appropriate for the assistant? Select all that apply.

2. Diagnosis

A serious disagreement has arisen between two staff nurses. The unit manager elects not to make a decision regarding the disagreement until more evidence is collected. Which part of the nursing process does this manager's critical thinking reflect?

1

A small creek has flooded, requiring the rescue of one person from a stranded automobile. Electrical service was interrupted for a short period and traffic will be diverted around flooded roads for a period of several hours. Local law enforcement and fire departments have been well equipped to manage the disaster. The newspaper should report that the town suffered a level ______ disaster.

3. The nurse manager is not delegating but rather making daily assignments.

A staff nurse asks the nurse manager, "What assignment are you delegating to me today? I would like to begin to organize my day before shift report begins." What is the error inherent in this statement?

4. Disruptive

A staff nurse has experienced disagreements with one of the medical residents about several issues. The resident reacts to this conflict by belittling the nurse in front of colleagues. This behavior is most characteristic of which type of conflict?

1. The group manager has line authority in relation to the group members individually. 5. The group manager has line authority in relation to all member of the group collectively.

A staff nurse is the manager of a command group consisting of other staff nurses, a nurse manager, a physician, and physical therapist. What line authority does the group manager hold? Select all that apply.

1. "Being politically active helps you influence events and the decisions of others."

A staff nurse says, "I have so much to do. Why should I spend time being politically aware and active?" Which response by the nurse manager would be most appropriate?

2. Followership is a valuable skill in nurses.

A staff nurse tells the manager, "I don't want to be promoted. I am a much better follower than I am a leader." How should the manager interpret this remark?

1. "I don't see anything wrong with the way our team works. Why do we have to go through team building?"

A task force leader says, "At the beginning of our next meeting we are going to do some team-building exercises." Which comment by a group member indicates a need for further education about team building?

3. "Let's review the steps of the procedures that we know are the biggest problems."

After several near-incidents during procedures, the nurse manager is increasingly concerned about how nursing staff communicates with physician staff. Which advice from the manager would be most beneficial to the nursing staff?

1. IV heparin restarted. Physician notified. Client's vital signs unchanged.

After shift change the nurse discovers that a client's IV heparin has been turned off at the IV controller. The amount of fluid left in the IV bag indicates that the client received half of the dose ordered. Which statement should be documented in the client's medical record?

2. Intuition 4. Past experience

Although the postoperative assessment of a client reveals no abnormalities, the nurse believes the client's condition is deteriorating and orders frequent vital signs. This intervention was made on the basis of which type of problem solving? Select all that apply.

4. Nurses formally organized to make decisions regarding practice standards

An accreditation visitor observes the following situations in a health care organization. Which situation would this visitor interpret and document as evidence of the shared governance type of shared leadership?

114

An acute care nursing unit has determined that an acuity level III client requires 6 hours of nursing care per shift while a level IV client requires 8 hours. Today the unit has seven level III clients and nine level IV clients. The manger should staff for ___ hours of nursing care for the next shift.

1. Physical 2. Self 3. Situational 4. Family

An emergency department has been notified that hundreds of injuries have occurred following the collapse of bleachers at a football game. The emergency department nurses should prepare to make which types of assessments? Select all that apply.

3. PRN staff from the emergency department nurses

An emergency department manager is looking over the next month's schedule and decides to supplement the schedule due to vacations. The manager decides to use decentralized pool staffing to lower costs and provide quality care. Which group of nurses is a part of this manager's decentralized staffing?

1. "I know it must be frustrating working with a new charge nurse, but how can we make this situation better?"

An employee is sabotaging the work of a newly oriented charge nurse, and the charge nurse has not been successful in addressing the problem. When the nurse manager addresses the issue, which is the most appropriate statement?

4. "The topic is not complicated, so I don't have to worry about misunderstanding."

An inexperienced speaker is practicing the delivery of a speech. Which statement indicates a lack of understanding about how easily communication is distorted?

4. As a man-made, biologic disaster

An outbreak of smallpox has followed a national sporting event. Terrorist activity is suspected. How would this event be categorized?

1. Were any unexpected bonuses awarded? 2. Did agency personnel hours exceed the number predicted in the budget?

An unfavorable rate variance has occurred in the salary budget of a unit. When investigating this variance, the nurse manager should look for which situations? Select all that apply.

3. The indirect cost

As a member of the budgeting committee, the nurse manager reviews the salaries for file clerks in the accounting department. These salaries should be included in which budget item?

4. "Initiate intravenous therapy within 30 minutes of the order being taken." 5. "Use scanning mechanisms to record the numbers of supplies used."

As a part of the strategic planning process, nursing units have been asked to develop strategies to meet designated objectives. Which statements represent strategies? Select all that apply.

3. Clinical practice knowledge

As a result of retirements, resignations, and reorganization, a nurse became nurse manager of a high-acuity unit 3 months after being licensed. The manager struggles with the responsibilities of the position and is often unable to make decisions. Which component of the AONE management competencies does this nurse probably lack?

2. Technical competence and knowledge 3. Ability to access data 4. Relationships with people who are influential in the organization 5. Being friendly, helpful, and likable

As part of a career advancement strategy, the nurse has identified a need to increase personal power in the organization. Which abilities should the nurse focus on improving? Select all that apply.

4. "There has been a 40 percent increase in medication errors on 3M since the new system began. We believe there is a problem."

As part of a shared visioning initiative, a new medication administration system has been adopted. A staff nurse has been chosen to relay the unit's dislike of the system to the evaluation committee. Which would be the most effective method to communicate the unit's disapproval?

3. Communication 5. Technical skills

As part of the disaster plan, the nurse executive is planning an education session on the core competencies for nurses established by the National Emergency Preparedness Education Coalition. Which topics should be included in the handout being written for this session? Select all that apply.

1. Benchmarking

As part of the process of promoting quality improvement, the nursing manager is comparing data between two hospitals on average length of stay for a total hip replacement. This comparison is an example of which process or step?

1. Continuity of care may suffer. 2. Client/staff communication may be an issue. 4. Delegation is necessary.

As the RN team leader, identify potential disadvantages of using team nursing to deliver care to assigned clients. Select all that apply.

3. "I'm concerned about the increased time and leadership our nurse managers will have to provide."

At a strategic planning meeting the nurse executive recommends instituting patient-centered care as a model of care delivery in the hospital. Which statement by the hospital CEO indicates understanding of this concept?

3. Do not critique any ideas presented.

At the beginning of a brainstorming session, the manager lists the rules to be followed. Which rule should be included and enforced?

1. Effective delegation allows the manager to focus more time on management tasks. 2. Efficiency is increased by effective delegation. 3. If the manager has more time to focus on managerial duties, there is more chance of career advancement. 5. The manager is interested in developing the entire staff to its maximum potential.

During the first staff meeting, a newly promoted nurse manager says, "I would like a commitment from all the nurses to review and improve the way delegation is done on the unit." Why would the manager be interested in delegation? Select all that apply.

