NU370 PrepU: Leadership & Management
Which nurse leader most clearly exemplifies transformational leadership? a) A leader who is dynamic and inspiring and promotes change by the power of the leader's convictions b) A leader who is careful to thoughtfully assess the issues and priorities surrounding a problem prior to acting c) A leader who prioritizes the delegation of leadership to the individual members of the group d) A leader who prioritizes the fact that every member of the team is considered valuable and equal
a) A leader who is dynamic and inspiring and promotes change by the power of the leader's convictions - Transformational leaders can create revolutionary change. They are often described as charismatic, and they are unique in their ability to inspire and motivate others. A careful examination of contextual factors is associated with situational leadership. Delegation to group members and an emphasis on equality are typical of laissez-faire and democratic leadership styles, respectively.
Conflict has emerged on a nursing unit because new graduates have found that some of the more experienced nurses are manipulating the client assignment to ensure a lighter workload during night shifts. How should the manager of the unit best address this conflict? a) Arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible. b) Gather evidence over the next several weeks in order to determine if the practice is indeed happening. c) Arrange for the newer nurses to organize the client assignment for a trial period. d) Reassure the new graduates that the more experienced nurses are acting in the interests of both staff and clients.
a) Arrange a meeting where the issue can be discussed and addressed by as many of the nurses as possible. - Open, explicit, and participatory conflict resolution that is based on collaboration is an effective strategy for the management of conflict. Gathering evidence does not directly address the conflict that currently exists and reassurance may be unwarranted and false. Allowing the new graduates to create the client assignment may perpetuate selfish practices and does not resolve animosity between the two camps.
A client is admitted to an acute care facility after having a stroke. The client will require a variety of healthcare services throughout the hospital stay as well as coordination of care prior to discharge. What referral would be a priority for overseeing the client's care? a) Case management b) Physical therapy c) Occupational therapy d) Dietary services
a) Case management - The person responsible for overseeing the client's care, usually an RN with a bachelor's or master's degree or another highly experienced health professional, is called the case manager. Physical therapy, occupational therapy, and dietary services are all important care disciplines but do not encompass all of the client's needs.
The charge nurse is unable to replace a registered nurse for a shift on an acute medical unit. The staffing department states they are able to send an additional unlicensed assistive personnel (UAP) to assist. What priority action would the charge nurse take in this situation? a) Create the client assignment by considering available staff's skill level and client needs. b) Refuse to create the client assignment and tell management that a nurse must be found. c) Call charge nurses on other units to request a registered nurse come assist on the unit. d) Notify the local nursing regulating body about the unsafe working conditions at the facility.
a) Create the client assignment by considering available staff's skill level and client needs. - When working with less than an ideal number of registered nurses for a given number of clients, the charge nurse's first priority is to ensure safe distribution of client needs among the available staff members. The charge nurse's primary duty is to the safety of the clients. If there were serious impediments to safely adjusting the workload, it may be reasonable to voice this concern to the management, but the priority is to attempt to create the safe client assignment within the current staffing realities. The nurse should not attempt to arrange for staffing independently by calling other charge nurses as this is outside the role and responsibilities and may create safety concerns on other units. If the working conditions are considered unsafe, this could be a matter to be brought forward to a regulating body. However, in the moment, the charge nurse's priority is to attempt to distribute the clients' care in a safe manner.
To help staff nurses who are resistant to change adapt to the use of a new medication administration system, which action(s) should the nurse manager take? Select all that apply. a) Describe the evaluation process with use of the new system. b) Implement change quickly to the new system on the unit. c) Discuss the potential for a decrease in medication errors with the new system. d) Encourage feedback by the nursing staff with use of the new system. e) Provide a long, detailed explanation of the use of the new system to all staff.
a) Describe the evaluation process with use of the new system. b) Implement change quickly to the new system on the unit. c) Discuss the potential for a decrease in medication errors with the new system. - To effectively implement a change on the nursing unit with nurses who are resistant, a nurse manager should have the staff be involved in the process by soliciting feedback and explaining how the change can be evaluated. The nurses should also understand why this is important so that they will be ready for change; in this case, a decrease in medication errors would be an important reason for nurses to want to adopt a new medication system. Ensuring that the system is explained in simple, concise terms rather than complex and detailed terms will help overcome resistance, as well as implementing change in stages or more slowly, rather than quickly.
