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Effective Leadership and Management - Midterm Combined

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The nurse manager asks staff members to work as a group in planning the activities for Nurses Week. The nurse manager should report to the supervisor that which type of group has been formed? 1. Command group 2. Task group 3. Competing group 4. Informal group

Correct Answer: 2

Which statement may reveal that the team member making the comment has a hidden agenda? 1. I dont understand the second of the goals we are discussing. 2. Are we voting on this outcome or has it already been decided? 3. I have to remember to add membership on the team to my resume. 4. Are there other teams working on similar projects on other units in the hospital

Correct Answer: 3

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

Establishing a standard of total participation During the first meeting a standard of total participation should be established.

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

Hospital administration

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

Indirect costs are expenditures that are necessary but do not affect client care directly.

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

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

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

Overdelegation Rationale: Overdelegation delegator loses control by providing the delegate with too much authority or responsibility. Discipline of an employee is a responsibility of the manager and cannot be delegated due to confidentiality and controversy associated with it.

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

Resentment against the team leader for not doing "real nursing" is a common drawback of team nursing.

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

The budgetary cycle takes up to 1 year to occur.

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

The regulations of the state nurse practice acts

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

While all four options are important, client need takes precedence over the others because nursing provides a service to the client.

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

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

Which is the most important factor in whether a conflict will be perceived or felt between two nurses? 1. How well the nurses know and trust each other 2. If the nurses are on the same job level 3. The congruence of the nurses values and beliefs 4. Whether or not the nurses perform the same roles

Which situation best exemplifies the nurse manager as a team leader? 1. The nurse manager posts the units positive accomplishments from the past month in the break room. 2. The nurse manager controls the staff meetings so the staff can get back to work quickly. 3. Every year the nurse manager does staff member evaluations to determine pay raises. 4. The nurse manager encourages conjunctive task performance on the unit.

In order to delegate, which must be present?

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

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

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

Which nurse has legitimate leadership authority in the organization?

1. Nurse managers 2.Case managers Rationale: The have legitimate authority conferred by the organization and described in job descriptions.

Which activities are expected from the nurse manager as team leader?

1. Offering constructive criticism 2. Encouraging group discussions 3. Facilitate group processes

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

1. Understaffing the unit 2. Low client acuity

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

1. Where will the service be housed? 2. When will the service begin? 3. Who will provide the services? Planning and implementation are critical.

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

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

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

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

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

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

The nurse manager has completed a series of team-building exercises with a command group. Which statement by a group member indicates that cohesiveness is occurring? 1. I think I understand the work of the group now. 2. I have gotten to know my group members better during these exercises. 3. We have so much work to do in this group. 4. I like the members of the group.

Which statement by the nurse managing a unit conflict indicates that the integrative decision-making strategy is being used? 1. Ive heard all I need to hear. Ill have a decision tomorrow. 2. Once you have signed this informed consent, the issue will go to mediation. 3. This will all blow over if everyone just tries to get along better. 4. Both parties should come up with as many alternative solutions as possible before our next meeting

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

All nursing responsibilities and changes have the expected outcome of improving client care.

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

Assessment is always the first action for a nurse in any situation.

During the first meeting of a newly created task force, the nurse manager notices that individuals tend to cluster with members of their specific nursing units. The nurse manager begins the meeting with an explanation of the focus of this group. These behaviors are characteristic of which stage of Homanss group process? 1. Norming 2. Storming 3. Performing 4. Forming

Correct Answer: 4

This is the first meeting of a task force. What should be the leaders primary objective of this meeting? 1. Determining when the task force has to complete the assignment 2. Identifying the expected outcomes in terms of measurable objectives 3. Asking members if they have time to serve on the task force 4. Establishing a standard of total participation

Correct Answer: 4 Rationale 1: The leader should also already have an idea of when the task must be completed. Rationale 2: The leader must clarify the objectives in specific measurable outcomes prior to the first meeting. Rationale 3: Task force members should be selected on the basis of their knowledge, skills, personal concern for the task, time availability, and organizational credibility. These attributes should have been considered prior to the first meeting. Rationale 4: During the first meeting a standard of total participation should be established.

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

Flexibility is a skill imperative when choosing a delivery system(s) for nursing care. The system must meet client and staff needs and organizational and unit-specific goals, as well as remain within cost constraints

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

Giving information is the most common method of changing individuals' perceptions, attitudes, and values.

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

In most cases, the normative-reeducative approach to change is effective in reducing resistance and stimulating personal and organizational creativity.

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

Moral agency is "doing the right thing." Reporting a medication error is the right thing to do.

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

Normative-reeducative strategy uses collaboration as its primary decision-making technique. It is most likely to result in the greatest number of people being happy with the decisions made.

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

Nurses are client advocates who routinely interact with multiple disciplines in the provision of quality care.

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

Practice partnerships allow for two personnel to work together in giving client care. Ideally, a senior RN can be paired with a novice RN.

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

Quantum Quantum leadership is based on the concepts of chaos theory, with the focus on outcomes.

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

Relationship building is essential to successful leadership. Rationale:Authentic caring in relationship is an important method of improving respect and competence as a leader.

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

Return to school to obtain a master's degree. Rationale: CNLs are educated at the master's level.

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

Send a written letter and résumé in the mail.

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

Sequential interdependence In sequential interdependence, activities must be coordinated with others in a designated order.