2. "I don't have time to finish everything I already have to do each shift." 3. "I don't want to practice nursing just like everyone else." 4. "The library at our hospital doesn't have many journals." 5. "If administration wanted us to use EBP, they would get us some more nurses to share the work."

Efforts to increase nurses' use of evidence-based practice (EBP) to improve client care in the hospital have failed. Which answers are nurses likely to give when asked why this is occurring? Select all that apply.

2. Capital expense

Every month the chief financial officer (CFO) reviews the budget with the hospital's board of directors. The CFO requests a million dollars to purchase a new MRI (magnetic response imaging) unit for the radiology department. Which category best describes this request?

4. The nurse expects the disagreement that started in the last meeting to carry over into this meeting.

In which situation would a "meeting before the meeting" be advisable?

1. Investigating a complaint about nursing care from a client's spouse 3. Talking to physicians about ways to improve client care 4. Keeping staff members on task throughout the workday 5. Making sure staff members work minimal overtime

In which ways can nurse managers reduce risks for the organization? Select all that apply.

1. Flexibility

Regardless of which delivery system or combination of delivery systems is appropriate, which skill is required for effective use?

3. Inform the case manager of variance in the critical pathway.

The RN working on an orthopedic unit is caring for a postoperative client with a hip replacement who is not transferring well from bed to chair. The client is behind on the mobility training program. What action is the nurse's priority?

3. Evaluation of the nurse's performance missing from file

The State Board of Health requests the employee file of all agency nurses employed within the past year. At the end of the review the organization receives a sanction associated with these nurses. What is the most likely cause of this sanction?

1. The nurse collaborating with physical therapy to establish mutually agreeable treatment schedules lobbies physicians to support nursing's position in any disagreements. 2. When staff nurses ask for the nurse manager's opinion on client care issues, the response is frequently, "I'll leave that decision up to you." 3. Administration has developed a plan in which each week two nurses from each unit are recognized as "best nurse of the week." 5. The nurse executive communicates with managers mostly by email.

The administration of a health care system advertises that it promotes "a healthy work environment." Which events would cause a nurse working in this system to question this statement? Select all that apply.

1. Preparing for a surge of casualties in case of a disaster 4. How to reduce disaster impact on clients and staff

The administrators of a small hospital are revising its disaster plan. What should be the primary focus of this plan? Select all that apply.

1. The average daily census for the facility over the last year 2. Current community wage ranges for employee classifications 3. Changes in accrediting body or legislative regulations 5. Current staff mix across the hospital

The budget committee of a hospital is holding the first meeting of the budgetary cycle in two weeks. The finance department is preparing an information packet to be distributed to members. What statistical information should be included? Select all that apply.

2. Command group

The chairperson of the nursing faculty leads the monthly meetings of the curriculum committee. This permanent group, which is designed to meet organizational goals, is which type of group?

1. Sick days 3. Vacation days 4. Holidays 5. Bereavement days

The chief nurse officer (CNO) is planning the budget for the coming year. A new position has been added to the nursing administration cost center. The CNO is determining how many benefit hours should be allocated for this new position. Which days should the CNO include in this calculation? Select all that apply.

2. Other nurses who work at the hospital 3. Physicians 4. Hospital administrators 5. Representatives from local insurance offices

The community hospital is considering a redesign initiative. As part of a SWOT analysis, nurses on the strategic planning committee have been asked to distribute surveys to stakeholders. The nurses will contact which groups? Select all that apply.

1. The CQI coordinator has read two research studies that show the process improves client outcomes. 2. The CQI coordinator has evidence that a particular practice is effective in decreasing length of stay. 4. The process being measured produces a desirable outcome. 5. There are very few unexpected bad effects from the process.

The continuous quality improvement (CQI) coordinator is establishing quality measures for a unit. These measures would be written according to which criteria? Select all that apply.

1. Distancing

The day shift nurses and night shift nurses are in clear opposition regarding the responsibilities that each shift should be assigned. This opposition has created a "we-they" distinction on the unit. This is an example of which phenomenon?

2. This electronic tool makes it easy to aggregate and display data.

The director of quality improvement reports that the hospital will soon be using "dashboards" as part of the quality management process. How should the staff interpret this information?

1. Identify what she really wants 3. Prioritize her needs in order of importance 4. Identify her current resources 5. Determine who stands in the way of what she wants

The female nurse identifies that many of the power positions in her organization are held by male nurses. Which strategies should the nurse use to improve her image and increase her power? Select all that apply.

339,150

The finance department of the hospital has distributed information for the next budget cycle that includes a projected 0.19 inflation factor in the cost of water. If the hospital spent $285,000 on water last year, the projected cost of water for this year would be $_______.

2. Inappropriate because it places blame on an individual

The following documentation was entered in the client's medical record: "The client was found lying on the floor. Dr. X was notified. Apparently the restraints were improperly applied." Which statement best describes this documentation?

3. One of the members should start the meeting.

The group leader often arrives several minutes late to meetings with excuses about workload, telephone calls, or traffic. Today's meeting was scheduled to begin 5 minutes ago and the leader has not arrived. What should the group members do?

1. Disciplinarian 3. Fact manager 4. Liaison 5. Support person 6. Discussion leader

The health care facility has elected to make a significant change in organization strategy. The change has been thoroughly researched and all levels of leadership have been included in the decision. Which roles are commonly undertaken by the nurse manager when such a change is necessary? Select all that apply.

4. "We believe clients are most important."

The health care institution has organized a committee to review and revise the strategic plan. As part of this work, committee members have been asked to submit a philosophy statement for consideration. Which statement meets the requirements of a philosophy?

3. Diagonal communication

The hospital chief operating officer holds monthly focus groups with the purpose of gaining ideas and insights from nursing administration and staff nurses. Which type of communication does this indicate?

1. Collaboration and work sharing are becoming more common among nurses in specialty care units. 2. An informal group of nurses, radiology technicians, and physical therapists have been discussing how to better care for clients with hip replacements. 3. Nurses have begun questioning the wisdom of standardizing some nursing procedures.

The hospital has a very formal organizational structure and culture. Which conditions or events would indicate that a counterculture is developing within this hospital? Select all that apply.

2. A competitive conflict that is positive to the work environment

The hospital has an annual campaign in which the staff is divided into two teams to raise money for hospital special events. The team raising the most money gets possession of a "trophy" designed by the administrative staff. This is an example of which type of conflict?

2. Historical data of expected client outcomes

The hospital has elected to use the demand management staffing system instead of the patient classification system. Because of this decision, the nurse manager who is staffing must focus on which of the following?

2. Demand management system

The hospital is caring for more high-acuity clients due to the recent flu endemic. The chief nurse officer (CNO) reviews the census from last year's flu season and instructs the manager to schedule more registered nurses for the weekend. Which system has the CNO used?