The nurse working with the hospital's infection control team is attempting to decrease the transmission of healthcare-associated pathogens. Which intervention will be most effective? a) Incentivizing health care workers to utilize hand hygiene b) Revising the facility's infection control protocols c) Encouraging visitors to adhere to isolation precautions d) Limiting visitors to family members over the age of 18
a) Incentivizing health care workers to utilize hand hygiene - Most healthcare-associated pathogens are transmitted via the contaminated hands of health care workers. Therefore, the most effective strategies for decreasing transmission are those that educate or encourage health care workers to utilize effective hand hygiene. Revising the agency's infection control protocols is not nursing centered. Encouraging visitors to adhere to isolation precautions is important but does not affect the immediate surroundings and personal space that can cause a contaminated work environment. Limiting visitors to family members over the age of 18 is not client-centered care and will not decrease transmission of pathogens.
When providing care to a client who consistently attempts to manipulate the staff, the nurse can best maintain the therapeutic milieu by doing what? a) Instructing the staff to enforce all unit rules consistently b) Encouraging questions and discussing the client's concerns c) Promoting social ostracism of the client's exhibiting manipulation d) Scheduling staff one-on-one time with the client
a) Instructing the staff to enforce all unit rules consistently - Being consistent in expectations regarding rules and regulations for all clients will minimize the threat of manipulation. The other options provided are appropriate but do not represent the best way to minimize manipulation.
Which indicates that the nurse, acting as a leader for a group of recovering clients with alcohol abuse, is addressing the responsibility of maintaining the group's process? a) Keeping the group on task by restating goals b) Deciding how often the group will meet c) Selecting individuals for membership in the group d) Determining that the group's format will be closed
a) Keeping the group on task by restating goals - In a therapy group, the nurse-therapist has both task and maintenance role functions. Group task functions are concerned with the practical issues of leading a group, whereas group maintenance functions focus on less tangible group processes. Keeping the group focused on its goals is "maintenance" in nature. Deciding how often the group will meet, selecting individuals for membership in the group, and determining the group's format are considered tasks rather than maintenance items.
A client in an acute care facility is assigned a case manager to oversee and coordinate care. What important function does a case manager have? a) Provide early, thorough discharge planning. b) Make sure the client is administered medications. c) Provide care to the client who is terminally ill and has less than 6 months to live. d) Make home visits to see that the client is taken care of after discharge.
a) Provide early, thorough discharge planning. - An important function of case managers is to provide early, thorough discharge planning. The case manager is not responsible for the administration of medications. Hospice care provides care to the client who is terminally ill. The case manager oversees the care of the clients while they are hospitalized. Referrals to community agencies and home healthcare will be made for home visits.
A registered nurse is caring for a group of clients on a psychiatric unit. Which task can the nurse delegate to the licensed practical/vocational nurse? a) Redressing lacerations on the wrists of a client who attempted suicide. b) Preforming a suicide assessment on a client recently admitted with depression. c) Educating a client on the newly prescribed escitalopram and zolpidem. d) Assessing a client who is withdrawing from alcohol and methamphetamine.
a) Redressing lacerations on the wrists of a client who attempted suicide. - A licensed practical/vocational nurse (LPN/LVN) can take care of stable clients with expected outcomes. LPN/LVNs can differentiate between normal and abnormal findings. A dressing change is an appropriate task to delegate to the LPN/LVN. A registered nurse (RN) must complete any task that requires nursing judgment. Providing education and assessing requires an RN.
