PPL Exam 1

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Organizational culture includes (select all that apply): a. Norms. b. Traditions. c. Behaviors. d. Values.

A,B,C,D

A good nursing decision maker is one who: a. Uses various models to guide the process based on the circumstances of the situation. b. Adopts one model and uses it to guide all decision making. c. Decides not to use any models because they are all useless. d. Develops a new model each time a decision has to be made.

As a manager in a new nursing home, where might you consult for guidance and evidence to support the development of safe patient practices? a. Hospitals b. Business c. Industry d. Outpatient clinics

Which of the following is an outcome of managed care? a. Shift of patients to outpatient and home health services b. Less complexity in funding sources c. Less complexity in rules for consumers to follow d. Greater consistency in the quality of care

With revenue reductions and cost-saving measures, the number of managers has been reduced, which has increased the number of team leaders supervised by managers by as many as three. This change may result in: a. Decreased patient satisfaction. b. Increased efficiency in costs. c. A more positive perception of managers. d. Little change to manager-staff relationships.

The parents of a toddler who dies after being brought to the ER launch a lawsuit, claiming that the failure of nurses to pursue concerns related to their son's deteriorating condition contributed to his death. The senior nurse executive is named in the suit: a. As a global respondent. b. Under the doctrine of respondeat superior. c. As a frivolous action. d. Under the element of causation.

When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidate's lack of eye contact reflects the candidate's cultural sensitivity. You are exhibiting: a. Acculturation. b. Cultural sensitivity. c. Ethnocentrism. d. Transculturalism.

Within the deaf culture, there is considerable disagreement about the use of SEE (Signed Exact English) and ASL (American Sign Language). This is indicative of: a. Dominant versus nondominant behaviors. b. The need to recognize diversity within groups. c. The impact of cross-culturalism. d. How language separates subgroups.

A patient refuses a simple procedure that you believe is in the patient's best interest. The two ethical principles that are directly in conflict in such a situation are: a. Fidelity and justice. b. Veracity and fidelity. c. Autonomy and beneficence. d. Paternalism and respect for others.

High-quality decisions are most likely to be made in nursing situations when: a. Team leaders make the crucial decisions. b. Individuals are advised of the problems. c. Group size is neither too small nor too large. d. Members are passively involved.

In keeping with standards of The Joint Commission (TJC), the nurse manager organizes an orientation for new staff members. As part of the orientation, the nurse manager reviews the employee handbook. Employers may be bound to statements in the employee handbook: a. Under the doctrine of apparent agency. b. Under the doctrine of respondeat agency. c. Based on the employee's or the employer's expectations. d. Based on the theory that the handbook creates an explicit contract.

A nurse manager working for a not-for-profit organization should be familiar with the regulations that impact the organization. Not-for-profit organizations: a. Pay dividends to stockholders. b. Can refuse clients who are unable to pay. c. Have no paid employees. d. Pay no taxes.

A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled but must often care for his wife, who is undergoing treatment for breast cancer. According to Maslow's need hierarchy theory, what would be the best approach to satisfying the needs of this nurse, other staff, and patients? a. Line up agency nurses who can be called in to work on short notice. b. Place the nurse on unpaid leave for the remainder of his wife's treatment. c. Sympathize with the nurse's dilemma and let the charge nurse know that this nurse may be calling in frequently in the future. d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife's treatments.

According to the complexity theory, which of the following should be the focus of measurement? a. Cost per hospital day b. Bed utilization c. Infection rates d. Staff morale and budgets

As a nurse manager on a urology unit, you note that there has been a marked increase in medication errors on the unit. Which of the following actions would be consistent with the National Database of Nursing Quality Indicators (NDNQI) measures? a. Staff are consulted regarding improvements in interprofessional approaches to patient care. b. Nursing staff are asked for input regarding the purchase of new medication carts. c. A recognition program is developed to acknowledge nurses who have provided safe and exemplary care utilizing skills in the staffing mix to optimize the delivery of patient care. d. Recent changes in staffing mixes are examined to determine if the timing of changes coincides with the increase in errors.

As a nurse manager, you embrace the usefulness of resources such as Smart Bed. This behavior is important to: a. Budget development. b. A manager's role. c. Succession planning. d. Encouragement of staff utilization of technology.

During a staff shortage, you hire an RN from a temporary agency. The RN administers a wrong IV medication that results in cardiac arrest and a difficult recovery for the patient. Liability in this situation: a. Is limited to the temporary agency. b. Is restricted to the RN. c. Could include the RN, the agency, and your institution. d. May depend on the patient's belief regarding the employment relationship.

In preparation for redesignation as a MagnetTM Hospital, how would you prepare? a. Commit staff resources over a 6-month period to updating procedure manuals. b. Educate staff through meetings and training sessions regarding appropriate answers to questions. c. Prepare a manual that outlines orientation procedures and ensure that all safety issues are addressed. d. Ensure that there are empirical data to support review of patient outcomes, actions taken, and results of actions.

Which of the following is not important in a positive work environment, as defined by the AONE? a. Clear, open, trustful communication b. Accountability and clarity of roles and responsibilities c. Participatory decision making d. Challenge and striving for excellence

As a nurse manager in a for-profit hospital, you are interested in promoting teaching programs for physicians, because evidence suggests that hospitals with teaching programs tend to promote better care for patients. Your administration indicates that it cannot support your ideas or proposal because of (select all that apply): a. Increased salary costs. b. Duplication of tests and procedures. c. Graduate medical education. d. Potential damage to reputation through learner error.

A,B,C

In a busy rehabilitation unit, the team manager decided that the best way to reward the staff was to give them a monetary bonus rather than time off. The staff was very concerned about the decision and went to the administration with a number of complaints. Critical thinking is a process that entails a number of steps. What steps did the manager omit? She should have (select all that apply): a. Identified what assumptions were underpinning the issues. b. Considered why it was important to make this change or the context for the change. c. Considered how this change might affect staff relationships. d. Attained a majority consensus of all staff.

A,B,C

One of your staff nurses asks for your advice because a patient refuses to sign a consent for surgery. The patient says that he won't sign because he doesn't understand the nature of the surgery. You advise that (select all that apply): a. Consent must not be coerced. b. The patient has a right to choose not to consent. c. The patient must sign the consent because the doctor wants him to sign. d. Witnessing a consent is related only to the voluntary nature of the signature.

A,B,D.

With regard to nursing practice, nurse managers are held responsible for (select all that apply): a. Practicing within legal guidelines established under state law and nurse practice acts. b. Ensuring that nursing staff under their supervision are currently licensed to practice. c. Referring all errors in nursing judgment to state discipline boards. d. Ensuring that physicians are properly licensed to provide care on patient care units.

A,B.

"Georgia Hospital will provide care that is a national example of consumer service" is a: a. Vision statement. b. Statement of philosophy. c. Mission statement. d. Rationale for care.

A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the nurse manager about seeing his "acupuncture doctor" for treatment of his migraine headache. The best response to this patient would be: a. "How long have you been using acupuncture treatment?" b. "Do you think acupuncture relieves your pain satisfactorily?" c. "What have you told your heart specialist about your migraines and treatment?" d. "Have you tried nonprescription pain medication or been given a prescription drug for your headaches?"

A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who begins to complain loudly about the quality of care his mother is receiving. His behavior is so disruptive that it is overheard by staff, physicians, and other visitors. The family member rejects any attempt to intervene therapeutically to resolve the issue. He leaves the unit abruptly, and the nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner? a. Reflect to gain insight into how the situation could be handled differently in the future. b. Try to catch up with the angry family member to resolve the concern. c. Discuss the concern with the patient after the family member has left. d. Notify nursing administration of the situation.

A client requires an appendectomy. The surgeon explains the procedure and asks the client to sign the consent. The patient speaks very little English and looks worried. As a nurse, you would: a. Suggest that an interpreter explain the procedure to the client and answer any questions. b. Ask the client if he has any questions. c. Draw a picture to show the incision. d. Not intervene.

A colleague asks you to give her your password access so that she can view her partner's healthcare record. This request violates the patient's right to: a. Privacy. b. Confidentiality. c. Undue authorization of treatment. d. Protection against slander.

A dispute arises between an RN staff member and an LPN over a patient issue. The tension between the two begins to affect other staff members, who are drawn into the conflict; eventually, the team becomes polarized toward either the RN or the LPN. This situation might have been prevented through: a. Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves. b. Asking other staff members what the real issues were in the dispute between the RN and the LPN. c. Reassigning one of the parties to another unit when it became apparent that the two individuals could not resolve the dispute themselves. d. Calling a staff meeting at the onset of the dispute to allow the team and the RN and LPN to discuss the initial dispute.

A facility that provides care for patients whose average length of stay is less than 30 days and to patients whose average length of stay is longer than 30 days, and who require inpatient and ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered: a. A healthcare network. b. A tertiary care institution. c. Rehabilitative. d. Long-term care.

A merger has occurred between a hospital and a local home health agency, creating new roles for the nursing staff in both agencies. The nurse managers of both systems begin to evaluate and revise patient care processes and systems. With the merger, the healthcare organization's changes are: a. Creating more jobs in the community for registered nurses. b. Resulting in an overall loss of jobs for registered nurses. c. Controlled by the federal and state governments. d. Controlled by the insurance agency.

A nurse executive is hired to restore a unit's productivity, which has decreased as the result of low staff morale. The nurse executive utilizes which of the following leadership principles? a. The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment. b. If staff members increase productivity, then they are given opportunity to engage in learning events such as workshops and conferences. If the staff members are not satisfied, they will insist on a different leader, who will get them what they want. c. Leaders at the national level who are seeking relief for nurses in the workplace are seen as the solution to the nursing shortage. d. Workplace satisfaction depends on staffing ratios, adequate pay, and tuition reimbursement, and these are things the leader can control.

A nurse manager in a for-profit environment finds it difficult to recruit staff. This difficulty may be most related to aggressive profit goals and: a. Lower salary compensation for staff. b. Rising expectations of impoverished and indigent individuals for services. c. Poor orientation and retention practices for staff. d. An overwhelming emphasis on accepting learners from health disciplines.

A nurse manager must implement a 2% budget cut on the nursing unit. Which approach should the manager use to most effectively empower the staff of the unit? a. Discuss the guidelines for the budget cuts with the staff, making the decisions with those who participate. b. Inform the staff of the budget cuts in a series of small group meetings and accept their ideas in writing only. c. Provide the staff with handouts about the budget cuts and let them make recommendations in writing. d. Hold a series of mandatory meetings on the budget cuts, asking staff for ideas on the cuts.

A nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks toward a patient with a previous history of sexual abuse. The patient sues, claiming malpractice. Which of the following conditions may not apply in this situation? a. Injury b. Causation c. Breach of duty d. Breach of duty of care owed

A staff nurse asks the nurse manager for a few days off for personal reasons. The nurse manager turns in the request to the human resources office with a note indicating that the staff nurse has demonstrated excellent working skills and is a valued employee. The nurse manager has used the influence of her position to help this staff member. Influence is the process of: a. Using power. b. Empowering others. c. Understanding power. d. Moving past apathy.

A staff nurse who was fired for reporting patient abuse to the appropriate state agency files a whistleblower lawsuit against the former employer. Reasons that the court would use in upholding a valid whistleblower suit claiming retaliation include that the nurse: a. Had previously reported the complaint, in writing, to hospital administration. b. Had threatened to give full details of the patient abuse to local media sources. c. Was discharged after three unsuccessful attempts at progressive discipline had failed. d. Had organized, before filing the complaint, a work stoppage action by fellow employees.

A unit manager watches a new RN graduate interacting with a patient. When the RN comes out of the room, the unit manager says, "I don't know what they taught you in your nursing program, but if I see you do that again, I will write you up." This example demonstrates: a. Coercive use of power. b. Appropriate application of control. c. Use of informatory power. d. Use of power to provide coaching.

After being interviewed for the unit manager position, the staff nurse reflects on the interview process. The staff nurse is aware that leadership begins: a. Within. b. Through a relationship with a mentor. c. With the job description. d. With the chief nursing officer of the organization.

An individual in a wheelchair is applying for the position of receptionist in an outpatient clinic. The nurse manager understands that the Americans with Disabilities Act of 1990 requires that employers: a. Make reasonable accommodations for persons who are disabled. b. Allow modified job expectations for persons recovering from alcoholism. c. Hire disabled individuals before hiring other qualified, non-disabled persons. d. Treat, for purposes of employment, homosexuals and bisexuals as disabled.

As a charge nurse, you counsel your RN staff member that he has satisfied his duty of care by notifying a child's physician of his concerns about deterioration in the child's status at 0330 hours. The physician does not come in. The child dies at 0630 hours. As the charge nurse, you could be held liable for: a. Professional negligence. b. Assault. c. Avoidance. d. Murder.

As a manager, the development of your decision-making skills related to safe patient care is facilitated by: a. Regular reflection on decisions. b. A culture of perfectionism. c. Recognition of who should be held responsible for individual errors. d. A culture of trust between the staff and you.

As a nurse manager in a hospital, you would expect which of the following to be the major contributor to funding and revenues in your organization? a. The federal government b. Medicare c. Medicaid d. Blue Cross/Blue Shield

As a nurse manager, you have hired two new staff members who have recently come to the United States from other countries. Which of the following strategies might indicate your efforts to assist these staff members with acculturation to your unit? a. Analyze a recent situation with them in which an order with a physician was not clarified and explore their beliefs about nurse-physician relationships. b. Expect them to behave in ways that are expected of staff who have grown up and been educated in the United States. c. Stress to these new staff that your unit is a "family" and that staff members take pride in saying that they are from Unit 4. d. Recognize that culture develops over time and leave them alone to figure out differences between their culture and that of the unit.

As a patient care advocate, you regularly coach patients on how to stay safe in health care by educating them about: a. The need to understand and record all medications being taken. b. Bringing their own linens and other personal items to the hospital. c. Washing hands frequently while in a healthcare environment and using a hand sanitizer. d. Following closely the directions and orders of healthcare providers.

At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. It would now be best to: a. Arrange another meeting in a week's time so as to allow a cooling-off period. b. Turn the dispute over to the director of nursing. c. Insist that participants continue to talk until a resolution has been reached. d. Back the unit manager's actions and end the dispute.

Because an increasing number of Hispanic patients are being admitted, a nurse manager designs a staff-development program to help her staff understand the Hispanic culture. A nurse should understand that culture is determined by which of the following? a. Behavior b. Love for people c. Shared vision d. Genetic predisposition

Becky graduated five years ago and is keenly interested in pursuing leadership opportunities. She has been active in learning about leadership through workshops and Internet research and recently began a graduate degree program with a focus on nursing administration. She has excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and sometimes aggressive behavior tends to alienate other staff members on the unit. In coaching Becky, you: a. Suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation. b. Suggest that she not consider leadership roles because her interaction skills are more suited to roles in which she has limited opportunities to work with others. c. Ask staff members on the unit with whom she works to provide her feedback about ways in which her behavior irritates or turns them away. d. Encourage her to continue her graduate courses, as information about strategies and technical aspects of the role will compensate for negative interactions.

During a discussion of concern about approaches used with aggressive patients in the Emergency Department, several staff members express concern for their safety. As a leader, the nurse manager should: a. Look directly at speakers and acknowledge their comments. b. Promise to implement each suggestion that is made. c. Implement the idea that receives the most discussion. d. Listen but implement the plan that she had in mind before the discussion began.

During managers' meetings, Lindsay is surprised by the forthrightness of male managers. She finds that, during discussions, she would be more likely to say: a. "I wonder if we should consider changing our policy on performance appraisals? What do you think?" b. "Sean, your approach to appraisal is completely off track and does not reflect available evidence." c. "The system that has been developed needs to be implemented. We have already spent enough time in discussion." d. "Forget about change in this policy. It is fine as it is."

During orientation of new nurse managers, the chief nursing officer stresses strategies that help nurse managers to achieve a powerful image. Which groups of behaviors best contribute to a powerful image for the nurse manager? a. Greeting patients, families, and colleagues with a handshake and a smile; listening carefully when problems arise b. For men, no facial hair, always wearing a suit and tie; for women, always wearing a suit and high-heeled shoes c. Maintaining a soft voice during times of conflict; making unbroken eye contact during interactions d. Smiling all the time; always wearing a suit, carrying a briefcase, and, if a woman, wearing no jewelry

If you are supporting the steps in the AHRQ document "Five Steps to Safer Health Care," you would ensure that: a. Patients are actively encouraged to make decisions related to care. b. Rules and decisions are made through centralized processes. c. You monitor the performance of each staff member closely. d. Preference is given to increasing staff numbers rather than staff credentials.

In accordance with changes by the Joint Commission (TJC), Pleasant Valley Hospital amends its safety practices and policies to emphasize: a. Safety goals specific to Pleasant Valley. b. Decision-making processes. c. Sufficient staffing for safe care. d. Increased numbers of baccalaureate-prepared RNs.

In designing programs through your institution to address the health needs of Hispanics in your community, you most likely would develop programs related to: a. Diabetes. b. Cardiovascular disease. c. Cancer. d. Asthma.

In opening a new dialysis unit, the nurse manager has to develop a philosophy for the unit. This philosophy needs to: a. Reflect the culture of the unit and its values. b. Be developed by the nursing manager on the unit. c. Identify the clients that will be served on the unit. d. Replicate the organization's philosophy.

Knowing when to have the entire team participate in the decision-making process or when to have only the team leader make the decisions depends on the situation and the desired outcomes. The autocratic process is used in which of the following situations? a. The task and the outcome are relatively simple and defined b. It is unlikely that the group will reach a consensus. c. A decision has to be discussed thoroughly. d. A number of options need to be considered.

Literature on oppression in nursing has: a. Verified the presence of behaviors associated with oppression within nursing. b. Suggested that oppression leads to bullying but has little or no effect on patient outcomes. c. Failed to establish that oppression is present in nursing groups. d. Indicated that nurses use oppression negatively.

Mr. M. complains to you that one of your staff asked him details about his sexual relationships and financial affairs. He says that these questions were probing and unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry with him and would not provide him with good care. Mr. M.'s statements reflect concern with: a. Privacy. b. Confidentiality. c. Veracity. d. Informed consent.

Nurses on Unit 17 complain that their manager frequently "checks up on them" and encourages little involvement in decision making and yet, during performance reviews, praises them for their outstanding performance. Nurses on Unit 18 indicate that their experience is different from that of nurses on Unit 17. The manager on Unit 18 encourages active involvement in decision making and provides authentic, growth-promoting feedback. The practices on Units 17 and 18 reflect. a. Differences in the managers' expectations of their role. b. Shaping of the workplace behavior of employees. c. Different approaches to cooperation and collaboration. d. Recognition of institutional priorities.

Sarah is a second-year nursing student. The clinical instructor overhears Sarah telling a patient that she "always" checks patients' bracelets before giving medication and she is not sure how the nurses on the unit "get away with" not making more errors than they do. The clinical instructor pulls Sarah aside and explores with her how her communication might affect the patient and what it reflects about her beliefs related to the team. The actions of the clinical instructor reflect competencies outlined by: a. QSEN. b. IHI. c. DNV/NIAHO. d. AHRQ.

Sarah, one of your RNs, tells you that she can't understand why Jim, an Aboriginal patient, wants to do a smudge. Sarah's response is based on her: a. Cultural marginality. b. Circle of familiarity. c. Cultural understanding. d. Acculturation.

Taylor Hospital has well-defined organizational units that provide maintenance, financial services, care for cardiac patients, care for surgical patients, and so on. The organizational chart indicates that surgical units report to a surgical manager and all nursing units report to a vice president of nursing; financial services to an accountant and then to a business executive; and so on. The primary disadvantage of this organizational structure is: a. Breakdown in function and communication across specialties. b. Lack of congruence in culture and organizational values. c. Highly centralized decision making and authority. d. Wide span of control.

The SBAR approach to patient safety encourages: a. Consistency in assessment and practices. b. Continuing education. c. Multidisciplinary approaches. d. Patient feedback.

The adage "leaders are born and not made" reflects which of the following ideas around leadership? a. Management can be taught; leadership depends on abilities. b. Mentorship is important in developing innate skills of leaders. c. Leadership is a natural skill that cannot be refined or developed. d. Succession planning and formal education related to leadership are ineffective.

The chief nursing officer is given the task of reviewing and revising the organization's mission, philosophy, and technology. In reviewing them, the chief nursing officer understands that they should be reflected in: a. The organizational structure. b. Line and staff responsibilities. c. The policies and procedures. d. Government regulations.