1. A client with a minor forearm laceration that will require a simple bandage and tetanus immunization

The hospital is conducting a drill of its emergency operations plan (EOP). A nurse is acting as triage officer. Which client would be triaged for immediate care?

1. There is little potential for interruption as the drill is all done in a meeting.

The hospital is preparing for a tabletop test of its emergency operations plan. What is the potential for an interruption in services from this drill?

2. Total quality management (TQM)

The hospital organization has developed a philosophy based on the client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. In which quality management process are these characteristics typically seen?

2. Diagnoses that carry high risk for the client and the provider

The hospital's management team wishes to institute case management to improve the quality of nursing care. As a beginning step, the team is choosing specific medical diagnoses on which to focus. What criteria should the team use when choosing these diagnoses?

1. Work assignment

The job description of the staff nurse states the nurse is responsible for attending hospital committee meetings as assigned. The nurse manager asking the staff member to attend a risk management meeting is an example of which concept?

2. The hospital CEO 3. The vice president in charge of finance

The leader of a continuous quality improvement (CQI) team has asked that an information packet be distributed to members of the resource group. The secretary would prepare packets for which people? Select all that apply.

4. Re-forming

The leader of the task force group announces that tentative plans for Nurses' Week activities have been approved by the hospital administration. The task force has also been given a new task of developing criteria for the nursing awards. What must the group accomplish now?

2. Information power

The local hospital has recently been acquired by a larger hospital corporation. The nurse manager encourages staff to attend the next unit meeting by hanging a poster announcing that the new wage scale and benefits package will be discussed. This is an example of which type of power?

1. Client care and satisfaction will suffer should it be allowed to continue.

The medical residents on a particular unit do not answer pages very quickly, and sometimes do not answer them at all. The nursing staff complains to the nursing supervisor. After several weeks, this conflict has spiraled into a heated disagreement. Which is the most important reason to make the necessary changes to settle this conflict?

2. Complete a variance report for the month's budget.

The medical-surgical nursing manager notices the education expenditure for the month is over budget. How should the manager deal with this difference?

4. Additional unlicensed assistive personnel

The medical-surgical unit is at capacity and the clients have a high acuity, requiring care such as turning, bathing, toileting, and feeding. Which level of supplementary staff would be cost-effective?

2. Client care needs

The medical-surgical unit's census has decreased since the previous shift. The manager is reviewing the staffing grid. Which factor is used to determine staffing mix?

4. "If you work overtime tonight I will authorize double your hourly pay rate."

The mother of a staff nurse is critically ill and the nurse must miss several shifts of work. If the leadership style of the nursing manager is transactional, which approach to covering these shifts is most likely?

2. Include the staff in identifying problems related to teaching strategies.

The new chairperson of the nursing department has determined that the faculty's teaching is stagnant and outmoded. The chairperson would like to encourage the faculty to adopt more innovative teaching strategies. According to Lewin, what is the first step in initiating this plan?

2. The budgetary cycle takes up to 1 year to occur.

The newly hired nurse manager is involved in the first budgetary cycle since being hired. The manager lists some capital equipment needs and is surprised when they are not available for staff use two months after the request. What is the reason for this?

4. "I think the implementation will go much better if I stay available the whole time."

The novice nurse manager is acting in the role of change agent for the unit. Which statement indicates that this manager needs further training in regard to change?

4. Competition and criticism

The novice nurse manager is hesitant to delegate tasks to competent, experienced staff nurses. Fear of which factor is most likely to explain this hesitancy?

1. Research the options that will work best for the nursing staff and the hospital.

The nurse administrator has been asked to work with other administrators to make a change in a long-standing hospital policy. What should be the nurse's first action?

4. Differences in values and beliefs

The nurse and a client are discussing instructions for self-care after discharge. The client's husband says, "I can't take care of her by myself. We need home health like we had before she came to the hospital." This statement reflects which antecedent condition?

1. Functional 4. Parallel 5. Matrix

The nurse applying for a position is told, "This hospital has a very traditional organizational structure." The nurse would expect the organization to use which structure? Select all that apply

3. Negative inquiry

The nurse asks the nurse manager if he can go home early because the census is low. When the request is denied, the nurse states, "I don't understand why I can't leave early. I will use vacation time and this will help minimize personnel costs for the shift." This statement is an example of which technique of influencing the supervisor?

1. Dear Senator:

The nurse cared for Senator Bill Smith while he was hospitalized last year. The nurse now wishes to send him a letter supporting a bill that will be voted on in the current legislative session. Which salutation should the nurse use in the letter?

2. "I can use power to teach the student how to motivate, communicate, and achieve outcomes."

The nurse educator has recruited nursing preceptors to work with senior nursing students. The educator is teaching the preceptors about power and the education process. Which statement by a preceptor indicates learning has been effective?

1. Sixty percent of respondents replied with the name of an unlicensed assistant when asked the name of the RN who cared for them.

The nurse executive is reviewing client satisfaction surveys. Which trend would the nurse evaluate as indicating the nursing care delivery system in use is not effective?

2. The number of nurses under age 30 has increased in the last two years.

The nurse executive is reviewing statistics about the nursing staff. Which statistic shows that the staff reflects national trends?

2. An environment that is better for nurses is associated with lower mortality rates. 3. Nurses are more satisfied working in an environment that is better for nursing.

The nurse executive of a for-profit hospital continually works to provide an environment that is better for the nursing staff. Why is this effort so important? Select all that apply.

4. "We conduct practice disaster drills."

The nurse executive of a hospital is surveying hospitals in a four-state area in regard to their disaster preparedness. The nurse would expect to hear which response to the question "What have you done to prepare for a disaster?"

1. The ability to be empathetic to clients and staff 3. Awareness of the needs of clients and the organization 4. Use of persuasion as a leadership technique

The nurse executive wishes to hire nurse managers who embody the service leadership mission of the organization. Which specific attributes should this nurse look for in applicants?

2. The relationship between the nurse and the receiver of the message

The nurse has a concern regarding the quality of care being provided in the hospital. What should the nurse consider first before communicating this concern?

1. "I knew that effective delegation made my job easier, but I never thought about how it could benefit the hospital."

The nurse has attended a "how to" refresher course on successful delegation. Which statement indicates successful learning has taken place?

1. "I won't be able to increase my team's motivation. That has to come from within them."

The nurse has been asked to assume a first-level management role on the nursing unit. Which statement indicates that this nurse will need further mentoring in the new role?

4. Ensure the communication is understood.

The nurse has been concentrating on improving personal communication skills. Which option represents the final step in this nurse's work to improve communication?

4. Practice the steps of the process as often as possible.

The nurse has determined that in order to provide the highest quality care it is important to become more creative. What is the most effective way for the nurse to increase creativity?

1. Image

The nurse has established a reputation for advocating for clients through honesty and hard work. The nurse has worked in the organization for 30 years and often volunteers in local and national political campaigns. This nurse is using which attribute to increase political effectiveness?