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

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

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

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

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

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

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

The work of the committee should not be delayed because the leader is late. One of the members should begin the meeting.

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

To direct client care activities and get the outcomes you desire, you need good leadership skills. Rationale: Nurses must direct client care in order to successfully achieve client outcomes in a timely fashion.

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

Total patient care means that all the care for the clients or residents is provided by the RN.

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

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

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

"The issue with this client is the time limit for Medicare to pay has almost expired, and we aren't ready for discharge." The team leader is the meeting facilitator, teacher, and client advocate for the patient care conference.

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

"The night shift differential is 10 percent."

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

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

Which ground rule statements by the leader will help the group meeting stay on task and on time?

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

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

0.12 To arrive at this figure, add the number of days off, multiply by 8 hours per shift, and divide by 2080 0.12 of an FTE.

The day shift nurses and night shift nurses are in clear opposition regarding the responsibilities that each shift should be assigned. This opposition has created a we-they distinction on the unit. This is an example of which phenomenon? 1. Distancing 2. Suppression 3. Group withdrawal 4. Unification

The staff nurses and nursing administration are attempting to construct a method of scheduling that meets the needs of both the clients and the nursing personnel. Because nurses and nursing administration have experienced conflict about the issue, their intent is to arrive at an agreeable solution between both parties. Which option does this process best exemplify? 1. Negotiation 2. Accommodation 3. Forcing 4. Consensus

Which statements would be important for the charge nurse to make when delegating a responsibility?

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

Which situations are examples of ineffective delegation?

1. Delegating committee attendance to a staff nurse, the nurse manager also attends the meetings. 2. Unit clerk asks the nurse manager to "listen for the phones". 4. Staff nurse asks the UAP to discharge a client. 5. The staff nurse often bathes clients because "I like to give bed baths."

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

1. The ability to be empathetic to clients and staff. 2. Awareness of the needs of clients and the organization. 3 Use of persuasion as a leadership technique.

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

1. The client may have multiple primary nurses if transfers within the facility are necessary. 2. Staff nurses cannot be held legally liable for care provided outside their work hours. 3. All persons caring for the client must have excellent communication skills.

A difference in opinion has arisen regarding methods to care for clients who are on mechanical ventilators. The nurse manager asks a group of nurses to meet and review evidence-based practice related to this client care situation. Each nurse volunteers to gather data prior to the next meeting. This is an example of which type of problem solving? 1. Negotiation 2. Collaboration 3. Compromise 4. Forcing

Which situations are examples of the nurse directing rather than delegating?

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

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

A capital expense is an expense that is above a set dollar amount such as $10,000 and that must be approved by the board of directors.

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

A supportive work environment for those experiencing the change is the strategy most likely to result in an easier transition.

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

Assessment is the first step of the change process, just as it is the first step of the nursing process.

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

Choosing a solution and gaining acceptance are most like Lewin's moving stage. Previous to this stage in both models, the work is to convince participants that change is necessary and to secure resources for the change. After solutions are identified and implemented, the final stage begins.

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

Concern over adding items to one's resume could indicate that the team member is more interested in personal achievement than in the goals of the team.

A newly hired nurse is asked to join a group working on unit protocols. This nurse is verbal and dominates the conversation of the group. The group leader identifies the disruption this nurse causes as being from which phenomenon? 1. Status incongruence 2. Group isolates 3. Emergence 4. Deviation

Correct Answer: 1

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

Develop a work plan with interim deadlines. This work plan will be necessary to keep all subgroups on task.

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

Diagonal communication Rationale 3: Diagonal communication involves dialogue among individuals at different hierarchical levels (e.g., staff nurses to chief executive officer of nursing).

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

Does this task involve nursing judgment? Rationale: The nurse should not delegate tasks that involve nursing assessment or judgment.

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

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

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

Followership is a valuable skill in nurses. Rationale: In any situation where people must work together, followership is a valuable skill.

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

The first step is to unfreeze the existing equilibrium by asking staff to become part of the process of change, particularly in the first phase.

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

The first step of the diffusion of innovation occurs when the decision-making unit is introduced to the innovation and knowledge is gained.

Which situation is an example of reverse delegation?

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

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

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

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

The relationship between the nurse and the receiver of the message

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

Work assignment Rationale: This assignment reflects duties listed in the nurse's job description so asking the nurse to attend a meeting is work assignment.

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

Your most important role is to ensure client care accountability. Rationale: Managers most important role is assuring quality client care, managers are accountable for quality care.

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

"I hate to bother you with this, but we have a problem." Rationale: Qualifiers are often used as "entry statements" into important discussions, but they can interfere with the message being communicated.

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

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

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

"You can expect additional efforts to help us keep on track." Sustainability is a part of this framework.

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

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

Which directions given by the nurse to the assistant are most likely to be understood and completed correctly?

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

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

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

A nurse and a physician are in conflict over the treatment of a client. Which statements by the nurse reflect the best way to handle interprofessional conflict? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. I think it would be better for the client to stay another day. 2. This client needs an additional day to learn how to care for a complex wound. 3. It will help this client manage her diabetes more effectively if she is assigned a diabetic educator. 4. Research has shown that early ambulation helps to reduce the likelihood of pulmonary embolism. 5. Do you not remember what happened when you sent that other client home too early?