The nurse-manager of a 20-bed coronary care unit is not on duty when a staff nurse makes a serious medication error that results in a client's overdose. The client nearly dies. Which statement accurately reflects the accountability of the nurse-manager? a) The nurse-manager would receive a call at home from the on-duty nursing supervisor, apprising the nurse-manager of the problem as soon as possible. b) Because the nurse-manager is off duty and not accountable for incidents that occur in their absence, the nurse-manager need not be notified. c) The nurse-manager only needs to be informed of the incident when the nurse-manager reports to work on the next scheduled day. d) Although the nurse-manager is off duty and not responsible for what happened, the nursing supervisor would call the nurse-manager only if time permits.
a) The nurse-manager would receive a call at home from the on-duty nursing supervisor, apprising the nurse-manager of the problem as soon as possible. - The nurse-manager is accountable for what happens on the unit 24 hours per day, 7 days per week. If a serious problem occurs, the nurse-manager should be notified as soon as possible. None of the other choices accurately reflect the nurse--manager's accountability in this situation.
A staffing agency is assigning a licensed practical/vocational nurse (LPN/VN) to cover a shift on a pediatric unit. Because the unit manager is unfamiliar with the nurse's skill level, what assignment is best for the LPN/VN? a) 8-year-old child admitted that morning with suspected meningitis b) 9-year-old child receiving subcutaneous insulin for diabetes mellitus c) 10-year-old child who had a tonsillectomy that morning d) 9-year-old child with Legg-Calve'-Perthes disease
b) 9-year-old child receiving subcutaneous insulin for diabetes mellitus - The unit manager should assign the LPN/VN to the child with diabetes mellitus. Because the client is receiving subcutaneous insulin rather than IV insulin, the diabetes is likely stable. Meningitis is an acute condition with the potential to progress into respiratory depression and seizures; this child will require frequent nursing assessments. The child who had a tonsillectomy remains at risk for hemorrhage during the first 24 hours following surgery. Legg-Calve'-Perthes disease is associated with impaired circulation to the femoral capital epiphysis; the child with this condition requires aggressive monitoring.
A nurse is caring for a client with a fresh postoperative wound following a femoral-popliteal revascularization procedure. The nurse fails to routinely assess the pedal pulses on the affected leg, and missed the warning sign that the blood vessel was becoming occluded. The nurse manager is made aware of the complication and the nurse's failure to assess the client properly. What action should be taken by the nurse manager? a) Review the nurse's malpractice insurance policy. b) Address the nurse's omissions as negligent behavior. c) Ask the nurse whether the client refused the assessments. d) Reprimand the nurse for being forgetful.
b) Address the nurse's omissions as negligent behavior. - Negligence refers to careless acts on the part of an individual who is not exercising reasonable or prudent judgment. It also refers to the failure to do something that a reasonable person (another nurse) would do.
How might one define leadership? a) Leadership is the process of planning, organizing, directing, and controlling activities. b) Leadership is the process of guiding, educating, motivating, and directing others. c) Leadership is the process by which the leader shares power with others. d) Leadership is the process of interviewing, hiring, and firing personnel.
b) Leadership is the process of guiding, educating, motivating, and directing others. - Leadership may be viewed as the process of guiding, educating, motivating, and directing the activities of others toward attaining goals. Management includes planning, organizing, directing and controlling activities. Empowerment is the process by which the leader shares power with others. It is the manager who interviews, hires, and fires.
A primary unit nurse tells the nurse-manager that a registered nurse hired 6 weeks ago needs an additional week of orientation to function effectively on the staff. Which action is most appropriate for the nurse-manager to take? a) Explain to the primary nurse that a 6-week orientation is standard. b) Meet with the new nurse and the primary nurse and help set up an additional week of orientation. c) Meet with the new nurse and question the new nurse about deficits in performance. d) Schedule a staff meeting to find out if there are deficiencies or flaws in the orientation process.
b) Meet with the new nurse and the primary nurse and help set up an additional week of orientation. - The nurse-manager is responsible for adequate orientation of new staff. A need for additional orientation does not mean that a nurse is not competent or that there are deficits in performance. Although a 6-week orientation may be standard, orientation periods should be individualized to meet the needs of the staff as well as provide the best client outcomes. Periodically reviewing and revising the orientation process is a good idea. However, in this case, the most appropriate course of action is to help the new nurse complete the orientation as efficiently as possible.