3. When listening to instructions, the nurse should ask anyone who interrupts to wait a moment. 4. The nurse should get sufficient time away from work to rest. 5. The nurse should be careful not to prejudge what the speaker is going to say.

The nurse has made several "near errors" in client care in the last 2 months. The nurse manager says, "These are simple errors. You just aren't listening." How could the nurse improve listening skills in this situation? Select all that apply.

49,440

The nurse has received a commendable progress evaluation and will receive a 3 percent merit raise. The base salary for an RN is $48,000. Based on this information, the new projected base salary for this RN will be $_____.

4. Return to school to obtain a master's degree.

The nurse has set a goal of becoming a clinical nurse leader (CNL). What actions should this nurse plan to reach this goal?

2. "The issue with this client is the time limit for Medicare to pay has almost expired, and we aren't ready for discharge."

The nurse is acting as team leader for a client care conference. Which opening statement is best for this meeting?

3. "How often did you want the furosemide given?" 5. "Doctor, what rate did you want for the IV?"

The nurse is always intimidated when asking a physician to clarify orders. Which statements should the nurse use to help counteract this feeling? Select all that apply.

1. A client's hand is injured during an arterial blood gas draw. 3. A client leaves the hospital against medical advice (AMA).

The nurse is assigned to the Risk Management Team. Which events would be addressed by this team? Select all that apply.

3. There have been concerns about privacy and confidentiality.

The nurse is trying to understand why it has taken so long for electronic health records (EHRs) to be used in health care. Which statement is a reason for this delay?

1. Are there different situational effects or contexts to be considered?

The nurse is using critical thinking skills to decide which of several options is the best. Which question is most important for the nurse to take into consideration?

2. "We are a good team, but we need to look at this problem from a different viewpoint."

The nurse is working on a committee charged with the responsibility for making policy decisions for the health care organization. During the work, the nurse has developed a strong belief that the focus of the committee is incorrect. Which statement by the nurse would be most appropriate?

2. "Have we looked at all available data in order to make an informed decision?" 3. "What are the obstacles to implementing this change within the organization?" 4. "Are we including the opinions of all stakeholders in this decision?"

The nurse is working on a committee tasked with making a major organizational change. Which comments by the nurse would help to advance the work of this committee? Select all that apply.

3. Ensure the client's safety as fully as possible.

The nurse is working on a unit with a blame-free environment and makes an error that puts a client at risk. What should the nurse do first?

3. The leader should survey employees regarding what is important to them for the organization's future. 4. The leader should encourage innovative ideas.

The nurse leader wishes to develop a culture of shared visioning for the health care organization. How should the nurse proceed with this plan? Select all that apply.

Anecdotal

The nurse manager asks a staff nurse why a procedure is done in a certain manner. The nurse replies, "I don't know why I started doing it this way. I've never read any research on it, but this technique always works for me." The manager would place this technique into which category of evidence?

2. Task group

The nurse manager asks staff members to work as a group in planning the activities for Nurses' Week. The nurse manager should report to the supervisor that which type of group has been formed?

1. Intrapersonal conflict

The nurse manager asks the staff nurse to work a double shift because the census is high. Although the nurse realizes the staffing for the night shift is low, the nurse has already made a family commitment for the same night. This is an example of which concept?

2. Motivate the participants to seek resolution.

The nurse manager assesses that there is conflict between two of the charge nurses. The decision is made to postpone an intervention and allow the conflict to escalate. Why might the nurse manager make this decision?

1. Confrontation

The nurse manager assesses that two staff nurses are engaged in a conflict that is having a negative impact on client care. The manager meets with the nurses involved and identifies the conflict. An attempt is made to resolve the conflict through knowledge and reason. What strategy is this manager using?

1. Quantum

The nurse manager consistently refocuses the staff on achieving outcomes and directly involves the staff in decision making to achieve those outcomes. How would this style of leadership be described?

2. Collect and analyze information about how the current system is working.

The nurse manager feels that changing the unit's method of assigning break times would benefit the flow of client care. What should be the manager's first action associated with this idea?

2. Overdelegation

The nurse manager gave the unit secretary complete responsibility for the unit's staffing, including finding replacements for call-ins and disciplining nurses with excessive call-ins. This is an example of which type of delegation?

3. Rational decision-making model

The nurse manager generally uses a stepwise method to arrive at decisions that are logical and that serve to maximize the achievement of the desired objective. Which decision-making model does this manager use?

1. "I know I haven't been too careful in keeping personnel costs low, but we are really going to need another position." 3. "I realize that my staff is not always positive about organizational changes, but having this extra staff member might reduce some of their stress."

The nurse manager has asked that another staff nurse position be funded for the unit. The supervisor denies the request. Which statements by the manager are examples of negative assertion? Select all that apply.

2. Selling the new system to the current emergency department staff 5. Coaching the staff through the implementation of a new schedule

The nurse manager has been assigned the task of developing and implementing a new staffing system for the emergency department. The nurse has reached the "directing" phase of this project. On which activities would the nurse focus at this point? Select all that apply.

3. "We have so much work to do in this group."

The nurse manager has completed a series of team-building exercises with a command group. Which statement by a group member indicates that cohesiveness is occurring?

4. Investigate to get the facts of potential infractions before responding to them.

The nurse manager has decided that the only way to deal with an issue is to use coercive power. What strategy is important for this nurse manager to employ?

3. "What is the exact clinical issue with which we are dealing?"

The nurse manager has decided to use evidence-based practice (EBP) to solve an issue and has called staff nurses together for input. Which question, as posed by the manager, reflects the first step of the EBP process?

1. Who is in control of the way holiday shifts are being assigned? 3. Who will lose when holiday shift assignments are changed? 5. Who is benefiting the most from the way holiday shifts are currently assigned?

The nurse manager has determined that changes are necessary in the way holiday shifts are assigned. When assessing the political climate surrounding this potential change, the nurse manager would ask which questions? Select all that apply.

1. Timing of the request

The nurse manager has determined the need to hire two staff nurses. Which factor is most critical as the nurse manager prepares to submit the request to administration?

3. Hawthorne effect

The nurse manager has established a program that recognizes a different staff member each month for contributions to client care. As a result, overall staff productivity and the number of client compliments have increased. This is an example of which concept of organizational theory?

3. "Our Generation Y nurses help keep us all up on new technology." 4. "The most loyal of all my nurses are the traditionalists." 5. "I expect that our next manager will come from my group of baby boomers."

The nurse manager has four different generations represented in the nursing staff on the unit. What statements indicate the manager is wise about how to deal with this generational mix? Select all that apply.

3. Being certain that e-mails go only to the intended recipients

The nurse manager has instituted a policy of sending information to the staff via e-mail. Many misunderstandings have occurred since this policy was implemented. What technique should the manager use to reduce this miscommunication?

4. Incubation

The nurse manager has scheduled a series of meetings with employees to solve a unit problem. The manager purposefully created a 2-week gap in the meetings to allow which portion of the creative process to occur?