The hospital administration gives approval to the chief nursing officer to hire clinical nurse specialists in staff positions rather than in administrative positions. A clinical specialist who has staff authority but no line authority typically is able to: a. Function through influence. b. Take complete responsibility for the care of clients. c. Interview and hire staff nurses for designated nursing units. d. Be granted functional authority to determine standards of nursing care and enforce them.

The maintenance department wishes to have the nursing lounge renovated, so the lounge will be more "user-friendly." The department asks the nursing staff to make a wish list of everything that they would like to see in the new lounge. This process is an example of which part of the decision-making process? a. Assessment/Data collection b. Planning c. Data interpretation d. Generating hypotheses

The manager of a surgical area has a vision for the future that requires the addition of RN assistants or unlicensed persons to feed, bathe, and walk patients. The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea. The best initial strategy in this situation would include: a. Exploring the values and feelings of the RN group in relationship to this change. b. Leaving the RNs alone for a time so they can think about the change before it is implemented. c. Dropping the idea and trying for the change in a year or so when some of the present RNs have retired. d. Hiring the assistants and allowing the RNs to see what good additions they are.

The nurse manager for a unit's culturally diverse staff creates a staff-development program so the professional nursing staff members can enhance their understanding of cultures on the basis of published literature. The literature reveals that the following characteristic is inherent in a culture. It: a. Develops over time. b. Maintains a strong work ethic. c. Changes easily. d. Develops quickly.

The nurse manager is anticipating changes on the unit because of managed care. It is up to the manager to "sell" the staff on this care concept. A goal of managed care that the staff must understand is that managed care is: a. Grounded in business theory. b. Useful for long-term patients only. c. Designed to reduce unit resources and staff. d. Not concerned with the best interests of clients.

The nurse manager of a rehab unit wants to purchase a new anti-embolic stocking. To make a high-quality decision, the nurse manager would: a. Involve the rehab staff in the decision. b. Involve the sales representative. c. Make the decision alone. d. Involve administration in the decision.

The risk manager wants to evaluate the reasons for an increased number of falls on the rehab unit. The risk manager devises a fishbone diagram. A fishbone diagram is a useful tool to: a. Identify the root causes of problems. b. List possible solutions to problems. c. Help leaders select the best options. d. Evaluate the outcomes of decisions made.

The successful integration of informatics into healthcare settings is key to: a. Quality decision making related to management of resources and patient care. b. Accessing current information about business practices. c. Meeting the modern-day expectations of staff regarding technology use. d. Speeding up calculations and decisions in budget development.

The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are angry and ask for a meeting to discuss the change. After hearing their concerns related to reduction in professional autonomy and care quality, you: a. Acknowledge the loss. b. Explain the reasons for change, emphasizing the need to reduce costs. c. Repeat the information several times, giving detailed budget overviews. d. Adjourn the meeting and provide explanation through e-mail.

The workgroup on NU 23 is marked by apathy toward the ward's patients, high absenteeism, open conflict among team members, and high turnover of personnel, including managers. The underlying behavior in this situation may be characterized as: a. Powerlessness. b. Anger. c. Apathy. d. Oppression.

Three gravely ill patients are candidates for the only available bed in the ICU. As the supervisor, you assign the bed to the patient with the best chance of recovery. This decision reflects which of the following ethical principles? a. Beneficence b. Autonomy c. Veracity d. Nonmaleficence

To achieve nurse-sensitive care standards developed by the NQF, you advocate for which of the following in your health facility? a. Evidence-based practice to reduce the prevalence of pressure sores b. Implementation of informatics at the bedside c. Staff-manager conferences to review reporting of adverse medical events d. Patient councils to review food, recreation, and nurse-patient relations

Which of the following would managers and staff review annually in order to ensure compliance with the Joint Commission (TJC) to improve patient safety? a. Appropriateness of charting terms and abbreviations b. Nursing hours per patient c. Acuity of patient admissions d. Wait times for care

With the help of a federal grant, the local school nurse has established a spreadsheet that contains relevant nursing data so that she can analyze children's health. School health programs are: a. Increasingly seen as primary care sites for children. b. Providing only health education programs for children and their parents. c. Capable only of providing referrals for health problems to primary care providers. d. Funded exclusively by local authorities.

You notice that Sally, a student on your unit, is giving information to an anxious young teen who seems very uncertain about preparation for an upper GI series. After Sally leaves the room, you ask her how she thought her conversation with the patient went and: a. Encourage her to ask the patient if he has questions or concerns about the procedure. b. Advise her to consider providing the patient with more information. c. Suggest that she leave some brochures on the procedure with the patient. d. Suggest that she also provide teaching to the adolescent's parents.

You pull staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions. Staff members are becoming distanced from the family. After inviting the concerns of staff, you explain that the organization values patient-centered care and that evidence supports that acting as an advocate and a listener is helpful to families. You ask the staff for ideas as to strategies that are effectively patient-centered in these situations. In this situation, you are taking on which role? a. Leadership b. Management c. Follower d. Visionary

As a nurse manager, you have to be effective in managing a culturally diverse staff. Which of the following nurse manager attributes would assist you in addressing the cultural needs of your staff (select all that apply)? a. Stereotyping of others b. Respecting others c. Understanding the importance of language d. Encouragement of potential in all staff e. Age bias f. Disrespect for others

B,C,D

"At Thoroughcare, we provide health care for women and children in transition" is an example of a: a. Vision statement. b. Mission statement. c. Goal statement. d. Statement of philosophy.

A group of managers is meeting to discuss ideas related to the successful implementation of evidence-based practice on their units. Susan has been asked by the director of care to assume leadership of these discussion groups. After two such sessions, Susan expresses disappointment to her mentor that the group seems disinterested in her ideas and that they are listening to Ken, who has much less experience with leadership. In discussing this with Susan, the mentor understands that leadership: a. Is a designated role. b. Must be earned. c. Is more likely to be taken by someone who is more talkative. d. Rarely is taken over by someone with less experience.

A local hospital has formed a corporate partnership with a reputable HMO (health maintenance organization). The nurse manager has had to educate staff and personnel about the financial implications of this partnership. An HMO: a. Provides more expensive care than other types of insurance plans. b. Has a centralized administration that directs and compensates physician services. c. Pays physicians on a fee-for-service basis. d. Does not pay as much for acute care as other practice plans.

A manager who is concerned with ensuring that patients on her surgical unit have the necessary information to make informed choices is: a. Practicing legal nursing care. b. Demonstrating respect for patient rights. c. Avoiding risks. d. Likely experiencing staff issues with informed consent.

A member of a patient's family calls the nurse manager of the palliative care unit to express concern that a member of the family, who died on the weekend, had requested analgesics from the RNs on duty. An RN came with the analgesic nearly 45 minutes later, just after the patient had died. The manager is aware that the unit was especially busy that weekend because many patients were seriously ill, staff had called in ill, and the staffing manager was unable to completely replace staff who were absent. The manager is deeply troubled that the family member had to die in pain because it violates what she knows should have been done. This manager is experiencing: a. Compromised agency. b. Moral distress. c. Moral sensitivity. d. Moral dilemma.

A nurse executive who considers herself a Baby Boomer will have the challenge of convincing the emerging workforce of the necessity of committee meetings. One of the primary reasons that the Baby Boom generation appears to have so many meetings in the work environment is that: a. They feel more comfortable in a group. b. They find that the journey to the solution is as important as the solution itself. c. They were deprived of collective action opportunities in the past and now feel that solutions are better when many people have input. d. Baby Boomers are aging and need the respite from work that meetings offer, so they can recuperate from the physical demands of the work environment.

A nurse manager is experiencing poor staff morale on her unit. While participating in a baccalaureate course, the nurse manager had learned that one of the reasons nurses lack power today is probably because of the past. In the early decades of the profession, nurses lacked power because: a. Nurses freely chose to defer to physicians and administrators with more education. b. Women lacked legal, social, and political power because of legal and cultural barriers. c. The first nursing licensure laws prohibited nurses from making most decisions. d. Nurses astutely recognized the risks of grabbing too much power too soon.

A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of the older adult patient. Using complexity principles, what would be the best approach to take in making this change? a. Leverage the hierarchical management position to get unit staff involved in assessment and planning. b. Engage involved staff at all levels in the decision-making process. c. Focus the assessment on the unit, and omit the hospital and community environment. d. Hire a geriatric specialist to oversee and control the project.

According to Leininger, "cultural imposition" is a major concern in nursing because nurses have a tendency to impose their values, beliefs, and practices on patients of other cultures. The discussion topic most likely to be without cultural imposition would be: a. Abortion. b. Wound management. c. Blood transfusion. d. Advance directives.

Amy has worked in the dialysis unit on staff for about 12 years. She is frequently consulted by other nursing staff regarding protocols and policies on the unit. What type of power is Amy using? a. Position power b. Expert power c. Personal power d. Competency power

An outpatient surgery manager is evaluating infusion pumps for the operating room. The manager should: a. Select the least expensive brand. b. Use a decision-making tool to evaluate brands. c. Ask the nursing staff which brand they prefer. d. Select the vendor the institution usually buys from.

As a leader on a rehab unit, you encourage all staff members to see themselves as having a role in decision making and quality care. You see your role as involving particular responsibilities in decision making but not as a hierarchal role. This view of decision making and leadership is consistent with: a. Trait theories. b. Complexity theory. c. Situated theory. d. Emotional intelligence.

As a nurse manager, you have been offered a position at a Veterans Administration hospital. In accepting the position, it is important for you to understand that veterans hospitals provide: a. Primary care and are privately funded. b. A range of services and are responsible to government and taxpayers. c. Secondary care only and are publicly administered and funded. d. Services to veterans under an HMO.

As the RN charge nurse on the night shift in a small long-term care facility, you've found that there is little turnover among your LPN and nursing assistant (NA) staff members, but they are not very motivated to go beyond their job descriptions in their work. Which of the following strategies might motivate the staff and lead to greater job satisfaction? a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night LPNs and NAs. b. Allow the LPNs and NAs greater decision-making power within the scope of their positions in the institution. c. Hire additional staff so that there are more staff available for enhanced care and individual workloads are lessened. d. Ask the director of nursing to increase job security for night staff by having them sign contracts that guarantee work.