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

A budget in the red necessitates change and pushes participants in the desired direction.

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

Building the team up by praising team accomplishments best exemplifies the nurse manager as team leader.

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

Client care is always the most important reason that nurses do what they do. If the change does not improve client care in some respect, is it worth the effort?

Correct Answer: 2

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

Efficiency variance is a reflection of the difference between budgeted and actual nursing care hours provided.

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

Having the charge nurse lead a nursing quality assurance task force

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

I won't be able to increase my team's motivation. That has to come from within them. Rationale: Manager can affect motivation by developing strategies and possible incentives.

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

If you work overtime tonight I will authorize double your hourly pay rate. Rationale: Transactional leadership is based on the principles of social exchange theory. The primary premise is that individuals act in their own best interest.

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

The burn unit likely has a core team of caregivers, a defined population to receive care, informational systems in place, support staff, equipment, and an environment that facilitates provision of care.

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

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

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

The nursing process reflects nursing care and consists of assessment, planning, implementation, and evaluation.

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

The role of the procedural technician is to support group activities by arranging the environment and providing necessary tools.

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

"Don't feel as if you are responsible for fixing every problem." Rationale: There are many gender differences in communication. Male tend to take responsibility and feel the need to "fix" things.

The nurse manager assesses that two staff nurses are engaged in a conflict that is having a negative impact on client care. The manager meets with the nurses involved and identifies the conflict. An attempt is made to resolve the conflict through knowledge and reason. What strategy is this manager using? 1. Confrontation 2. Resolution 3. Negotiation 4. Forcing

Which activities are expected from the nurse manager as team leader? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Offering constructive criticism 2. Settling all employee conflicts 3. Encouraging group discussions 4. Facilitate group processes 5. Foster team dependence

1,3,4

Which statements by the nurse manager would demonstrate effective change management?

1. "We cannot lose sight of the mission and values of our institution as we begin to integrate these changes." 2. "Although this task is going to be difficult, we have the full support of our hospital administration."

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

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

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

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

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

The nurse manager meets with the staff nurses to discuss ways to improve communication among the shifts. Which statement by the nurse manager best exemplifies the final stage of conflict management? 1. We need to clearly define the nature of the conflict. 2. I will evaluate the outcomes of our strategies on a monthly basis. 3. Lets create a time line for the implementation of our strategies. 4. Hopefully, each group can understand each others perceptions of the issue.

While providing continuing education about group dynamics and team building, the nurse manager attempts to explain the difference between a group and a team. Which statement by the manager is most effective? 1. A team is bigger than a group. 2. Teams have authority; groups may be informal. 3. A group has similar goals, whereas a teams goals are dissimilar. 4. Groups are formally designated by the organization, while teams are generally informally organized.

A nurse has a longstanding conflict with another nurse working the same shift. Over the last few days the first nurse has made an effort to smooth over the conflict. Which statement would the nurse manager evaluate as an example of a smoothing comment? 1. We are never going to agree because I am from Generation X and you are a baby boomer. 2. Im tired of this fight and Im not going to argue with you anymore. 3. Even though we dont agree on much, I do think you are correct about enforcing the length of lunch breaks. 4. I think everything is fine and that we can get along.

A nurse manager has been appointed leader of a large task force charged with a complex assignment. What strategies should the manager use? 1. Limit full task force meetings to an initial meeting, a middle meeting, and a final meeting. 2. Lead one of the subgroups established at the first full task force meeting. 3. Develop a work plan with interim deadlines. 4. Set deadlines that are at least 1 week earlier than necessary to give subgroups time to be late.

The group leader often arrives several minutes late to meetings with excuses about workload, telephone calls, or traffic. Todays meeting was scheduled to begin 5 minutes ago and the leader has not arrived. What should the group members do? 1. Call the leaders cell phone to see when arrival is expected. 2. Wait until the leader is 10 minutes late and then cancel the meeting. 3. One of the members should start the meeting. 4. Wait for the leader to arrive.

The leader of the task force group announces that tentative plans for Nurses Week activities have been approved by the hospital administration. The task force has also been given a new task of developing criteria for the nursing awards. What must the group accomplish now? 1. Forming 2. Adjourning 3. Rebuilding 4. Re-forming

The nurse and a client are discussing instructions for self-care after discharge. The clients husband says, I cant take care of her by myself. We need home health like we had before she came to the hospital. This statement reflects which antecedent condition? 1. Task interdependence 2. Resource competition 3. Structural conflict 4. Differences in values and beliefs

The nurse manager has been asked to assemble several groups to work on tasks to improve the units performance and client satisfaction scores. This manager would put the fewest people in a group working on which type of task? 1. Additive 2. Disjunctive 3. Divisible 4. Conjunctive

The nurse manager presents an issue to the nursing staff for a decision. The group assesses the problem, and a decision is made meeting the needs of both the nurse manager and the nursing staff. This is an example of which conflict management strategy? 1. Integrative decision making 2. Win-lose strategy 3. Accommodation 4. Consensus

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

A variance report provides a rationale for over expenses for the month that could result from a variety of unexpected expenses

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

Ability to inspire the others to commit to the team's goals. A nursing leader must be a visionary in order to empower others to make needed changes for the good of the group.

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

According to Lippitt's phases of change, the final stage is terminating the helping relationship.