1. Efficiency

The nurse manager identified that the census was higher than anticipated and the client acuity level was also high; however, there were fewer nursing hours paid. This variance is an example of which budgetary variance?

4. Subjective probability

The nurse manager is calculating the cost of offering two bonus incentives to nursing staff for covering call-ins for sickness. After reviewing the statistics, the manager finds that option A is more cost-effective than option B but decides to implement option B because it seems safer. Which option best describes the basis of this decision?

1. Creativity

The nurse manager is challenged to find an innovative way to adequately staff the unit and provide quality nursing care. Which ability would be most useful to the nurse in this situation?

4. Discuss the complaint with the individual nurse face-to-face.

The nurse manager is concerned about a family member's complaint regarding the professional behavior of a nurse on the unit. Which is the most effective method to address this issue?

2. The nurse participated in testing a new charting system before it was installed on the unit. 3. In a private meeting with the nurse manager, the nurse critiqued the manager's decision to change the unit's method of client assignment. 4. After attending an in-service presentation on a new intravenous access catheter, the nurse used one of the devices the next time an IV was ordered.

The nurse manager is conducting a nurse's annual performance review. Which events from the previous year would be evidence that this nurse is a successful follower? Select all that apply.

2. "Don't feel as if you are responsible for fixing every problem."

The nurse manager is counseling a male nurse about several recent incidents in which female nurses complained that he was abrupt and condescending. What advice should the manager give this nurse?

2. Variable costs

The nurse manager is creating the budget for the next fiscal year. Because the client census has been higher in the past year, more supplies were used. Which type of cost does this reflect?

7.33

The nurse manager is determining the day's nursing care hours (NCHs) by analyzing the client workload. The unit census is 30 and there is a total of 220 nursing care hours. The average nursing hours per client per day (NHPPD) figured to the nearest hundredth decimal point is ____.

2. Nursing shortages and salary constraints have affected staffing patterns.

The nurse manager is explaining her staffing budget to the hospital administration. The manager has developed a flexible staffing pattern. The administration questions the manager as to why this pattern was developed. Which answer is most correct?

1. Contracting with outside agency nurses 2. A decentralized float pool 4. Establishing an internal float pool of nurses who are cross trained 5. Developing a float pool of nurses shared with another hospital in the system

The nurse manager is explaining the organizational staffing policy to a newly hired nurse. The nurse will be scheduled on an as-needed basis. The manager explains this policy is a supplemental scheduling policy. Which staffing strategies would be included in this policy? Select all that apply.

1. The manager distributes a handout explaining the new system and how to use it.

The nurse manager is facilitating change to a new documentation system in the unit. If the manager wants to use the most common method to overcome resistance to the change, which strategy would be chosen?

4. Collaborating 5. Competing

The nurse manager is facilitating the work of a collaborative team whose mission is to negotiate employment contracts with physicians. The nurse manager does not want to compromise the nurses' concerns in favor of the doctors' concerns. Which strategies would facilitate this outcome? Select all that apply.

3. Resistance can negatively impact future client care.

The nurse manager is facing resistance to change from many staff nurses. Why should the manager work hard to address this resistance?

2. "I have created an agenda that identifies the amount of time allotted for each step of the problem-solving process." 4. "The meeting will be called to order at noon and be adjourned in 1 hour." 5. "It is important that each of you is fully engaged in the decision-making process."

The nurse manager is leading the monthly staff meeting for the professional nursing staff. Which statements by this leader reflect effective leadership? Select all that apply.

1. Deciding on priorities 2. Being a liaison 3. Coordination of client care 5. Delegation responsibilities

The nurse manager is listening to new nurses discussing nurses as managers and overhears one state, "I don't care how long I am a nurse; I will never be a manager." In which ways do nurses manage regardless of their official role? Select all that apply.

2. Solutions are identified to create change.

The nurse manager is planning to initiate new policies in the department and is reviewing several change theories. Which step of Havelock's model will the nurse find most closely resembles Lewin's moving stage?

3. Understaffing the unit 4. Low client acuity

The nurse manager is reviewing the previous month's budget and notes a favorable efficiency variance of the full-time equivalents (FTEs). Which options may be reasons for this favorable variance? Select all that apply.

1. The FTE factor for an LPN hired this month 3. The names of all unit clerks working in the unit 4. The level of licensure of a nurse working on the unit 5. The fact that two RNs have retired this year

The nurse manager is updating the position control sheet for the fiscal year prior to beginning a new budgetary cycle. What would the manager include in this sheet? Select all that apply.

1. Charge nurse

The nurse manager is working on a committee whose task is to review and revise job descriptions for nursing employees. In which job description would the committee most likely include the phrase "Management responsibilities include shift-by-shift coordination and promotion of quality client care"?

3. Pay attention to the people above and below this person on the organizational chart.

The nurse manager knows that maximum power will be needed to achieve a desired change and has identified a key person on the organizational chart who will be affected by the change. What is important for the nurse manager to do?

2. Transparency

The nurse manager makes an error that results in the unit being $20,000 short on operating budget for the fiscal year. When asked about the error, the nurse takes full responsibility This statement reflects which component of emotional intelligence?

2. "I will evaluate the outcomes of our strategies on a monthly basis."

The nurse manager meets with the staff nurses to discuss ways to improve communication among the shifts. Which statement by the nurse manager best exemplifies the final stage of conflict management?

3. Having the charge nurse lead a nursing quality assurance task force

The nurse manager needs to delegate specific tasks to the charge nurse of the unit. Which action is an appropriate use of delegation?

1. Hospital administration

The nurse manager of a critical care unit creates the operating budget with the knowledge that a minimum of two professional nurses must be paid per shift regardless of the patient census. Which group determines this standard?

4. Increase the number of registered nurses.

The nurse manager of a postsurgical unit is preparing the next month's schedule. The manager has reviewed the surgery schedule for the corresponding month and notes there are several high-acuity surgeries. Which staffing adjustment would the manager make to best provide the care needed by these postoperative clients?

1. Current licensure to practice within the state 2. Orientation to the facility and the unit 4. Documentation of malpractice insurance

The nurse manager of an intensive care unit has several open shifts that require an RN to fill. Several nurses have taken overtime shifts but there are still several uncovered shifts. The chief nurse officer (CNO) decides to fill these vacancies with agency nurses. The CNO realizes that agency personnel must have which requirements prior to working in the facility? Select all that apply.

4. "When I make a mistake, I should report it and look for ways to prevent it from recurring."

The nurse manager orienting newly hired nurses has explained the organization's blame-free environment. Which remark by one of the nurses indicates understanding of the policy?

2. "The demand for nurses is declining because of fewer hospital admissions."

The nurse manager overhears staff discussing the shortage of nurses. Which statement by a staff member would the manager evaluate as misinformation?

4. Consensus

The nurse manager presents an issue to the nursing staff for a decision. The group assesses the problem, and a decision is made meeting the needs of both the nurse manager and the nursing staff. This is an example of which conflict management strategy?