Which of these statements regarding a nurse manager role is accurate? a) The nurse manager's main role in the nursing unit is to manage the unit budget. b) To effectively manage the nursing unit, the nurse manager should also be a leader. c) A healthy work environment is not within the scope of the nurse manager's role. d) The nurse manager will decide on the financial targets for the nursing unit.
b) To effectively manage the nursing unit, the nurse manager should also be a leader. - In order to be an effective nurse manager, the nurse manager must also be a leader. This is important with management of a healthy work environment, which is a responsibility of the nurse manager. This is done by helping ensure that interpersonal conflicts are resolved. The nurse manager is also accountable for client census, staffing, supplies, and budget, but is not responsible for setting financial targets for the budget; this is usually managed at the executive level.
The nurse is caring for multiple clients on a medical-surgical floor. Which task may the nurse delegate to unlicensed assistive personnel (UAP)? a) irrigating a nasogastric (NG) tube b) assisting a client 3 days post-op to ambulate in the hallway c) taking orthostatic blood pressure readings on a client on a new medication d) administering an antacid to a client with symptoms of heartburn
b) assisting a client 3 days post-op to ambulate in the hallway - Because the client had surgery 3 days ago, the nurse may safely delegate the task of assisting with ambulation to a UAP. Irrigating an NG tube, administering medications, and taking orthostatic readings for a new medication are tasks that must be performed by licensed nursing personnel.
A client with stage IV Parkinson's disease is admitted to the emergency department with heart failure. The client's advance directive dictates no cardiopulmonary resuscitation, intubation, or artificial feedings. The client is receiving diuretics to treat heart failure. The licensed practical nurse states, "This client shouldn't have come to the hospital because they have an advance directive." Which response by the registered nurse is best? a) "You're right. Caring for this client is a waste of our time." b) "We're not administering cardiopulmonary resuscitation or feedings, so we're meeting the client's wishes." c) "Just because the client has an advance directive doesn't mean that we shouldn't treat reversible conditions such as heart failure." d) "The advance directive applies only to treating complications associated with Parkinson's disease."
c) "Just because the client has an advance directive doesn't mean that we shouldn't treat reversible conditions such as heart failure." - Option 3 is the best response; the advance directive doesn't dictate that care be withheld when reversible conditions such as heart failure exist. Option 1 is an inappropriate response. Option 2 is an accurate response; however, it isn't the best response because it doesn't provide an accurate explanation of advance directives. The advance directive covers all irreversible conditions, not just the client's Parkinson's disease.
A nurse is planning to delegate client care to an unlicensed assistive personnel (UAP). The UAP is experienced but has limited exposure to the type of clients who are on the nursing unit. Which client should the nurse recognize as being appropriate to delegate to the UAP? a) A client who had a stroke with dysphagia two days prior and needs assistance being fed b) A client who is one day postoperative for scoliosis surgery and needs to use a bed pan c) A client who is admitted for hypovolemic shock one day prior and needs to have urinary output measured d) A client with asthma needing education regarding the use of a metered-dose inhaler
c) A client who is admitted for hypovolemic shock one day prior and needs to have urinary output measured - The stem of the question indicates that the UAP is not familiar with the client population but is an experienced health care professional. The UAP's qualifications and capabilities should be considered before delegating tasks. The client requiring urinary output measure is the most appropriate client for the UAP because no additional training would be required to complete the task. Clients who have recently undergone hypovolemic shock have an indwelling catheter, and UAPs can easily measure the amount of urine contained in the drainage system. Clients who have experienced stroke may have difficulty swallowing and require professionals trained in assisting them to swallow and who can respond to accidental choking. Clients who have had scoliosis surgery must be logrolled during the first postoperative day and require professionals experienced in logrolling. Education is outside of the scope of practice for a UAP and should be performed by an RN.