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

Case management organizes client care by major diagnoses and focuses on attaining predetermined outcomes within a specific time frame.

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

Charge nurse Rationale: The charge nurse is unique to the health care setting and assists with the shift coordination and promotion of quality client care as well as efficient use of resources.

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

Contingency Rationale: Contingency planning is a proactive response to problems that may interfere with getting work done.

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

E-mail Rationale: To avoid misunderstanding of supplies needed, a written request is the most appropriate choice. It avoids misunderstanding, as the needs can be checked off a list.

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

Ensure the communication is understood. Rationale: Ensuring all parties understand the communication is the last step as it involves evaluation.

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

Functional nursing breaks down client care into tasks assigned to the appropriate professional or skilled caregivers. This may result in one nurse (the "med nurse") administering all the medications on the unit.

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

In total patient care, one nurse cares for a client and, being totally accountable for the client, can give continuous, holistic, and expert care.

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

Nurses formally organized to make decisions regarding practice standards. Rationale: Shared governance is a formal process. Decision making is done by designated nurse representatives.

Status incongruence means that the status of the newly hired nurse is not congruent with being a dominant player in the group

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

Team-building exercises were originally used to improve interpersonal workplace relationships and this group member may still think of them in that vein.

Teams have a designated task and line authority. Groups may be either formal or informal.

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

The Institute of Medicine has proposed residency programs for nurses. The IOM has made this proposal.

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

The case manager tracks all variances, reports to the collaborative team, and may revise the critical pathway.

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

The purpose of a task group is to deal with specific issues involving a specific need within a given time limit. Because this group is working on "Nurses' Week," the project is time limited.

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

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

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

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

A new triage area has been built in the emergency department causing conflict between the nurse manager and the nurses who think the design is not user friendly. After repeated complaints the nurse manager asks maintenance to change the arrangement of the room. What is the most important reason this change occurred? 1. The complaints motivated the nurse manager to make the change to increase unit effectiveness. 2. The room design was uncomfortable for the nurses, which convinced the nurse manager to change the design. 3. The nurse manager was afraid the nurses would refuse to work in the room so the room had to be changed. 4. The nurses would keep complaining so the nurse manager changed the room to stop the griping

A nurse manager states, I cannot stand all these conflicts in my department. Nothing good can come out of it. Which indicates the best reason the managers statement is untrue? 1. Conflict can stimulate more people to become involved in a situation, thus creating more innovative solutions to the issue. 2. When people are in conflict, they tend to work harder just to avoid the conflicting situation. 3. Groups in conflict spur competition, which is always beneficial to the units from which the groups emerged. 4. When there is conflict in an organization, people are more open to discussion, thus conflict can open the lines of communication.

A task force leader says, At the beginning of our next meeting we are going to do some team-building exercises. Which comment by a group member indicates a need for further education about team building? 1. I dont see anything wrong with the way our team works. Why do we have to go through team building? 2. That should help us meet the goals we have written. 3. I did some team-building work a long time ago. I probably need a refresher. 4. I hope the men on our task force will cooperate.

The medical residents on a particular unit do not answer pages very quickly, and sometimes do not answer them at all. The nursing staff complains to the nursing supervisor. After several weeks, this conflict has spiraled into a heated disagreement. Which is the most important reason to make the necessary changes to settle this conflict? 1. Client care and satisfaction will suffer should it be allowed to continue. 2. The residents cannot be allowed to continue such unprofessional behavior. 3. Residents who do not answer pages do not get the most out of the experience. 4. Physicians do not know what is going on with clients if the residents do not tell them.

The nurse manager asks the staff nurse to work a double shift because the census is high. Although the nurse realizes the staffing for the night shift is low, the nurse has already made a family commitment for the same night. This is an example of which concept? 1. Intrapersonal conflict 2. Interpersonal conflict 3. Intragroup conflict 4. Intergroup conflict

A group member has failed to complete assigned tasks for three of the last four meetings, despite reminders that incomplete work slows down the entire team. At each meeting the noncompliant member promises to complete tasks for the next meeting. What group actions are likely to occur? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The remaining group members may begin to use manipulation to get the tasks done. 2. The other group members may attack the noncompliant member. 3. Other group members will quietly complete the noncompliant members work. 4. The remainder of the group will ignore the noncompliant member. 5. The group members will extend patience and understanding to the noncompliant member.

1,2,4

A nurse manager has just completed a difficult assignment managing a group that was not cohesive. Which group should the nurse identify as likely having good cohesiveness? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Nurse who each have 7 to 8 years of experience 2. Nurses who work on different units throughout the hospital 3. Staff nurses who are interested in learning about the task of the group 4. Staff nurses who work with one another on a daily basis 5. Staff nurses who are all between 35 and 40 years of age

1,3,4,5

Conflict has arisen within the hospital regarding who will staff a proposed high-acuity unit. The nurse executive and other administrators have purposefully not intervened in this conflict. Why is that strategy appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Conflict draws attention to an issue. 2. The administrators do not like conflict management. 3. Conflict can stimulate new ideas about how to manage the high-acuity unit. 4. Conflict about the unit will help to identify the compromises necessary to make it a viable part of the hospital system. 5. Conflicts about staffing may make current staff members reexamine their own performance.