4. The best strategy is to undertake all power interactions in a polite manner.

The nurse manager realizes that power must be used to influence a change that is needed on the unit. What should this nurse remember when exerting this power?

2. A staff nurse the manager has worked with for 25 years

The nurse manager should be most careful not to hold preconceived beliefs when listening to which person?

1. One nurse has responsibility for all the medications on the unit.

The nurse manager tells a newly hired nurse that the unit practices functional nursing. What should the new nurse expect?

1. The personnel budget

The nurse manager's goal is to adequately staff the unit and use minimal supplementary staff. The manager has added the cost of this supplementary staff to the unit's operating budget. A colleague informs the manager it should have been added to which budget?

2. Send a written letter and résumé in the mail.

The nurse plans to seek employment in an acute-care setting after graduation. Which form of communication would be most effective in applying for a position?

2. Deciding on the delegate

The nurse prepares the medication ordered for the client. The nurse asks the nurse assistant to give the medication when the client receives breakfast and to report on the task at its completion. The nurse assistant agrees. Which component of the steps of delegation was violated by this request?

2. "I will need some education on the accreditation process before I can accept this task." 4. "Please tell me more about what this assignment entails."

The nurse supervisor would like to delegate accreditation preparation activities to the nurse manager. The manager is unsure of what is expected and has no experience with accreditation. How should the manager respond? Select all that apply.

2. Primary care focused

The nurse works in a school clinic that is part of an integrated health care network. How would this nurse explain to parents and teachers the focus of care provided in the clinic?

3. "If the nurse practitioner at the clinic thinks the rash is significant, you will be referred for additional care."

The nurse's friend says, "I've been thinking about going to that health care clinic in the grocery store so someone can look at my daughter's rash. What do you think?" Which response by the nurse is appropriate?

4. The change will lead to improved client care on the unit.

The nursing committee is planning a change in the unit's organization. Which statement reflects the priority expected outcome of these change agents' work?

3. Add more information to existing care plans as the study unfolds.

The nursing faculty would like to incorporate problem-based learning into the curriculum. Which action is essential?

3. Gather information to define the problem.

The nursing group has been charged with the task of solving a patient care problem on the units. Which step should this group take first in this process?

4. Incompatible goals

The nursing staff is continually upset about inability to provide clients with supplies needed because third-party payers will not reimburse for those items. This is an example of which conflict antecedent?

4. This staffing pattern would not be cost-efficient.

The nursing staff of a medical-surgical unit would like to work four 10-hour shifts each week. For which reason would the unit nurse manager probably deny this request?

2. The supervisor has gradually withdrawn from the role of change agent.

The nursing supervisor identifies ineffective communication as a problem among the managers. According to Lippitt's phases of change, which action by the supervisor reflects the final stage of improving this issue?

2. The unit culture may foster distrust and poor communication among staff. 3. Client complaints are usually an indicator of a larger unit problem. 4. Nurses on the unit are in need of additional training and skills.

The nursing supervisor is assessing a unit that has received several written complaints. The nurse manager seems overwhelmed and stressed trying to address many client situations. The charge nurse is trying to help everyone at once. Based on this assessment, what might this supervisor conclude? Select all that apply.

2. Understanding the role of the physician 3. Understanding the role of the nurse 4. Communication across disciplines 5. Active listening skills

The nursing supervisor is planning an education session on collaborative communication between nurses and physicians. Which topics should be on this agenda? Select all that apply.

4. The nursing supervisor is concerned that staff is ill-prepared to assume additional responsibilities.

The nursing supervisor states, "I really don't have the time to delegate this task to a nurse manager. I can do it faster!" What is the most likely basis for this statement?

4. An unlicensed nursing assistant

The nursing supervisor would like to delegate an information-gathering task. All the people listed have the ability to perform the task. In general, whom should the supervisor ask to do this work?

4. Process standard

The nursing task force is developing measurable goals for each client on the orthopedic unit. The statement "Each client will have a written assessment and plan of care document within eight hours of admission" is an example of which component of quality management?

1. Nurses are involved in decision making. 4. Nurses may be asked to work overtime. 5. Nurses are involved in educating the community about health.

The organization that awards Magnet status would look for environments where which practices are the norm? Select all that apply.

1. He will focus more on the issue than on personal experience.

The person who has just been promoted to nurse manager is male. If this nurse communicates in a way that is considered typical for men, what can the staff expect?

2. A representative from pharmacy 3. A representative from the medical staff 4. A staff nurse who works with clients in pain

The procedures for managing client pain are being investigated as part of the hospital's total quality management program. Whom should the manager plan to invite to this meeting? Select all that apply.

1. We will compare outcome indicators with other health care conglomerates of similar size and organization.

The quality management director of a large health care conglomerate wishes to initiate benchmarking strategies to assess care. Which directive should this manager publish?

2. Share the report with the full task force prior to presenting it to administrators. 4. Brief key administrators regarding the report prior to the administrative presentation.

The work of a task force is completed and the leader has compiled a written report of findings and recommendations. What actions are necessary by this leader? Select all that apply.

4. Contingency

To address the problem of increasing costs of staffing agencies, a hospital has developed a plan for an internal float pool of nurses to be used when scheduled staff nurses call in sick. What type of planning has the administrative staff done?

2. Decreasing resources 4. Increasing numbers of retirees 5. Complicated technology

To be effective in today's health care system, the nurse manager must be aware of which trends? Select all that apply.

80

To meet the Institute of Medicine (IOM) recommendation, nursing should strive to have ____ % of nurses prepared at the baccalaureate or higher level by 2020.

true

Two nurses have agreed to share a schedule in which each will work 4 hours each day for a total of 20 hours a week. In 2 weeks ____ FTEs will be generated by these nurses.

1. What is the anxiety level of the nurses in regard to the vacation schedule? 3. Will the conflict decrease the efficiency of the unit while the nurses are self-solving the issue? 4. How intense is the conflict about vacation scheduling?

Two staff nurses are in conflict about the summer vacation schedule. The nurse manager is contemplating assigning both nurses to a task that will require frequent contact with each other, hoping that they will resolve the issue themselves. What should the manager consider before making this assignment? Select all that apply.

2. Discuss the problem with the nurse's team leader and then the charge nurse if the problem remains unsolved.

Using the classical organizational theory model, what would be the most appropriate method for the nurse to voice concern over unfair client workload assignments?

3. Clarify the time line and expectations.

What action is necessary by a delegate accepting delegation?

1. Adaptation and innovation are encouraged.

What is occurring as the traditional parallel structure found in hospitals is being replaced by service-line structure?

2. Nurses wear colorful scrubs.

What is the best example of a pediatric unit's organizational culture?

3. Communication

What is the most common skill shared by effective nurse leaders in leadership theories or models?

2. All nursing activities occur in relationships.

What is the most important reason that excellent communication skills are essential for nurses?