According to the American Nurses Association (1995), the advanced practice registered nurse is distinguished from other registered nurses according to scope of practice. Select the activity that would distinguish the advanced practice nurse from other RNs. a) Interprets health care provider orders b) Develops nursing care plans c) Prescribes medications d) Reports abnormal test results
c) Prescribes medications - All registered nurses are responsible for interpreting health care provider orders, developing nursing care plans and reporting abnormal diagnostic test results. Only RNs with a master's or doctoral degree and credentialed by the American Nurses Credentialing Center or a Specialties National Certification Body can function as advanced practice nurses and prescribe medications.
After a nurse manager implements a solution to the problem of delays in obtaining supplies, the first task for the manager is to: a) ask the staff members for other solutions. b) plan to monitor the supply cabinets. c) assess whether the desired results have occurred. d) make an appointment with the chief nursing officer.
c) assess whether the desired results have occurred. - The nurse manager must evaluate the results of the efforts to determine whether the desired results have occurred. The nurse manager should solicit input from staff members about potential solutions before, not after, implementing a solution. Monitoring the supply cabinets would be more appropriate if the problem were suspected drug diversion by staff but would be unnecessary for evaluating for improvement in delays for obtaining supplies. Making an appointment with the chief nursing officer is not necessary and would not help the nurse manager evaluate the change in procedure related to obtaining supplies.
Which task may be safely delegated to a licensed practical nurse (LPN)? a) teaching a client newly diagnosed with diabetes mellitus about insulin administration b) admitting a client who underwent a thoracotomy to the nursing unit from the postanesthesia care unit c) changing the dressing of a client who underwent surgery 2 days ago d) administering an I.V. bolus dose of morphine sulfate to a client experiencing incisional pain
c) changing the dressing of a client who underwent surgery 2 days ago - The registered nurse may safely delegate dressing changes for the client who underwent surgery 2 days ago to the LPN. Teaching a client newly diagnosed with diabetes mellitus about insulin administration requires careful evaluation of the effectiveness of teaching and may not be delegated to an LPN. Admitting a client to the postanesthesia care unit is beyond the scope of practice for an LPN; LPNs aren't permitted to give I.V. push drugs.
The nurse has provided an in-service presentation to ancillary staff about standard precautions on the birthing unit. The nurse determines that one of the staff members needs further instructions when the nurse observes which action? a) use of protective goggles during a cesarean birth b) placement of bloody sheets in a container designated for contaminated linens c) wearing of sterile gloves to bathe a neonate at 2 hours of age d) disposal of used scalpel blades in a puncture-resistant container
c) wearing of sterile gloves to bathe a neonate at 2 hours of age - One of the staff members needs further instructions when the nurse observes the staff member wearing sterile gloves to bathe a neonate at 2 hours of age. Clean gloves should be worn, not sterile gloves. Sterile gloves are more expensive than clean gloves and are not necessary when bathing a neonate.
The charge nurse is making assignments for a group of clients on a medical unit. When reviewing the acuity of the clients, the charge nurse assigns the RN to the clients with higher acuity levels. Why would the charge nurse assign the RN to the clients with a higher acuity? a) LPNs do not understand how to care for clients with complex disorders. b) Assigning an LPN would allow them to provide care out of their scope of practice. c) Higher acuity clients request the services of an RN versus other care providers. d) A higher acuity client requires a greater need for highly skilled care.
d) A higher acuity client requires a greater need for highly skilled care. - Generally, higher acuity requires a greater need for highly skilled care. Clients with complicated or high-risk surgery, massive trauma, or critical illness will be cared for in an acute care hospital, where a high level of professional, skilled, and technological care is available. RNs are instrumental in caring for these clients. LPNs may understand how to care for clients with complex disorders, but RNs are instrumental in the client care. There are no guidelines about practicing for LPNs and the acuity of clients. Clients generally do not request care by a specific provider.