1,3,4,5

A staff nurse is the manager of a command group consisting of other staff nurses, a nurse manager, a physician, and physical therapist. What line authority does the group manager hold? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The group manager has line authority in relation to the group members individually. 2. The group manager has line authority in relation to the other nurses in the group, but not in relation to the other disciplines in the group. 3. The group manager has no line authority in this group. 4. The group manager has line authority in relation to all members of the group except the physician. 5. The group manager has line authority in relation to all member of the group collectively.

1,5

Manager approaches nursing supervisors requesting approval for 12-hour shifts into scheduling. Supervisor denies the request, due to previously with poor outcomes. Which responses by the nurse manager may positively influence the supervisor?

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

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

1. "I don't care what they say; I'm not giving care that way." 2. "I bet I can make it very difficult for this change to occur."

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

1. "I have created an agenda that identifies the amount of time allotted for each step of the problem-solving process." 2. "The meeting will be called to order at noon and be adjourned in 1 hour." 3. "It is important that each of you is fully engaged in the decision-making process."

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

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

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

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

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

1. "If we use critical pathways, we won't have physical therapy to help us ambulate clients." 2. "The critical pathway lists discharge outcomes but won't help us with day-to-day guidance of care." 3. "Once the client is on a critical pathway, we must follow it until discharge."

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

1. "It helps to coordinate care to a group of clients." 2. "It organizes care responsibilities." 3. "It provides skilled care by skilled staff."

Which statements by a hospital executive reflect power-coercive strategies to implement change?

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

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

1. Average daily census for the facility over the last year. 2. Current community wage ranges for employee classifications. 3. Changes in accrediting body or legislative regulations. 4. Current staff mix across the hospital.

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

1. Deciding on priorities. 2. Being a liaison 3. Coordination of client care 4. Delegation responsibilities.

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

1. Disciplinarian 2. Fact manager 3. Liaison 4. Support person 5. Discussion leader

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

1. Disperse information about the change as quickly as possible. 2. Remind staff that change is part of the health care environment. 3. Talk about the change in positive terms.

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

1. Educational level 2. Experience 3. Nurse preference

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

1. Effective delegation allows the manager to focus more time on management tasks. 2. Efficiency increases with effective delegation. 3. Focus on managerial duties, provides better advancement. 5. The manager maximuming entire staffs potential.

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

1. FTE factor for an LPN hired this month. 2. Names of all unit clerks working in the unit. 3. Licensure of a nurse working on the unit. 4. Fact that two RNs have retired this year.

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

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

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

1. Higher turnover rate of nursing staff on the medical unit. 2. Critical care manager is a better manager than the medical unit manager. 3. More staff on the medical unit received premium pay this year.

What should the nurse executive consider when planning the nursing care delivery system of a new hospital?

1. How to optimize use of nursing knowledge 2. How to ensure that clients receive optimal care 3. Skill sets likely to be present in the nurses who will be employed at the hospital 4. What groups of nurses are available for employment

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

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

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

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

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

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

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

1. Nurse participate in testing a new charting system before placed in unit. 2. Critiquing the manager's decision to change the unit's method of client assignments privately. 3. An in-service on a new intravenous access catheter, the nurse used one of the devices the on the next I.V. ordered.

Which nursing interventions would be in line with the chronic care model?

1. Nurse provides client with URL for website dedicated to self-management chronic respiratory disease. 2. Nurse advocates for client who decided to forego further dialysis. 3. Client information is entered into E.H.R. 4. Operating hours of community recreation center, provided to client with CAD.

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

1. Nurse who each have 7 to 8 years of experience 2. Staff nurses who are interested in learning about the task of the group 3. Staff nurses who work with one another on a daily basis 4. Staff nurses who are all between 35 and 40 years of age

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

1. Observe group member behaviors during a meeting. 2. Listen to how group members interact with one another 3. Ask a team member how the work of the group is proceeding.

Which topic would likely appear on the agenda for a staff meeting chaired by a nurse manager who follows transactional leadership?

1. Progress on request to increase personal day benefits. 2. Review of policy and procedures for unit evacuation 3. Standardized first of shift assessments.

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

1. Reviewing the client's plan of care with the UAPs 2. Discussing the client's increasing shortness of breath with the LPN 3. Updating the care plan of a client who will undergo surgery tomorrow 4. Calling the physician to discuss the client's response to a new treatment

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

1. Selling the new system to the current emergency department staff. 2. Coach the staff through the implementation of a new schedule. Convincing or "selling" the new idea and coaching and counseling are major roles in the directing phase.

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

1. Sick days 2. Vacation days 3. Holidays 4. Bereavement days

Which leadership activities exemplify a quantum leadership style?

1. The leader is accepting of change. 2. The leader encourages staff nurses to help clients access internet sites about their disease process. Rationale: Change is excepted by the quantum leader. Informational power is shared by the quantum leader.

Which situations would cause concern about liability with regard to delegation?

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

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

The vice president for nursing services is aware that many of the problems in the nursing staff result from poor management at the unit level. What are some reasons that nurse managers are sometimes ineffective in their role?

1. There is little training available for nurse management positions. 2. Entry-level educational programs for nurses do not contain sufficient managerial content. 3. Management techniques are often learned "on the job." 4. Nurses often experience poor supervision in their own careers.

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

1. Who is in control of the way holiday shifts are being assigned? 2. Who will lose when holiday shift assignments are changed? 3. Who is benefiting the most from the way holiday shifts are currently assigned?