At Hospital XYZ, staff members on Y3 have dealt with the third head nurse in three years. Donna, the current head nurse, lacks confidence in patient-nurse relationships, and scheduling and other processes are routinely left to the last minute. Staff members approached Donna first and then administration with their concerns about Donna's effectiveness as a leader. The staff was told that the problem is likely staff related, that it is simply an unhappy group, and that there is nothing that will be done further about their concerns. The philosophy of the organization indicates that "open, transparent communication between staff and management is desired and supported," and that "innovation and creative thinking are the foundation of the organization's progress." In assessing this situation as a newly hired senior executive, you anticipate that: a. Staff members will resolve the conflict on their own. b. The situation will lead to ongoing disgruntlement and attrition. c. No further discussion or concerns will come out of the situation. d. The head nurse will be able to resolve the conflict on her own.

Budgeting and protection of revenues is a function of: a. Leadership. b. Management. c. Team leadership. d. Followers.

Chart audits have revealed significant omissions of data that could have legal and funding guidelines ramifications. As the unit manager, you meet with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. This is an example of: a. Leadership. b. Management. c. Decision making. d. Vision.

Decision making is described by the nursing educator as the process one uses to: a. Solve a problem. b. Choose between alternatives. c. Reflect on a certain situation. d. Generate ideas.

During a fire drill, several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This autocratic decision style is most appropriate for: a. Routine problems. b. Crisis situations. c. Managers who prefer a "telling" style. d. Followers who cannot agree on a solution.

During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is: a. Empowering. b. A leadership tag. c. A symbol. d. A management task.

During performance appraisal, you praise Xia for her attention and care to nursing details. You suggest that her care would be further enhanced by greater acknowledgment of patients' feelings. Xia bursts into tears and leaves the office. Later, you learn that criticism is perceived as akin to failure in Xia's culture. You reflect on how you could modify your approach in the future to acknowledge different cultural interpretations of feedback. Your response is indicative of: a. Bias. b. Cultural awareness. c. Cultural diversity. d. Ethnocentricity.

During review of back injuries, it is determined that a large number of injuries are occurring in spite of mechanical lifts being used. Furthermore, it is determined that some lifts are outdated. In addressing this concern, the unit manager: a. Meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure. b. After consultation with the staff about the review, orders new lifts to replace older ones that are malfunctioning. c. Blames the system for inadequate funding for resources. d. Reviews the system of reporting incidents to ensure that appropriate reporting is occurring.

In a telehealth organization, a nurse who is licensed in New York and Pennsylvania provides teaching to a patient who resides in Pennsylvania. The patient charges that the teaching failed to provide significant information about a potential side effect, which led to delay in seeking treatment and untoward harm. Under which state nurse practice act and standards would this situation be considered? a. New York b. Pennsylvania c. Neither New York nor Pennsylvania d. Both New York and Pennsylvania

In matrix organizational structures, a nurse manager understands that this type of structure: a. Is a simplified organizational structure. b. Has both a functional manager and a service or product-line manager. c. Arranges departments strictly according to function. d. Promotes harmony in organizational decision making.

Joan, the nursing unit manager, finds it difficult to work with Thomas, a new graduate. Thomas has many ideas, and his manner of presenting them irks Joan. After reflection and discussion with others, Joan recognizes that she also feels threatened by his behavior. She comes to understand that Thomas is trying to establish his own role on the unit, is not trying to challenge her, and needs guidance, coaching, and affirmation. Joan is demonstrating: a. A positive self-concept. b. Deepening self-awareness. c. Leadership. d. Acquiescence.

John Smith, one of three managers at BSG Labs, drafted a policy that would allow his department to do more testing in his lab. This policy included the times for regular collection as well as a new process for emergency laboratory testing. The policy and procedures were never followed. The reason was that: a. The policy was too lengthy and inundated readers with too much detail. b. The policy made decisions for other departments in the company. c. The staff did not believe that the new policy would be effective. d. Testing should not be done in the lab.

Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style? a. Transformational b. Transactional c. Trusting d. Truthful

Nurses in the CCU are unhappy and frustrated with their nurse manager. They complain that "nothing is ever good enough for him." These statements suggest that the nurse manager's goals may be: a. Measurable. b. Unrealistic. c. Attainable. d. Too low.

Nurses who engage in in-fighting, seek physician support against nursing colleagues, and avoid political advocacy through membership in nursing organizations: a. Refuse to believe that they are acting like members of groups that suffer socioeconomic oppression. b. Do not understand how their failure to exercise power can limit the power of the whole profession. c. Purposefully choose to exercise their power in the workplace through indirect means. d. Suffer from learned helplessness as a result of abuse by powerful nurse executives.

One means of ensuring that nurses floated to other patient care areas in healthcare organizations are qualified to work in those areas is: a. Employing additional staff to assist with orientation processes. b. Cross-educating staff members to other areas of the institution. c. Transferring patients to units where the staffing pattern is optimal. d. Orienting staff members to all patient care areas as part of their general orientation to the institution.

One of the staff nurses on your unit makes the comment, "All this time I thought Mary was black. She says she is Jamaican." The best response would be to say: a. "Who cares what she is?" b. "What did you think when you learned she was Jamaican?" c. "Why did you assume she was black?" d. "We have never had a Jamaican on this unit."

Recruiting among the emerging workforce (18- to 35-year-olds) is a challenge for healthcare agencies. Marketing brochures should address the leadership and vision of the healthcare agency. Which of the following workplace environments will attract applicants in the emerging workforce? a. A highly professional environment b. A nurturing and receptive environment c. An environment highlighted by lots of meetings, so staff members can have lots of input d. A totally online environment, so staff members will not have to interface with uncaring colleagues

Sarah, RN, complains to you that a male nurse from a different culture sits very close during charting and leans toward her when speaking. In responding to Sarah, you consider that differences across cultures that are relevant to this situation include: a. Eye contact. b. Personal space. c. Harassment. d. Expressions of feeling.

The IOM Health Professions Education report highlighted patient safety concerns as: a. A normal risk in professional practice. b. A result of disciplinary silos. c. A reflection of frontline staff. d. Related to systems errors.

The NQF provides a model for advancement of healthcare quality that could be used in healthcare organizations. The use of this model by the Centers for Medicare & Medicaid Services specifically affects the interaction between adverse events and: a. Staffing. b. Funding. c. Composition of executive councils. d. Composition of consumer-based councils.

The Sunny Long-Term Care Facility has experienced numerous difficulties with staff relationships, despite its success in maintaining financial viability and judicious use of resources. Staff members complain that the primary concerns of the facility include applying policy, saving money, and ensuring that lawsuits are avoided. There is little trust in, and involvement of, staff members. This facility may be: a. Well managed and well led. b. Overly managed and not well led. c. Poorly managed and well led. d. Overly led and overly managed.

The chief nursing officer and the dean of the School of Nursing believe that by establishing rules and regulations and controlling the environment, this partnership will: a. Promote professional medical authority, autonomy, and responsibility. b. Need a degree of flexibility to engender success. c. Be essential for self-governance. d. Provide for the establishment of medical committees.

The hospital administrator approves a case management position for a new rehabilitation unit to help reduce costs. In developing the job description, the nurse manager understands that a key element of case management is: a. Managing of care by nurse managers. b. Coordination of resources for effective outcomes. c. Rapid discharge of clients to decrease costs. d. Managing of care for outpatient clients only.

The institution where you are a nurse manager has resisted the adoption of a new document management software, citing cost as a concern. You meet with other nurse managers who are in favor of the software and prepare a proposal to take to the senior executive with the goal of persuading the executive to adopt the software. This is an example of: a. Collaboration. b. A coalition. c. Networking. d. Policy building.

The local health department nurse manager has developed and implemented a disaster readiness plan as part of a community service. Community services: a. Care for the specific needs of individual families in the community. b. Focus on the treatment of community-wide problems rather than on individual health problems. c. Do not include services provided by public health departments. d. Provide personal health follow-up for all acute care hospitalizations.

The new head nurse on G Unit has been the subject of a great deal of discussion and complaining during breaks. She is a competent nurse of tremendous integrity with approximately 30 years' experience. Her predominant method of problem solving and communication is through meetings, which can go over the allotted time. The staff may: a. Be represented by a high number of Baby Boomers. b. Be presenting different generational values and attitudes than the head nurse. c. Be unresponsive to her transactional leadership style. d. Want a leader rather than a manager.

The nurse manager in the Emergency Department needs to implement new staffing patterns. As a transformational leader, the nurse manager should: a. Explain in detail how well the new idea will work. b. Reinforce how this change will respond to the ideas and solutions generated by staff members. c. Reason with staff members that the new idea will save money and allow more free time. d. Imply that raises will be smaller than anticipated if the new idea is not accepted.

The nurse manager plays a unique role in institutional management in that the nurse manager: a. Encourages shared decision making. b. Models professional nursing behavior. c. Interprets healthcare trends and their impact on revenues. d. Coordinates care and allocates resources.

The nurse manager, as the leader of the unit's "customer (client) first" initiative, has asked the staff nurses to develop and administer a survey to every client before discharge. In asking the staff nurses to accomplish this task, the nurse manager is demonstrating: a. Accountability. b. Shared leadership. c. A common purpose. d. Independence in the nursing manager's role.

The style of leadership that Kari is exhibiting is likely to: a. Ensure that the organization is financially stable. b. Stifle innovative thinking about ways to move out of financial jeopardy. c. Lead to apathy and disinterest in the organizational goals. d. Lead to decreased attrition of staff on her unit.

Tracy is an RN case manager who interfaces between the Centers for Medicare & Medicaid. Tracy's responsibilities most likely would include: a. Managing physician-led research. b. Monitoring physician documentation of the need for medical care. c. Determining which services are designated fee-for-service. d. Identifying errors in physician diagnoses.

Two nurses approach their manager about a conflict regarding the next month's schedule. The nurses are talking loudly and at the same time. The manager most effectively uses communication skills to resolve the conflict by: a. Taking both nurses aside, separately and then together, and charging them with resolving the problem without her direct intervention. b. Listening to each nurse speak to the other without interruption and asking clarifying questions to help them resolve the issue themselves. c. Separating the nurses, instructing each to decide how the problem can be resolved, and meeting with them the next day. d. Calling an emergency scheduling committee meeting and asking volunteers to resolve the conflict between the two nurses.