1. Those who deliver the nursing care make the most educated decisions for a particular unit.

What is the primary belief behind the evolution of the clinical microsystem as a nursing care delivery system?

1. How to optimize use of nursing knowledge 3. How to ensure that clients receive optimal care 4. Skill sets likely to be present in the nurses who will be employed at the hospital 5. What groups of nurses are available for employment

What should the nurse executive consider when planning the nursing care delivery system of a new hospital? Select all that apply.

3. Early majority

When faced with the prospect of change, the nurse states, "We have always done it this way and never had any problems." A few weeks later, the same nurse remarks, "This new way seems to work better than the old way did." This statement is characteristic of which type of change response?

2. E-mail

When the nurse manager orders supplies for the unit, which communication mode is best?

3. The nurse manager agrees with a proposed budget that does not provide badly needed new client beds.

Which action by the nurse manager is a demonstration of satisficing?

4. The nurse executive does more talking than listening in meetings.

Which action is most likely to undermine the political power of a nursing department?

4. Creating a supportive environment for those undergoing the change

Which action will have the greatest impact on the successful implementation of a planned change?

3. Address only one issue in each correspondence. 5. Always make an appointment before visiting an elected official.

Which action would help the nurse work with public officials to influence policies? Select all that apply.

2. Addressing colleagues in endearing terms 3. Using power plays to achieve goals 4. Aggressively advocating for clients 5. Accepting orders without question

Which actions diminish the image of power for nurses? Select all that apply.

1. Offering constructive criticism 3. Encouraging group discussions 4. Facilitate group processes

Which activities are expected from the nurse manager as team leader? Select all that apply.

3. Nursing overtime hours increased by 25 percent in the last quarter.

Which data would be of most interest to an organization using Lean Six Sigma as a means of quality improvement?

1. "Here are your directions for this morning. Please give the clients in rooms 2156, 2158, and 2159 total bed baths." 2. "Go to the diet kitchen and get a cup of apple juice for the client in room 2112."

Which directions given by the nurse to the assistant are most likely to be understood and completed correctly? Select all that apply.

1. The nurse is promoted to nurse manager.

Which event would likely improve a nurse's position power within an organization?

3. "I hate to bother you with this, but we have a problem."

Which example represents a qualifier that may interfere with the message to be communicated?

4. A financial deficit of millions of dollars

Which factor best represents a driving force in the process of change?

2. "We will always meet on the second Wednesday of the month at 1:00 p.m. as this is the time all members have indicated is most convenient." 5. "You can expect to receive an agenda for the meeting at least 1 week in advance of the meeting."

Which ground rule statements by the leader will help the group meeting stay on task and on time? Select all that apply.

3. Nurse managers

Which group determines the level of nursing care and hours of care necessary to meet the needs of the hospitalized client?

2. At 2:00 p.m. the nurse orders a lunch tray for a client who has just been removed from NPO status. 3. A nurse tells the manager that a housekeeper's work is not up to standards. 4. A nurse volunteers to take a Spanish language class to be able to communicate with clients.

Which health care situations reflect the philosophy of quality management as designed by Deming? Select all that apply.

1. Work to develop a just culture within the organization.

Which is the most effective method of creating a blame-free environment?

1. Client need

Which is the most important consideration in choosing a structure for nursing care?

1. How well the nurses know and trust each other

Which is the most important factor in whether a conflict will be perceived or felt between two nurses?

3. Higher client satisfaction

Which is the most important reason that practicing and mastering effective delegation skills is essential for nurses?

3. The leader is accepting of change. 4. The leader encourages staff nurses to help clients access Internet sites about their disease process.

Which leadership activities exemplify a quantum leadership style? Select all that apply.

1. "I am taking a day off tomorrow for my annual physical."

Which manager statement reflects concern about the most important requirement for today's nurse manager?

2. Nurse manager 3. Case manager

Which nurse has legitimate leadership authority in the organization? Select all that apply.

3. An inpatient burn unit

Which nursing care delivery situation best reflects the concept of a clinical microsystem?

2. The nurse provides the client with the URL for a new website dedicated to self-management of a chronic respiratory disease. 3. The nurse advocates for the client who has decided to forego further dialysis. 4. Client information is entered into an electronic medical record. 5. Information about the operating hours of a community recreation center is provided to the client with coronary artery disease.

Which nursing interventions would be in line with the chronic care model? Select all that apply.

1. Magnet Recognition Program

Which organization would the hospital management team contact to pursue certification as a Magnet hospital?

3. Failure is tolerated.

Which part of Six Sigma is vastly different from other quality management programs?

1. The amount of material opened and wasted for surgical procedures will drop by 25 percent this fiscal year. 3. Wait times in the emergency department will decrease by 15 percent this year. 5. Fewer than 5 percent of clients will report inadequate pain control while hospitalized.

Which quality improvement initiatives would help the health care organization meet Institute of Healthcare Improvement (IHI) goals? Select all that apply.

4. The staff nurse's mentor calls to see how the nurse's first day on a new unit progressed.

Which relationship is an example of staff authority in classical theory?

1. The nurse manager posts the unit's positive accomplishments from the past month in the break room.

Which situation best exemplifies the nurse manager as a team leader?

2. The office nurse calls in orders for admission on a client following a surgical complication.

Which situation indicates the nurse needs additional training on effective delegation?

1. Two different units have purchased a demonstration model that could be used by both units.

Which situation is an example of a major weakness of service-integrated structure?

4. ICU nurses know to take turns covering each other's clients to facilitate eating breakfast and lunch on the day shift.

Which situation is an example of organizational culture?

3. The licensed practical nurse asks the nurse manager to administer insulin to her client.

Which situation is an example of reverse delegation?

4. The nurse wipes up a spilled drink before clients are allowed to enter a room.

Which situation is an example of the overall goal of quality management in today's health care activities?

2. The nurse changes the client's abdominal dressing daily.

Which situation reflects the primary service provided by home health care?

1. A nurse routinely changes nursing notes after a client is discharged. 4. A nurse does not complete an incident report after a medication error.

Which situation represents an exception to the blame-free environment? Select all that apply.

3. There is a budget shortfall for the current fiscal year

Which situation represents an obstacle to delegation?

1. The nurse manager discovers that two clients require the use of a new piece of equipment and that the one the hospital has is the only one in the state.

Which situation requires an adaptive decision?

2. A client is left waiting in the hallway because the transport person did not make contact with the client's nurse. 3. A nurse gives a medication by the wrong route. 4. A client developed sepsis after insertion of a urinary catheter. 5. Surgery is done on a client's right eye instead of the left eye.

Which situation would be included in reporting for Joint Commission mandatory national patient safety goals? Select all that apply.

1. After delegating committee attendance to a staff nurse, the nurse manager also attends the meetings. 2. The unit clerk asks the nurse manager to "listen for the phones" so the clerk can go to the hospital's celebration of hospital week. 4. The staff nurse asks the UAP to provide simple discharge instructions to a client. 5. The staff nurse often bathes clients because "I like to give bed baths."