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

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

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

1."The finance department sent me the budget worksheet with last year's expenses." 2. "We have $1,000 left in our account we need to spend before the year is over, any ideas?" 3. "I like this type of budget preparation, it is simple and straightforward."

Which statements would alert a nurse manager that a unit conflict has become disruptive? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. I wont stop until I have gotten her fired. 2. He doesnt fight fairly. 3. Ive almost forgotten what started this, I just focused on beating her. 4. I am going to win this argument. 5. He is so wrong, he just has to go.

1235

A nurse manager is using Homanss framework to evaluate the need for team building in a group appointed to work on accreditation issues. Which strategies should the manager use as part of this evaluation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Observe group member behaviors during a meeting. 2. Listen to how group members interact with one another. 3. Compare the group to a similar group from the last accreditation cycle. 4. Review the groups final report. 5. Ask a team member how the work of the group is proceeding.

125

Two staff nurses are in conflict about the summer vacation schedule. The nurse manager is contemplating assigning both nurses to a task that will require frequent contact with each other, hoping that they will resolve the issue themselves. What should the manager consider before making this assignment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. What is the anxiety level of the nurses in regard to the vacation schedule? 2. Have the nurses ever worked together before on a project? 3. Will the conflict decrease the efficiency of the unit while the nurses are self-solving the issue? 4. How intense is the conflict about vacation scheduling? 5. Are the nurses talking to the rest of the staff about the conflict?

134

A nurse manager and a staff nurse are in conflict. The nursing supervisor has decided to use mediation to arrive at a solution. The supervisor should be most concerned about which persons level of comfort when choosing a place for the mediation meeting? 1. The manager 2. The staff nurse 3. The supervisor 4. There should be equal concern for all participants.

Question 4 Type: MCSA The chairperson of the nursing faculty leads the monthly meetings of the curriculum committee. This permanent group, which is designed to meet organizational goals, is which type of group? 1. Competing group 2. Command group 3. Task force 4. Informal group

The nurse manager assesses that there is conflict between two of the charge nurses. The decision is made to postpone an intervention and allow the conflict to escalate. Why might the nurse manager make this decision? 1. Allow sufficient time for the problem to spontaneously resolve. 2. Motivate the participants to seek resolution. 3. Give the nurse manager time to identify problem-solving strategies. 4. Relieve the nurse manager of the time commitment necessary to intervene

A serious conflict between a nurse and a nursing assistant erupted into a shouting match in the hallway. The nurse attempted to slap the nursing assistant. What conflict responses are appropriate for the assistant? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Accommodating 2. Withdrawal 3. Avoiding 4. Smoothing 5. Negotiation

2,3

Why does conflict help generate change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Conflict assists change to occur more rapidly than it would otherwise. 2. It brings more attention to an issue in need of change. 3. People get involved because conflict breeds curiosity. 4. If there is an existing conflict, a change must occur to stop the conflict. 5. Change is inevitable, and some people refuse to change, which causes conflict.

2,3

A nurse manager is focused on team building activities with a group chosen to write new unit policies. As a beginning step in this process, the manager should ask which questions to assess the groups context? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. How well has this group been able to relate to similar groups across the organization? 2. What are the groups current goals? 3. How have the members organized the group? 4. What is the general culture of the group? 5. How complex is the job the group has been assigned?

2,3,4

The work of a task force is completed and the leader has compiled a written report of findings and recommendations. What actions are necessary by this leader? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Plan on the leader presenting the report to administrators. 2. Share the report with the full task force prior to presenting it to administrators. 3. Send the report to administrators by e-mail. 4. Brief key administrators regarding the report prior to the administrative presentation. 5. Print and bind the presentation in a professional manner prior to presenting it to the full task force.

2,4

The nurse manager is leading the monthly staff meeting for the professional nursing staff. Which statements by this leader reflect effective leadership? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. I will assume responsibility for developing the mission and goals of the group. 2. I have created an agenda that identifies the amount of time allotted for each step of the problem-solving process. 3. I realize there will be dissension; however, I prefer that we not take time from our agenda to address it. 4. The meeting will be called to order at noon and be adjourned in 1 hour. 5. It is important that each of you is fully engaged in the decision-making process.

2,4,5

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

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

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

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

A physician criticizes the care provided by a nurse in an area where others are present. Which actions by the nurse would the manager interpret as a covert conflict behavior resulting from this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse says, You cant talk to me like that. 2. The nurse avoids the physician in the hallway. 3. The nurse refuses to care for the physicians clients. 4. The nurse is no longer as careful in caring for this physicians clients. 5. The nurse is apathetic about the care of clients.

245

Which ground rule statements by the leader will help the group meeting stay on task and on time? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. We will wait until everyone who is going to attend is here before we call the meeting to order. 2. We will always meet on the second Wednesday of the month at 1:00 p.m. as this is the time all members have indicated is most convenient. 3. If you have information to distribute for discussion, please bring a copy for every member. 4. We will limit verbal participation to designated key members each week. 5. You can expect to receive an agenda for the meeting at least 1 week in advance of the meeting.