Which ethical principle is primarily involved in informed consent? a. Veracity b. Autonomy c. Beneficence d. Nonmaleficence

Which of the following nurses is MOST likely to inspire others to do their best? a. Nancy, RN, is an individual who enjoys details and organization. She regularly leaves notes for the next shift about what has been done incorrectly or omitted. b. Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious. c. Clara has been the head nurse on Unit 3Y for years. She is quiet but enjoys patients and their families. She has not been to a conference in years because the unit is her entire life. d. Karen is a team leader. She is extraordinarily vigilant about ensuring that everyone is treated fairly in assignments. She is also very conscientious about care and regularly checks up on what everyone is doing to ensure that it is done correctly.

While walking past a patient's room, you overhear one of the RN staff telling a patient that the patient has no right to refuse chemotherapy treatment because the family and the doctor think the treatment is the best option for the patient. This patient is 40 years of age and alert. When you meet later to discuss what you heard with the RN, it is important to: a. Discuss how statute law enforces the right of the doctor, but not of families, to ensure that patients comply with recommended treatment plans. b. Discuss that statute law provides for patient autonomy and refusal of treatment. c. Remind the nurse to provide clearer explanations to aid in the patient's comprehension of the treatment and compliance. d. Acknowledge the nurse's role in ensuring that she does not fail in her duty of care for the patient.

You overhear a newly graduated RN telling one of your colleagues that leadership and management belong to the unit manager and not to her. As a nursing colleague, you respond by demonstrating understanding that the perception of the new graduate: a. Is correct. Leadership is not the role of the staff nurse. b. Would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals. c. Has been influenced by nurse leaders and managers who leave for other positions. d. Is related to the general perception that nurse leaders and managers are not satisfied in their jobs.

Your colleague Mary, a recent graduate, announces one day that she intends to leave nursing in 3 to 4 months to pursue a position in marketing. While at your agency, she plans to give patients excellent care and to learn as much as she can, because "Who knows? Nursing is a great job with a great pay and I may return someday." Mary's statements most accurately exemplify which orientation to the concept of nursing? Nursing as a(n): a. Profession. b. Occupation. c. Flexible discipline. d. Career with off and on ramps.

A family is keeping vigil at a critically ill patient's bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with people in such situations. In response to this situation, you approach the unit manager to apprise her of your concerns that the family dynamics of the patient involved may lead to staff-family and patient-family conflicts. You suggest that the physician may need to discuss the treatment plan with the family. The unit manager advises that he will arrange this discussion. If, after the meeting with family members, this is identified as a desired approach, you support the manager's decision. Your actions indicate that you are acting in what role? a. Leadership b. Management c. Follower d. Evidence-based

A grievance brought by a staff nurse against the unit manager requires mediation. At the first mediation session, the staff nurse repeatedly calls the unit manager's actions unfair, and the unit manager continues to reiterate the reasons for her actions. What would be the best course of action at this time? a. Send the two disputants away to reach their own resolution. b. Involve another staff nurse in the discussion so as to clarify issues. c. Ask each party to examine her own motives and issues in the conflict. d. Continue to listen as the parties repeat their thoughts and feelings about the conflict.

A group of patients with early Alzheimer's disease and their spouses approach you regarding help with the establishment of a local Alzheimer's Society for the support and education of affected individuals and their families. As a manager in an ambulatory care clinic, what suggestion or advice would you offer this group? a. Self-help groups are, by nature, directed, funded, and led by those requiring help, and therefore, the patients and families should need no help from your clinic. b. Your healthcare organization would be pleased to help as long as your organization financially takes over responsibility for direction, leadership, and management. c. Through partnership, you will provide supports, if possible, that the patients and spouses themselves identify as necessary in the establishment of the group. d. The services that the patients and spouses are proposing are likely being offered somewhere else already.

A hospital is working toward becoming a Magnet™ hospital. The chief nursing officer is aware that professional nursing departments of the future will: a. Not be directed by nurses. b. Be virtual organizations. c. Be designed to maintain nursing standards of practice. d. Be entitled to have client care departments.

A manager relies on his director (immediate supervisor) for advice about enrolling in graduate school to prepare for a career as a nurse executive. The director may exercise what kinds of power in the relationship with the manager in this advisory situation? a. Expert, coercive, and referent b. Reward, connection, and information c. Referent, expert, and information d. Reward, referent, and information

A new CEO has been hired at Valley Hospital who proposes to change the centralized organizational structure that was put in place ten years ago, based on widespread consultation with staff. The proposed structure involves substantial flattening of the organizational structure, with significant decision making being made at the point-of-care and an emphasis on interprofessional collaboration. There is a great deal of discussion about the balance between hospital-wide budget decision making and unit-based decision making. This discussion represents: a. Chaos theory. b. Organizational redesign. c. Organizational reengineering. d. Restructuring.

A new graduate RN joins your unit. After a few weeks, she complains about some of her peers on the unit and compares their practices negatively to what she learned in her nursing program. She also is vocal about how she has learned so much here that she did not learn in her program. She is best described as: a. Having cultural sensitivity. b. Experiencing cultural diversity. c. Experiencing cultural marginality. d. Experiencing acculturation.

A nurse manager at a home healthcare service has resigned to take a position at a local ambulatory care center. She has been hired because of her expertise in TJC accreditation. To initiate the changes, the nurse manager has to be knowledgeable about the differences between a home healthcare institution and an ambulatory care center, which is a primary care institution. Primary care institutions are facilities that provide: a. Rehabilitative or long-term care. b. Disease-restorative care. c. First access to care. d. Only outpatient services.

A nurse manager has worked rapidly to bring the staff to accept changes in the unit's mission, so that downsizing can be avoided. This nurse manager is using quantum leadership by: a. Focusing on past concerns related to the mission. b. Teaching staff members how to self-manage themselves. c. Determining accurately the direction of change in the institution. d. Requiring all staff members to review and reinforce their technological skills.

A nurse manager is experiencing considerable conflict among staff members because of weekend staffing coverage. During a called staff meeting, the nurse manager asks the disgruntled staff to meet as a group and determine the best staffing practices. In doing this, the nurse manager is using the concept of collaboration to: a. Demonstrate interdependence. b. Depict flexibility and broadmindedness. c. Focus all energies of staff members on a best possible strategy. d. Defuse the possibility that staff members will escalate their discontent when staffing the unit on weekends.

A nurse manager recognizes the need to expand her professional network as she begins a job search for a middle-management position. Which of the following actions is least likely to expand her job-searching network? a. Reviewing her address book or card file for names and phone numbers of former colleagues who are now in middle-management positions b. Making an appointment to meet with a former instructor from her graduate program in nursing administration c. Making a long overdue return call to a former colleague who is now a chief nurse executive d. Attending a state-level conferences for nurse managers and executives and volunteering to help with professional organizations' informal luncheons and receptions

A primary care clinic is established in Pleasantville to provide comprehensive services to infants, children, and families within the community. The executive director of the clinic oversees physician and nursing services for infants, children, and families; a neurodevelopmental clinic; psychology, family counseling, and social work services; nutritional counseling; speech and hearing services; and physiotherapy. This type of organizational structure is known as: a. Hierarchical. b. Bureaucratic. c. Service-line. d. Matrix

A staff nurse in the area that you manage has excelled in the delivery of patient education. You are considering implementing a new job description that would broaden her opportunity to teach patients and orient new staff members to the value of patient education. The ethical principle that you are most directly reinforcing is: a. Justice. b. Fidelity. c. Paternalism. d. Respect for others.

As a manager, you are responsible for two separate units: a CCU and a cardiac step-down unit. The organization and relationships on these units are distinct and very different from one another. Your decision has been to support the uniqueness of these units because each is effective in different ways in providing patient care. This approach is consistent with which principle? a. Transculturalism b. Cross-culturalism c. Multiculturalism d. Acculturation

As the clinical director of 24 employees, you have been asked to explain to staff members why they are not getting a raise this year, even though they have been working short-handed for many months and patient satisfaction scores have never been higher. Because you believe yourself to be a transformational leader, you will approach this problem by: a. Telling the assistant clinical director and asking her to share the bad news with the other staff members. b. Posting a note on the bulletin board that includes the phone number of the chief nursing officer, so anyone who has complaints may express them. c. Showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future. d. Meeting with a small group of seasoned staff members and asking them how to break the news.

As the nurse manager who wants to increase motivation by providing motivating factors, which action would you select? a. Collaborate with the human resource/personnel department to develop on-site daycare services. b. Provide a hierarchical organizational structure. c. Implement a model of shared governance. d. Promote the development of a flexible benefits package.

At Health Center XYZ, staff members on the rehab unit have a head nurse who is intolerant of error and publicly chides anyone who makes a mistake. Over time, the rules on the unit dictate that mistakes are hidden and that areas of concern related to the functioning of the unit are discussed in tub rooms and are never openly discussed during periodic meetings. New staff members are quickly made to realize that silence is expected. The situation described is an example of: a. Ethnicity. b. Work environment. c. Work culture. d. Marginalization.

Collaborative partnerships between hospitals and schools of nursing are examples of hybrid organizational structures. A hybrid organizational structure: a. Has many divisions of labor. b. Best fits long-term care units. c. Has a mixture of the characteristics of various organizational types. d. Places the authority for decision making closest to the places where workers perform.

Cultural diversity is the term used to describe a vast range of cultural differences. Events have symbolic meanings for the nurse manager and the staff. The event that would be most likely to provide symbolic meaning to a nurse manager and staff is a: a. Task force formed to commemorate a New Year's celebration in the Western tradition. b. Project to provide Christmas gifts to the children in a daycare program. c. Celebration of National Nurses Week with the focus on cultural care. d. Task force to develop a poster for the unit depicting religions of the world.

Despite repeated invitations by his colleagues to become involved in regional and state nursing practice committees, Tom refuses. His reason is that "nursing committees rarely get anything worthwhile done because of politics and conflicts." According to the text, Tom's view of involvement: a. Is rare in nursing today. b. Reflects a fear of power. c. Reflects the essential process of power. d. Reflects empowerment and capacity to make his own decisions.

From the information supplied in this chapter, which statement best defines critical thinking? Critical thinking is a: a. High-level cognitive process. b. Process that helps to develop reflective criticism for the purpose of reaching a conclusion. c. High-level cognitive process that includes creativity, problem solving, and decision making. d. Discussion that guides the nursing process.

Healthcare organization XYZ provides women's health services on an inpatient basis (average stay of less than 30 days). This facility would likely be considered: a. Primary care, specialized. b. Tertiary care, long-term. c. Acute care, specialized. d. Public care, specialized.