Which situations are examples of ineffective delegation? Select all that apply.

2. A staff nurse asks the assistant to sit with the roommate of a client who has just died. 3. During a code blue situation, a nurse tells another nurse to start an IV. 4. A nurse tells an assistant to move a client into the hallway during severe weather.

Which situations are examples of the nurse directing rather than delegating? Select all that apply.

1. The nurse asks the LPN to change a central line dressing. 2. The nursing supervisor asks the nurse for details about a client's history. 4. The supervisor asks the charge nurse to give a nurse a difficult assignment.

Which situations would cause concern about liability with regard to delegation? Select all that apply.

1. "It helps to coordinate care to a group of clients." 2. "It organizes care responsibilities." 5. "It provides skilled care by skilled staff."

Which statement by a newly licensed nurse indicates an understanding of why it is necessary to structure nursing care? Select all that apply.

3. "I would like to thank everyone for your hard work and dedication while we have been short staffed." 4. "I am certain that our new assignment system is going to make the workload more equitable." 5. "I know this week has been rough. I feel a little like sandpaper myself."

Which statement by the formal leader of a nursing unit reflects the personality required to energize the staff and promote creativity? Select all that apply.

4. "Both parties should come up with as many alternative solutions as possible before our next meeting."

Which statement by the nurse managing a unit conflict indicates that the integrative decision-making strategy is being used?

1. A decision made by a group is often better than a decision made by one person. 3. Groups can provide more input into the process. 4. A decision made by a group can create a greater obligation to achieve results. 5. Routine decisions are more often made by individuals.

Which statement describes the primary difference between group and individual decision making, besides the number of individuals involved? Select all that apply.

4. "To direct client care activities and get the outcomes you desire, you need good leadership skills."

Which statement explains why nurses must be leaders to be successful in client care?

2. The nurse knows a lot about what is going on in the organization. 3. People often say that the nurse has a way of dealing with difficult people and situations. 4. Staff members seek out this nurse's ideas on how unit problems should be solved. 5. The nurse has a "sixth sense" about when to present new ideas.

Which statement indicates that a nurse has the skills to be politically involved? Select all that apply.

2. "I should practice making decisions by developing potential solutions and then choosing one."

Which statement indicates understanding of how a nurse could improve personal decision-making skills?

3. "I am going to delegate the responsibility of creating the vacation schedule."

Which statement made by the nurse manager is an example of the first step of delegation?

3. "I have to remember to add membership on the team to my resume."

Which statement may reveal that the team member making the comment has a hidden agenda?

2. The nurse can use power to impact and improve client care.

Which statement reflects the most important use of power in nursing?

2. Much more research must be done before the impact of EMR on quality can be determined.

Which statement regarding the use of electronic medical records (EMR) is accurate as associated with quality improvement?

3. A nurse manager says, "I'm not going to change this process, because I'd have to change the CQI monitors."

Which statement reveals the most dangerous result of using measured standards as part of the CQI process?

1. "We must follow the federal guidelines in the way we bill for our services." 2. "If we don't reduce our nosocomial infection rate, Medicare won't reimburse us." 3. "Administration has to make this change or our accreditation status will be at risk."

Which statements by a hospital executive reflect power-coercive strategies to implement change? Select all that apply.

1. "We've already talked about this enough. We need to present a united front on this issue." 2. "The medical unit nurses won't like this decision because it is too much work." 3. "Let's all vote yes on this so we can get back to work."

Which statements by a nurse in the emergency department are examples of groupthink? Select all that apply.

4. "We cannot lose sight of the mission and values of our institution as we begin to integrate these changes." 5. "Although this task is going to be difficult, we have the full support of our hospital administration."

Which statements by the nurse manager would demonstrate effective change management? Select all that apply.

1. "I am always curious about why we do things the way we do." 3. "Can you help me understand your perspective a little better?" 5. "I don't think I can make that decision until I have more information."

Which statements exemplify the attributes of critical thinking essential to nurses? Select all that apply.

2. "I have such respect for her and the work she does." 3. "It is an honor to work with her." 4. "She had an opportunity to go to another hospital, but she chose to stay here and help us through accreditation."

Which statements reveal that the nurse being described has real power? Select all that apply.

1. "I won't stop until I have gotten her fired." 2. "He doesn't fight fairly." 3. "I've almost forgotten what started this, I just focused on beating her." 5. "He is so wrong, he just has to go."

Which statements would alert a nurse manager that a unit conflict has become disruptive? Select all that apply.

1. "I think it would be important to our organization if you represent the unit on the policy and procedure committee." 3. "I think your attendance at the task force meeting will be a good reflection on our unit."

Which statements would be important for the charge nurse to make when delegating a responsibility? Select all that apply.

2. "The nurse's prioritization will be different in a disaster." 3. "Clinical judgment skills will be an essential part of nursing's contribution to disaster management." 5. "The nurse's abilities will make the difference in successful management of a disaster."

Which statements would the nurse manager interpret as indicating a nurse understands the critical thinking skills necessary for disaster management? Select all that apply.

1. Maintaining expertise by attending continuing education events 3. Encouraging all disciplines to work towards organizational goals 4. Attending local events with influential people 5. Asking questions about reasons behind processes and policies

Which strategy could be used by nurses to promote nursing's power image?

1. Develop a "can do" attitude and reputation.

Which strategy is best for the newly licensed nurse who wishes to develop power in the organization?

4. Ensure adequate training, recognition, and easy access to the Internet.

Which strategy is most likely to increase participation in the use of evidence-based practice in nursing?

2. Shared governance

Which structure is reflected by the statement "Nursing practice is best determined by nurses"?

1. Progress on request to increase personal day benefits 2. Review of policy and procedure for unit evacuation 3. The value of teamwork 5. Standardized first of shift assessments

Which topic would likely appear on the agenda for a staff meeting chaired by a nurse manager who follows transactional leadership theory? Select all that apply.

2. Dressing, speaking, and acting in a professional manner

Which would be the most effective way for nursing to improve the power of its image? Select all that apply.

2. Teams have authority; groups may be informal.

While providing continuing education about group dynamics and team building, the nurse manager attempts to explain the difference between a group and a team. Which statement by the manager is most effective?

2. It brings more attention to an issue in need of change. 3. People get involved because conflict breeds curiosity.

Why does conflict help generate change? Select all that apply.

2. To evaluate the performance of those involved 3. To initiate any improvements needed 4. To evaluate the overall effectiveness of the plan

Why is postdisaster follow-up an essential part of disaster planning? Select all that apply.

1. Shared visioning makes change easier.

Why would the strategic planning committee choose shared visioning as a strategy for change?

2. The nurse's decision to use fewer supplies when changing a dressing

With the current health care industry focus on managed care, nurses must be more cost-conscious. Which option is an example of a nurse being cost-conscious?