The hospital has an annual campaign in which the staff is divided into two teams to raise money for hospital special events. The team raising the most money gets possession of a trophy designed by the administrative staff. This is an example of which type of conflict? 1. A conflict that is disruptive to the work of the hospital 2. A competitive conflict that is positive to the work environment 3. An intragroup conflict that is not appropriate in health care 4. A felt conflict that will result in unresolved feelings of frustration

A nurse manager has just posted the membership list for a newly formed quality management task force. Which statement, overheard by the manager, indicates the most potential for problems on the team? 1. Im glad I didnt get chosen for this task force. Im so busy with my kids right now. 2. I was on one of these teams at my last hospital. 3. This is certainly an interesting choice of people to put together. 4. She is such a good nurse; I hope she doesnt work herself too hard.

A nurse manager is trying to manage a conflict between a staff nurse and a medical student. Which statement by the manager would the nursing supervisor interpret as following the rules of basic mediation? 1. Both parties need to grow up. They are so immature. 2. The problem is partially the fault of both parties. 3. I stopped the conversation frequently to have the parties summarize what was being said. 4. They just went on and on. I had to stop the discussion because I was out of time.

Hospital administration has elected to use TeamSTEPPS as a method of team building. What should the nurse manager tell staff about this training? 1. This program was developed by a nurse to use specifically in small hospitals. 2. Teams of nurses will be sent to national training seminars. 3. You can expect additional efforts to help us keep on track. 4. This is a simulation-based training similar to the old disaster drills we used to do.

The staff nurse has been appointed to a task force. What can the nurse expect regarding this group? 1. There will be no official leader for the group. 2. The nurse will be working with people from several different departments within the hospital. 3. The assignment will be time limited. 4. The group members will compete for resources for their own units.

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

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

A staff nurse has experienced disagreements with one of the medical residents about several issues. The resident reacts to this conflict by belittling the nurse in front of colleagues. This behavior is most characteristic of which type of conflict? 1. Competitive 2. Role 3. Perceived 4. Disruptive

In order to come to a solution for an ongoing conflict among several nursing units, the nursing supervisor says, Your managers will meet to create a voting form representing both sides of this issue. Each of you will vote and the majority will rule. What kind of a solution is the supervisor seeking? 1. Consensus 2. Win-win 3. Forcing 4. Win-lose

In which situation would a meeting before the meeting be advisable? 1. The nurse is managing a standing committee on the unit. 2. The nurse is meeting with a social group to establish a plan for weight loss by walking. 3. The nurse has written information to distribute to members before the meeting. 4. The nurse expects the disagreement that started in the last meeting to carry over into this meeting.

The nursing staff is continually upset about inability to provide clients with supplies needed because third-party payers will not reimburse for those items. This is an example of which conflict antecedent? 1. Task interdependencies 2. Distancing 3. Role 4. Incompatible goals

The nurse manager is facilitating the work of a collaborative team whose mission is to negotiate employment contracts with physicians. The nurse manager does not want to compromise the nurses concerns in favor of the doctors concerns. Which strategies would facilitate this outcome? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Accommodating 2. Compromising 3. Smoothing 4. Collaborating 5. Competing

4,5

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

A "we" statement indicates that the group member feels like a part of a cohesive group.

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

A fixed budget is one in which budgeted amounts are set regardless of changes that occur during the year, such as patient volume or program activities.

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

A person cannot be promoted to the role of leader. Organizations cannot promote someone to a position of leader. Interpersonal skills influence others to accomplish a specific goal. The organization can promote a person who may become a leader.

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

A staff nurse the manager has worked with for 25 years Rationale 2: When there is a long-term relationship, the listener sometimes thinks they know what the other person is going to say. Careful listening is necessary in these situations.

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

An unlicensed nursing assistant Rationale: The rule of thumb is to ask the lowest person in the hierarchy who has the requisite capabilities.

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

As part of the capital budget.

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

Attend the hospital-based communication training. Rationale: Attending training on communication would be the best plan for this nurse. The strategies described in the other options would likely be included in this training.

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

Being certain that emails go only to the intended recipients

According to the behavioral view of leadership, how are leaders formed?

By being educated With training Through life experiences. Behaviorists believe leaders are made, not born.

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

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

What action is necessary by a delegate accepting delegation?

Clarify the timeline and expectations. Rationale: It is important for the delegate to make sure the timeline and expectations are clearly defined, and he or she may opt to outline the specifications in writing

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

Clinical practice knowledge. Rationale: To effectively manage a high-acuity unit, the nurse must have sufficient experience to develop clinical practice knowledge. three months is not long enough for that to occur.

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

Communication Rationale: Regardless of the type of leader or the type of unit a nurse manages, communication skills are the key to effective leadership.

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

Competition and criticism Rationale: The novice nurse manager may be insecure and fear that another staff member could perform the task more effectively. There is a fear that a successful delegate could threaten the nurse manager's credibility as a leader.

The nurse is acting as team leader for a client care conference. Which opening statement is best for this meeting? 1. We are all here to discuss the issues with this clients discharge. What issues are we facing? 2. The issue with this client is the time limit for Medicare to pay has almost expired, and we arent ready for discharge. 3. I dont really have time for this meeting today; is there anything I can do to expedite this meeting? 4. I will let you all decide what might be best, as I am not really as familiar with this client as I should be.

Correct Answer: 2 Rationale 1: The team leader should arrive at the meeting prepared to discuss the issues, not to find out what issues exist. Rationale 2: The team leader is the meeting facilitator, teacher, and client advocate for the patient care conference. The team leader should know the issues with the client and be able to facilitate the meeting by listing those issues. Rationale 3: The leader should be willing to give sufficient time to the team to achieve the stated goals. Rationale 4: The team leader should be familiar with the client and the issues.