In caring for a patient from an East Indian culture, the staff expresses frustration that many people are in the room at any one time, which interferes with care. As the nurse manager, you provide leadership in understanding that this behavior of the family and friend network reflects: a. Lack of understanding of the seriousness of the patient's illness. b. Lack of communication between family members. c. The social organization of friendships and family networks in East Indian culture. d. Lack of caring about the hospital environment by the friends and family.

In planning a new wing, the nurse manager complies with the workplace safety requirements of the Occupational Safety & Health Administration (OSHA). Which of the following groups is considered to be at high risk for violence in the workplace? a. Pediatric staff b. Postsurgical unit staff c. Emergency Department staff d. Medical oncology unit staff

In reviewing the current delivery model, the nurse manager is aware that a demographic change that will have a significant effect on the healthcare delivery systems of the future is: a. Changes in staffing patterns. b. Increasing reports of violence in the workplace. c. The increasing percentage of the population that will be over age 65. d. Escalations in the cost of health care.

In the Unity Healthcare organization, communication flows: a. Laterally. b. Bottom to top. c. Top to bottom. d. Intermittently.

In the Unity Healthcare organization, decisions, including those at the unit level, are made by a group of senior executives. Rules for employees are clear, and nursing care is delineated by procedures and protocols. This exemplifies: a. Transformational leadership. b. Transactional leadership. c. Bureaucratic organization. d. Chaos theory.

In which of the following situations would you expect low morale and frustration? a. Statement of philosophy indicates "We value our staff." When staff members leave, careful evaluation is done to determine whether staff should be replaced by full- or part-time employees. b. Practices include annual staff recognition celebrations. During times of change, staff members are actively included in issue identification and solution finding. c. Recruitment ads promise opportunities for advancement for everyone. Promotions are given only to individuals with long-standing service and entrenched relationships. d. The vision indicates that there is strong commitment to lead in research. The organization has tried to implement a strong campaign to attract leading nurse researchers but has experienced difficulty in doing so.

In working with Cheryl, her mentor suggests that it is really important for Cheryl to engage in self-appraisal and to know her strengths. This observation is based on an understanding that: a. Self-confidence comes automatically out of leading. b. Self-confidence requires constant self-affirmation of strengths. c. There is little external motivation and affirmation in leadership. d. Supervisors of leaders rarely provide feedback.

Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high turnover rate among rehab-assistants because of the heavy work assignments. Despite his need for staff, Justin decides to review each application thoroughly and interview candidates carefully because he recognizes that it is important to hire staff who can best provide high-quality care and who will fit well with the team. Which of the following decision-making models did Justin use in making his decision? a. Subjective model b. Objective model c. Optimizing model d. Satisficing model

Maintaining a culturally diverse staff and working with a culturally diverse patient population is an important function of a nurse manager who works in the hospital of a large medical center. On your palliative care unit, you have recently received complaints from families about ineffective pain management for their family members and you determine this occurs primarily when certain nurses are working. What approach might you take to resolve the concerns of the families, patients, and potentially, the staff? a. Reinforce to staff that practice guidelines support as-needed analgesia for the terminally ill. b. Ask staff input on the development of stricter guidelines to ensure that all terminally patients are given sufficient analgesia. c. Encourage conversation with patients and among staff that facilitates learning about cultural beliefs and priorities in dying. d. Advise families that the administration of analgesia is based on the expert clinical judgment of nurses who are familiar with care of patients in palliative care.

Mary joins 5W nursing unit. Mary is a new graduate who is anxious to fit in. She soon learns that some of her "book learning" is being criticized by her colleagues, so she adapts her practice to what others on the unit are doing. She is demonstrating: a. Cultural awareness. b. Cultural sensitivity. c. Acculturation. d. Cultural marginality.

Mary, an 85-year-old patient with cognitive impairment and gross instability, wanders continuously. Lately, she has fallen twice, and the family demands that she be restrained. As the unit manager, you have initiated a least restraint practice. An appropriate action in this situation would be: a. Setting up a nursing team meeting to review practices. b. Calling the family to inform them of the practice. c. Initiating a multidisciplinary and family meeting to focus on Mary's needs.

On your nursing unit, you employ LPNs, RNs, and advanced practice nurses. You will need to be familiar with at least: a. Two nursing practice acts. b. Two nursing practice acts in most states. c. At least one nursing practice act. d. One nursing practice act and a medical act.

One day, at coffee, your co-worker suggests that you and she sit with unit members of the hospital research committee. She suggests that this would be an excellent way to get to know people who share her interest in research. Her actions are an example of: a. Mentorship. b. Politics. c. Networking. d. Empowerment.

Politics is usually: a. Confined to legislatures. b. Seen in dysfunctional workplaces. c. Found in all social organizations. d. A representation of self-interest.

Select the statement that best defines the difference between problem solving and decision making: a. Decision-making skills require critical thinking; problem-solving skills do not. b. Problem-solving skills require critical thinking; decision-making skills do not. c. Decision making is a goal-directed effort; problem solving is focused on solving an immediate problem. d. Problem solving is a goal-directed effort; decision making is focused on solving an immediate problem.

Several nurses on an adolescent psychiatric unit complain that the teens are becoming unmanageable on the 0700-1900 shift. To resolve this problem, the nurse manager decides that the staff should have a brainstorming session. The goal of brainstorming is to: a. Evaluate problem solutions. b. Critique the ideas of others. c. Generate as many solutions as possible. d. Identify only practical and realistic ideas.

Susan, an RN in the ED, would like to pursue leadership roles in her career. She is frustrated that others in her working environment seem to pay little attention to her creative ideas or place her in informal leadership positions. As her colleague, you want to provide her with helpful feedback. Which of the following statements will provide feedback as to how she might communicate power and demonstrate that she is capable of handling other leadership responsibilities? a. "I find your soft voice and manners very reassuring and calming to patients." b. "Try using a wider vocabulary and big words so that people will think that you are knowledgeable." c. "At times, you tend to slump and avoid eye contact when you are talking with colleagues and families." d. "Don't worry about what others think of you. If you feel like saying something, say it, even if it hurts other people's feelings."

The Rehabilitation Unit at Pleasant Valley Hospital has a high number of falls. Which of the following interventions might assist to reduce the number of falls on the unit? a. Determining who is responsible for the falls b. Strengthening unit policies to avoid inappropriate admissions c. Encouraging involvement of nurses in education related to falls and safety d. Ensuring that patients are appropriately restrained if they are at risk for falls

The facilities department is experiencing some challenges and is undergoing reorganization. Because of your familiarity with systems theory, you: a. Know that this challenge is their issue and that it has nothing to do with your unit. b. Understand that such events are localized and do not have an impact on the organizational culture. c. Know that the nature of challenges and reorganization in facilities will have an impact on other areas. d. Anticipate that your prior experiences with facilities have no effect on the current situation.

The hospital administration is discussing the possibility of closing hospital beds in your unit because of a nursing shortage and the increased amount of overtime required to care for patients. As the leader on the unit, which of the following examples best demonstrates your transformational leadership style? a. Your entire staff walks out on strike. b. Your staff sends an ultimatum to the clinic director demanding higher pay. c. A group of your staff members goes to the administration to propose closing of a different unit. d. A group of your staff members goes to the administration to request that they be allowed to work the overtime hours.

The principle that requires nurses to uphold a professional code of ethics, to practice within the code of ethics, and to remain competent is which of the following? a. Veracity b. Autonomy c. Fidelity d. Honesty

To increase safety in patient care areas of the Valley Hospital, the executive begins by: a. Asking the community what the safety issues are. b. Consulting with a management expert about staffing schedules. c. Ensuring that the senior nursing officer attends the board meetings. d. Instituting improved practices to reduce needle-stick injuries.

To retain supervisory staff members, the director of nursing develops a mentoring program. The best person to be a mentor for a new supervisor in a leadership position is someone who has: a. Been in exactly the same position and can relate to the new supervisor's problems. b. Had vast leadership opportunities and likes to talk about his or her past experiences. c. Leadership experience and time to spend communicating with the new supervisor about his or her experiences. d. People who can help the new supervisor get what he or she needs to make the organization grow quickly and prosper in the process.

To solve a problem, the nurse manager understands that the most important problem-solving step is: a. The implementation phase. b. Identification of numerous solutions. c. Accurate identification of the problem. d. Evaluation of the effectiveness of problem resolution.

Which of the following would be the most appropriate focus in developing a business plan for a nurse-owned home healthcare service? a. Programs to educate the community on preparing healthy meals for a limited cost b. Reduction of injuries from alcohol-related accidents c. Pain management for patients with low back pain d. Reduction of falls among seniors

You recently acquired a position as a unit manager. During your time on the unit, you have formed a strong social network among your staff, have promoted the development of relationships between your staff and workers in other areas of the organization, and have formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, you are engaging which principle? a. Empowerment b. Systematic thinking c. Development of networks d. Bottom-up interactions

You volunteer at a free community clinic. A 13-year-old girl claims to have been diagnosed with SLE and presents with chlamydia. The team leader at the clinic advises that: a. The state-defined age of legal consent is 18; therefore, no treatment can be delivered. b. The teen is underage and should be referred to the family general practitioner. c. Care can be provided as long as consent is voluntary and information about treatment and options is provided. d. Treatment is provided as long as telephone consent is obtained from a parent or legal guardian.

You walk into Mr. Smith's room and find him yelling at the LPN, Miss Jones. He is obviously very upset and after you speak with him regarding his behavior, you determine that he has not slept for three nights because of unrelieved pain levels. The LPN is very upset with Mr. Smith and calls him an "ugly, old man." You acknowledge her feelings and concerns and then suggest that Mr. Smith's behavior was aggressive but is related to lack of sleep and to pain. You say to Miss Jones, "Can you both, together with Mr. Smith, determine triggers for the pain and effective approaches to controlling his pain?" This approach demonstrates: a. Lack of empathy and understanding for Miss Jones. b. Concern with placating Mr. Smith. c. Leadership behavior. d. Management behavior.

Which of the following is an example of an HMO? a. Nurse practitioners are paid promptly at discounted fees for each service rendered at a women's health clinic. b. Physicians in a large urban center are reimbursed for visits made to their clients. c. Physicians are paid for each service delivered to enrolled patients through a prepaid plan. d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.