Which situations should a supervisor consider in making assignments for nurses in the neonatal unit? a) A pregnant nurse shouldn't care for a neonate whose mother was positive for human immunodeficiency virus (HIV). b) A nurse with young children shouldn't care for a neonate whose mother has gonorrhea. c) A nurse with young children shouldn't care for a neonate with erythema toxicum. d) A pregnant nurse shouldn't care for a neonate with cytomegalovirus (CMV).
d) A pregnant nurse shouldn't care for a neonate with cytomegalovirus (CMV). - CMV exposure can affect the fetus; women who are pregnant should avoid contact with CMV-positive clients. HIV is transmitted via blood and body fluids; all staff should take contact precautions. When a mother has gonorrhea, a nurse should administer eye prophylaxis to the neonate to prevent neonatal ophthalmic infection. It isn't a concern for staff. Erythema toxicum is a common rash in infancy; communicability isn't a concern.
A client with stage II Alzheimer's disease is admitted to the short stay unit after cardiac catheterization that involved a femoral puncture. The client is reminded to keep their leg straight. A knee immobilizer is applied, but the client repeatedly attempts to remove it. The nurse is responsible for three other clients who underwent cardiac catheterization. What's the best step the nurse can take? a) Continually remind the client not to move their leg and to leave the immobilizer alone. b) Sedate the client. c) Apply wrist restraints. d) Ask the staffing coordinator to assign a nursing assistant to sit with the client.
d) Ask the staffing coordinator to assign a nursing assistant to sit with the client. - The nurse should ask the staffing coordinator to assign a nursing assistant to sit with the client. This action promotes client safety while avoiding restraint use. Applying wrist restraints doesn't prevent injury to the lower leg. Also, restraints should be applied only after other less restrictive measures have been attempted. A client with stage II Alzheimer's disease has memory impairment that impedes their ability to remember repeated instruction. Sedation isn't indicated for this client.
The nurse manager calls a staff into a unit meeting to discuss patient satisfaction. During the meeting, several staff members assume control. The nurse manager does not intervene to regain control of the group. Which type of leadership style is the nurse embodying? a) Quantum b) Autocratic c) Democratic d) Laissez-faire
d) Laissez-faire - Laissez-faire leadership style involves the leader relinquishing power or control to the group. Democratic leadership style involves sharing the decision making process and activities with others who have an interest. Autocratic leadership style involves assuming control over the decisions and activities of the group. Quantum leadership style involves seeing an organization and members as interconnected and collaborative. This style involves change as continually unfolding, and frequently incorporates technology.
A nurse-manager in the office of a group of surgeons has received complaints from discharged clients about inadequate instructions for performing home care. Knowing the importance of good, timely client education, the nurse-manager should take which steps? a) Inform the nurses who work in the facility that client education should be implemented as soon as the client is admitted to either the hospital or the outpatient surgical center. b) Review and revise the way client education is conducted in the surgeons' office. c) Because none of the clients suffered any serious damage, the nurse-manager can safely ignore their complaints. d) Work with the surgeons' staff and the nursing staff in the hospital and outpatient surgical center to evaluate current client education practices and make revisions as needed.
d) Work with the surgeons' staff and the nursing staff in the hospital and outpatient surgical center to evaluate current client education practices and make revisions as needed. - Every nurse who provides client care should provide client education. Nurses must work together to establish the best methods of educating clients. The most appropriate response is to contact the facility's nurse-manager, not the nursing staff. Evaluating client education in only the surgeon's office doesn't consider the entire client education process and all of the staff providing it. Client education is an important nursing responsibility and every complaint deserves attention.