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

Deciding on the delegate Rationale: The violation occurred at the step of deciding on a delegate. Nurse assistants cannot administer medications.

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

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

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

Dependent Rationale: This dependent "you make the decision and I'll do it," statement is characteristics of an ineffective follower.

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

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

Forming occurs in the initial stage of the group process; the members are cautious in approaching each other as they come together as a group.

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

He will prefer to ask questions rather than make statements Rationale 4: Women are more apt to ask questions to seek input.

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

Higher client satisfaction Rationale: When effective delegation takes place in an organization, everyone benefits. This leads to higher client satisfaction, which is the ultimate goal of nursing care and nursing management.

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

If a 3 percent merit raise is projected and the base salary for an RN is $48,000, then the new base becomes $49,440

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

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

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

In a conjunctive task, the group succeeds only if all of the members succeed, so it makes more sense to have fewer members on the team. However, the members should be highly qualified for the work.

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

In the re-forming stage, the group must refocus its activities and recycle through the four stages. The leader explains the new direction and provides guidance in the process.

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

Intersender conflict Rationale: Intersender conflict occurs when a person receives two conflicting messages from different sources.

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

Labeling the cost of each item in the clean supply closet

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

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

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

Metacommunication Rationale: Metacommunications are nonverbal messages conveyed by body language and environmental factors.

Nurse asks nurse manager if he can go home early.The request is denied, says, "I don't understand why I can't leave early.This statement is an example of which technique of influencing the supervisor?

Negative inquiry Rationale: Negative inquiry is a statement of "I don't understand." Negative inquiry is an effective technique, provided the person to whom it is directed does not become defensive or distraught.

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

Staying available the whole time is not realistic and will make it difficult for the change agent to maintain the energy it will take to make the change more successful.

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

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

RN receives morning reports. Delegates to LPN and NA. Busy, with physician visits and new orders, and RN communicates orders to LPN and NA. RN meets with case manager to discuss nursing home placement. What type of nursing care delivery system is in place in this hospital?

The RN in this case is leading a team. A variety of skilled caregivers cares for a group of clients.

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

The assignment will be time limited. A task group is charged with accomplishing a specific time-limited assignment.

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

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

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

The assumption of the empirical-rational model is that people are rational and will follow their rational self-interest if that self-interest is made clear to them.

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

The clinical microsystem method allows those who are involved in the smallest unit of care to make the decisions for that unit.

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

The early majority prefers the status quo but eventually accepts change.

Hospital concerned about low customer satisfaction ratings and poor evaluation on quality indicators. Nurse managers implement nursing delivery system that is cost-effective and improves both customer satisfaction and quality of care. Which nursing delivery system should the managers implement?

The focus of patient-centered nursing is the promotion of efficiency, quality, and cost control.

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

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

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

The nurse manager's role in patient-centered care requires considerable time. The nurse manager must be a strong leader.

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

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

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

The original model of nursing care delivery was total patient care or the case method. During the 1920s, total patient care was the typical delivery system, with much RN care being provided in the home.

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

The people just above and just below this person will be important to the way this key player reacts to the change.

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

The personnel budget projects the salary costs that will be paid and charged to the cost center in the budget period.

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

The purpose of a command group is to accomplish tasks in an organization, and these groups are recognized as legitimate organizational entities.

Which situation represents an obstacle to delegation?

There is a budget shortfall for the current fiscal year Rationale: Resources such as qualified nurses, finances, and educational resources may be limited, which are obstacles to delegation.

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

This response may indicate that the RN is not able to provide the skilled care needed. There may be a lack of RN presence in patient care.

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

This statement may reveal that members assigned to the team have problems working together. The manager should be watchful for any personality issues that might arise.

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

Timing of the request Rationale: The nurse manager should plan to meet with administration when there is sufficient time and the supervisor seems receptive.

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

Transformational leadership This is concerned not with the status quo but with effecting revolutionary change in organizations and human service.

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

Transparency Rationale: Transparency is displaying honesty and integrity.

Newly promoted nurse manager fears that previous coworkers will undermine her in the position. She does not share info with these coworkers on needed changes that are going to occur in the organization. Which emotional intelligence self-management competency is this nurse most clearly violating?

Transparency Rationale: Transparency is displaying honesty, integrity, and trustworthiness. this nurse is not displaying these traits.

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

Variable costs depend on and change in direct proportion to client volume and acuity, such as client care supply expenses.

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

1. "How often did you want the furosemide given?" 2. "Doctor, what rate did you want for the I.V.?"

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

1. Continuity of care may suffer. 2. Client/staff communication may be an issue. 3. Delegation is necessary.

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

1. There are problems with delegation. 2. Communication on the team or with the nurse manager is flawed.

A conflict has arisen between two staff nurses who work on the same unit. Which strategy is most important for the nurse manager to consider? 1. Address the conflict in the break room. 2. Make a timely decision regarding if and when to intervene. 3. Accept full responsibility for developing a solution. 4. Redirect expressions of disagreement between the participants.

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

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

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

All nursing activities occur in relationships. Rationale: Nursing activities occurring in relationships make communication skills essential.

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

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