Sue, a nurse manager, has a staff nurse that has been absent a great deal for the past three months. A whistleblower gives some information to Sue indicating that the staff nurse will be resigning and returning to school. Because of this, Sue decides to do which of the following? a. Immediately fire the staff nurse. b. Speak to the whistleblower and elicit more information. c. Speak to the staff nurse and ask her to resign. d. Do nothing.

A clinic nurse has observed another nurse deviating from agency policy in performing wound care. The best approach for the clinic nurse to take is to: a. Stay out of it. b. Inform the nursing supervisor. c. Fill out a notification form (incident report). d. Assess the risk to the client and the agency before proceeding.

A new director of nursing in a small rural hospital wants to make changes from the traditional model of governance to a shared-governance model. Select the characteristic below that best describes the traditional organizational structure in which a staff nurse is assigned to carry out nursing tasks for clients but is not given the chance to provide input into forming the policies and procedures by which care is delivered or the standards by which care is evaluated:

A nurse belongs to several professional organizations, serving on a state-level committee of one group and on two task forces at work. The nurse is committed to a range of health issues and knows the state senator from the nurse's district, as well as the name of the representative in Washington, DC. This nurse exemplifies which level of political activism in nursing? a. Gladiator b. Buy-in c. Self-interest d. Political astuteness

A nurse is participating in a baccalaureate course. For the class, she has to attend the legislative session regarding the new role of medication assistants. Nurses should be involved in shaping public policy primarily because: a. Involvement will enable nurses to take over the healthcare system at some point in the future. b. Other healthcare professions are less concerned about the essential needs of clients. c. Such activities are important career builders for nurses who seek top-level executive positions. d. They are closest to the front line of health care and see how it affects clients and families.

A nurse manager in a hospital is deeply concerned that senior administration makes decisions about budgetary directions that affect staffing and other resources without sharing the rationale for changes or demonstrating concern as to how these changes may affect patients or staff. She says she does not feel respected and is emotionally tired as a result. This situation represents: a. Bureaucratic organization. b. Realities of current health care. c. Negative organizational culture. d. Quantum leadership.

A nurse manager's responsibility for financial management involves making budgetary decisions. Budgets that allow the nurse manager to allocate resources at the unit level allow: a. Minimal nurse manager input. b. Limited rationale for budgetary requests. c. Budgetary allocations at the executive nurse level. d. Budgetary decision making at the point-of-service (POS).

A nursing informatics specialist hired by Blue Cross/Blue Shield (a form of third-party payers benefit package for a prepaid fee that uses specific standards to approve a period of time for the use of inpatient and community health services) is participating in: a. Critical pathways. b. Healthcare networks. c. Health maintenance organizations. d. Managed care.

A statement such as "We believe in the right of patients to make choices and to have care that is sensitive to their preferences and needs" is a _____ statement. a. Mission b. Goal c. Vision d. Philosophy

After a newly hired director of nursing has reviewed the hospital's strategic plans, she develops a timeline for achieving those plans. The new leader is: a. Not expecting that novice leaders will have a vision. b. Demonstrating mistrust of the abilities of her staff to implement the plans. c. Instituting deadlines against which the performance of staff will be evaluated. d. Translating a global document into realistic plans for nursing.

After assessing an older adult patient in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. The nurse manager's decision and actions are based on: a. An established clinical pathway. b. Confirmatory scientific evidence. c. Unit protocol. d. Experience.

After consulting with practice environments about quality and safety concerns in health care, the Dean of Health Programs at U.S. University develops: a. A nursing program that emphasizes the development of a strong disciplinary identity. b. Programming that stresses discipline-based research. c. Partnerships with health care to develop software for the reporting of adverse events. d. An interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizes collaborative learning teams.

After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of teenagers who are unmanageable. To maximize group effectiveness in decision making and problem solving, the nurse manager has: a. Prevented conflict. b. Formed highly cohesive groups. c. Used majority rule to arrive at decisions. d. Encouraged equal participation among members.

As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety and reducing morbidity and mortality on your unit. Which of the following recommendations would be consistent with the IOM The Future of Nursing report? a. Careful screening of nursing staff for substance use and abuse b. Increased RN staffing on the unit c. Salary and benefits that reflect nursing accountabilities d. Increase in the percentage of baccalaureate-prepared nurses to 80%

As a nurse manager, you have been asked to assist in designing a subacute facility for open heart patients who require further complex care after hospitalization. In setting up the facility, which of the following would require reassessment? a. Patients admitted to the facility must have adequate health insurance to cover the services provided. b. A local nurse education program asks you if nursing students can gain clinical experience with recovering surgical patients in the facility. c. Public funding will be provided to enable care of patients who have an ordinary course of recovery. d. The facility is an older house that is more than 30 minutes away from the acute care center.

As a nurse manager, you have been asked to be part of a design team for health services that have vertical integration. In planning for these services, your team will design a proposal that will: a. Cluster like services together, such as outpatient clinics for the care of children with various developmental and medical needs. b. Plan for the smooth transition of patients from the emergency services department to other units in the hospital. c. Ensure that funding follows the patient from acute care to long-term care services. d. Bring together acute care, ambulatory, home care, and palliative care services for the management of patients diagnosed with cancer.

As a nurse manager, you identify that a shift in nursing care models might increase patient and staff satisfaction and avoid downsizing. Administration is reluctant to adopt this approach because downsizing is seen as critical to reduction of costs. To leverage your ideas, you: a. Ask staff to send e-mails to administration encouraging consideration of your option. b. Invite a senior member of administration to your staff meeting, so you can tell him what you are planning. c. Write a letter of complaint to a member of the institutional board about the lack of openness of the administration. d. Identify influential members of your nurse manager group with similar ideas and request an opportunity to meet with administration to discuss options.

As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas. You are employing _____ leadership. a. Situational b. Trait-based c. Contingency-based d. Transformational

As the manager on an acute care medical unit, you note that the incidence of medication errors has increased since the implementation of staffing changes. As part of your strategy to reduce errors, it is important to a. Re-visit reporting standards for medication errors in your organization. b. Ensure that medication errors are consistently reported. c. Provide staff with additional education related to safe practice in medication administration. d. Involve RN staff in determining reasons for errors and practice solutions to increase the safety of medication administration.

As the manager, you have been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperatively that is being operationalized throughout your organization. Which of the following illustrates effective leadership? a. The training modules are left in the staff room for times when staff are available. b. The current approach is continued because it is also evidence-based and is more familiar to staff. c. You decide to implement the approach at a later date because of feedback from the RNs that the new approach takes too much time. d. A RN who is already familiar with the new approach volunteers to take the lead in mentoring and teaching others how to implement it.

At Orangetown Hospital, the nursing department is developing a mission statement for nursing. Which would be a suitable mission statement? a. "Nursing provides services for patients admitted to Orangetown Hospital." b. "To participate fully in the professional services offered by Orangetown Hospital." c. "To lead by the lamp; services for seniors." d. "At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership, education, and interprofessional collaboration."

Because of rapid turnover and the ongoing hiring of new graduates, the skill levels of staff in a busy CCU are varied. Senior staff are becoming burned out with the need to provide mentorship and guidance to new staff. As the manager, you propose the addition of a nurse in advanced practice to provide consultation and education for staff. This position is termed a(n): a. Hierarchical position. b. Ancillary. c. Line position. d. Staff position.

During a unit meeting, you notice that Vivian listens attentively when Mary is speaking and offers support and advice when Mary presents ideas to the group. You are surprised because Vivian has often confided that she does not like Mary. Vivian's behavior is best described as: a. Insincere. b. Networking. c. Politically sophisticated. d. Collegial.

Electronic health records (EHRs) are being instituted at Pleasant Valley Hospital. Some of the staff on Unit 4 complain to the manager that acquiring the technologic skills required is too time consuming. They question its value in patient care. The manager responds that: a. The use of technology is inevitable in our technologically oriented society. b. The hospital is no longer able to find the space to accommodate paper record keeping. c. The initiative is being driven by decision makers higher up in the hierarchy and there is no choice. d. EHRs will increase effectiveness of care by enhancing coordination and improving patient outcomes.

In a rural hospital, the unit for which you are charge nurse has a particularly busy morning. A 52-year-old patient is complaining of left-sided chest pain and a multiparous patient is about to deliver. A child with asthma is experiencing early signs of an attack. The other RN on the unit is a recent graduate who has not yet been orientated to the labor room and has limited cardiac nursing experience. An unregulated assistant is also available. You must decide which patient situation you will take and where the RN's skills can best be used. Given the limitations in skills and experience, number of staff available, and time constraints, you must make a decision that involves: a. A higher-order thinking process. b. Selecting the best option for reaching a predefined goal. c. Optimizing. d. Satisficing.

In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital reduced the number of its managers and increased the number of units for which each manager was responsible. Within a year, the number of adverse events on the units had doubled. This may be attributable to: a. The overload of staff nurses. b. Resistance to change by staff. c. A change in reporting systems. d. Fewer clinical leaders to remove barriers to care.

In designing a quality, safe healthcare environment, the primary emphasis needs to be on: a. Evidence-based practice. b. Informatics. c. Staffing. d. The patient.

In developing an orientation program, the hospital educator breaks essential organizational information down into chunks, which she develops as online modules. This is an application of which of Drucker's functions of management? a. Establishment of goals and objectives b. Motivation and communication c. Analysis and interpretation of performance d. Organization of activities into manageable tasks

Individuals living with asthma, who also live in poverty, are much less likely to seek early care and are more likely to go to emergency rooms for assistance. This example reflects: a. Stereotyping. b. Cultural diversity. c. Ethnocentricity. d. Transcultural care.

Jane, an experienced head nurse, is given the task of completing the summer vacation schedule for the pediatric unit. She is fully aware of the hospital's restrictions on time off and the number of staff on vacation at any given time, as well as its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative? a. Ask for requests for vacation time in advance, and post the times. b. Post the completed vacation schedule. c. Post a tentative schedule, and request feedback. d. Post a blank schedule, and ask staff members to fill in their times by a given date.

John is interested in leadership positions within his nursing organization. Al-though he has been on the same unit for 10 years, he has attended two workshops during that time and has steadfastly refused opportunities to engage in leadership development opportunities or other learning offered as part of the hospital's succession planning strategy. He says that he is interested in a leadership role primarily because it will give him a more stable work schedule and will enable him to spend more time with his family. In coaching John, it would be important to: a. Affirm that his years of service and stability on the unit are the most important attributes for assumption of a leadership role. b. Reinforce that his concern with maintaining balance outside work would be a key factor in selecting him for a leadership position. c. Encourage him to consider the financial rewards of the position, as well as the positive effect on his work schedule. d. Encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in life-work balance.

Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high turnover rate among rehab-assistants because of the heavy work assignments. Despite his need for staff, Justin decides to review each application thoroughly and interview candidates carefully because he recognizes that it is important to hire staff who can best provide high-quality care and who will fit well with the team. Which of the following decision-making solutions should Justin consider to have a more efficient department a. Replace staff only with qualified applicants. b. Determine what the problem or problems are before hiring new staff. c. Consult with the human resources department and develop a plan for hiring new staff. d. Consider all the options listed.

Lucy, head nurse on the surgical unit, works with her staff to find ways in which they can work together with other disciplines to provide more effective care for patients on the unit. Lucy likely knows her power is: a. Limited, thereby necessitating involvement of others in implementing ideas. b. Restricted, which necessitates finding alternative means to achieve strong patient outcomes. c. Directed primarily toward those who are subordinate to her. d. Of unlimited capacity when shared with others. ANS: D Those like Lucy, who share power, tend to be the strong collaborators and see power as an unlimited quantity when shared. Empowered nurses make professional practice possible, creating a culture that satisfies all nurses.

Nancy is a staff nurse who works on a rehabilitation unit. Nancy tells you that the assistants are experiencing difficulty with the new lift and wonders what your thoughts are on organizing an in-service training. Nancy is exhibiting which trait of a follower? a. Provides a vision for safety that is communicated b. Thrives on taking risks in identifying the problem with safety c. Coordinates the development of knowledge and skills necessary to use the lift d. Assumes responsibility for identifying a safety concern and concedes authority for solution to you

On the West Surgery unit, you want to institute a new system for checking armbands that evidence suggests may increase safety in medication administration. The system involves technology. Which of the following strategies may assist with rapid adoption of the technology and system? a. Employ a centralized decision-making approach. b. Use simulators for initial practice to build confidence. c. Bring in a nurse consultant who is familiar with the technology. d. Use early adopters among the staff as leaders and role models in implementation.

Role theory has its underpinnings in management theory. Management theories influence managers' leadership styles. Which of the following theories would a nurse manager be most likely to follow when redesigning the staffing schedule? a. Humanistic b. Productivity c. Psychological d. Quantum

Sarah is a clinical nurse educator in the dialysis unit at Pines Health Center and provides education, consultation, and training support. Sarah has: a. Direct responsibility for patient care. b. Direct accountability for patient outcomes. c. An authority relationship to staff. d. An influence over patient outcomes.

Sarah, one of your RNs, tells you that she can't understand why Jim, an Aboriginal patient, wants to do a smudge. In coaching Sara, you suggest which of the following? a. "Explain to Jim that there is no smoking in the hospital." b. "Inform Jim that fires are not allowed in the hospital." c. "Insist that he give you his tobacco because it is unhealthy for him." d. "Ask him what he means by a smudge and what meaning it has for him."

Sondra, a new graduate, recently began a position as a registered nurse in a rural hospital, where she is the youngest and newest staff member. Although she has limited experience, she has a strong knowledge base, is confident, and was considered to have strong entry-level skills on graduation. Sondra meets with her former instructor and confides that she is very frustrated that others do not seem to accept her leadership. What might you suggest that would help Sondra to understand what is happening in terms of power and influence? a. As a new graduate, it is unlikely that she has acquired the experience and knowledge of other staff, including aides and practical nurses. b. Rural settings tend to be closed systems and therefore are, not welcoming of those who are not from their community. c. Morale on her unit can be improved by engaging in shared decision making. d. Identify the informal leaders on her unit and how they affect care decisions.

Susan, a new graduate on the dialysis unit, appears to take Kari's remarks very seriously and works even harder, often volunteering for extra assignments. She also is often in Kari's office, advising of successes with her patients and of the extra effort that she is committing. This behavior suggests that Susan: a. Is fearful of losing her job. b. Lacks understanding of Kari's leadership style. c. Is not intimidated by Kari's leadership style. d. Knows how to "play the game."

The Wellington Mental Health Institute is fully accredited by the AOA and not directly by the CMS. This means that the Wellington facility: a. Cannot accept mental health patients who are Medicare beneficiaries. b. Can care for only Medicaid and not Medicare beneficiaries. c. Has not met the standards set by the CMS as determined by an external review panel. d. Has been reviewed and accredited by the AOA, which is a deeming authority for CMS.

The agency in which you are a nursing leader makes a decision to reduce the number of RN positions in favor of PN positions because agency data suggest that the clients in the agency can receive appropriate care from PN staff. Furthermore, the agency is facing a decline in funding and without restructuring, some clients might not receive services at all. You provide this information on this decision to the staff and ask them to advise you if they have any feedback, concerns, or alternative solutions. This decision-making style is known as: a. Paternalistic. b. Shared. c. Reasoned d. Informative.

The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility. While making rounds on the units, the staff development coordinator overhears RN staff complaining that they feel it is insulting to be required to participate in a competency program. Which behavior by the staff development coordinator is most appropriate in this situation? a. Disregard staff concerns and continue with development of the program. b. Inform the nurses that this program is a requirement for JCAHO accreditation. c. Schedule a meeting with the chief nurse executive to apprise her of the situation. d. Facilitate a meeting so nurses can articulate their values and concerns about a competency program.

The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader? a. The unit secretary who knows everyone's business b. The chief nursing officer who is in charge and is responsible for nursing services c. The chief cardiologist who admits the largest number of patients and brings in more revenue than any other physician d. The staff nurse who persuades other staff members to practice by making evidence-based decisions

The manager in the coronary care unit believes that the most important ethical considerations in performance evaluations are that they include the employee's good qualities and that they give positive direction for professional growth. This belief is an example of: a. Justice. b. Fidelity. c. Beneficence. d. Nonmaleficence.

The nurse manager of a unit is asked by a family member of a dying Native American patient if it is possible to have the patient's eight-member family recite the rosary by the bedside. The manager responds affirmatively. The nurse manager is most likely exhibiting behavior related to: a. Acculturation. b. Ethnocentricity. c. Cultural diversity. d. Cultural sensitivity.

The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports about patients falling during the 11-7 shift. The nurse manager knows that the best way to resolve the problem is to: a. Use creativity. b. Obtain support from the 7-3 shift. c. Use institutional research. d. Identify the problem.

The senior executive praises John for the positive patient evaluations that his unit has received. As an effective leader, John: a. Thanks the senior executive for having confidence in him and celebrates by going out to a special restaurant. b. Points out the impact that the changes he has initiated have had on the unit. c. Advises the senior executive that the mission statement and goals are important to him. d. Points out the contributions of his staff to the outcomes and shares the praise with his staff.

To prepare for the orientation of newly hired nurses, the nurse manager plans a presentation outlining the concept of healthcare networks. Healthcare networks are: a. Units that provide only primary care services. b. Owned by the institutions. c. A feature of all public institutions. d. Units that serve large populations.

To satisfy duty of care to a patient, a nurse manager is legally responsible for all of the following except: a. Notifying staff of changes to policies related to medication administration. b. Scheduling and staffing to ensure safe care. c. Delegating in accordance with practice acts. d. Supervising the practice of the physician.

When confronted with the controversy and the apparent poor morale of the evening staff, the unit manager decided the staff needed to take some time off. He scheduled holidays for the staff without consulting them. A couple of the staff nurses approached the manager and indicated that the problem was not scheduling, but rather the team leader and her patient assignments. What was the unit manager's first missed step in problem solving? a. Not using a problem-solving model b. Not considering a number of alternatives c. Poor evaluation of outcomes d. Incorrect problem identification

When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidate's lack of eye contact reflects the candidate's: a. Lack of confidence. b. Professional behavior. c. Cultural sensitivity. d. Ethnicity.

Which of the following interactions is MOST consistent with the idea of networking? a. Meet with the same colleagues daily to have coffee and share concerns about the workplace and stories about colleagues. b. Join an online workplace forum to gain ideas about how to handle workplace conflict. c. Suggest that you and a new team member meet after work for coffee to review unit guidelines. d. Join a nurse executive interest group to meet other executives for support and for sharing ideas of expertise.

Which of the following is the best example of skilled negotiation? a. Linda, the manager on pediatrics, takes a proposal to her supervisor, outlining the benefits of a walk-in preoperative area for children. b. Kim, RN, asks for leave to pursue a semester of full-time study in her graduate program. She proposes to accept less popular rotations during peak vacation time, in return. c. George, the head nurse in ER, asks for additional staff for his department and points out the benefits of being able to keep patients for longer periods. d. Jerry speaks with his supervisor about his supervisor's concerns related to bedside reporting before presenting a proposal to change this process.

Which of the following patients would be most likely covered under Medicare? a. Jim, who lives on the street and has occasional infections b. Alysha, who is on social assistance and has a 5-year-old daughter with frequent ear infections c. Karen, a housewife, 45 years of age, whose husband recently abandoned the family d. Dan, who is 68 years of age and in good health

Which of the following would be the most appropriate mission statement for a nursing center? a. "At Plentyville, we provide rehabilitative services for addicted adolescents." b. "Georgiatown provides treatment and prevention services for county residents." c. "At Heart, our aim is to provide services that lead the nation in health education and research." d. "At Coeur, we strive to achieve optimal pain management with patients who are experiencing chronic pain."

While explaining the importance of developing leadership skills among nurses to a group of first-year nursing students, Natalie, a nursing unit manager, emphasizes that: a. Most nurses are not expected to assume leadership roles. b. The role of nurse leadership is only at the bedside, ensuring that patient care is performed according to established standards. c. Only individuals in formal leadership roles are expected to be leaders. d. The public depends on nurses to assume leadership in moving consumer advocacy concerns forward.

You are a nurse manager in a facility that is part of a national system of specialized hospitals that provide services to children and that is funded and managed through a religious charity organization. This system emphasizes compassionate, faith-based care. What level of consolidated system is represented in this example? a. First level b. Second level c. Fourth level d. Fifth level

You are the nurse manager for a not-for-profit health service for the homeless and for drug users in an impoverished neighborhood. As the manager, your concern about sustainability is related to: a. The possibility of violence. b. An increase in prescription drugs available for abuse. c. Decisions of the public board. d. An increase in uncompensated care events.

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