Leadership Chpt 1-6 Nurse act

sexual misconduct in the practice of nursing means

vilation of the nurse-patient relationship sect 464.017

Good leaders need to be able to demonstrate an intuitive skill of empathy and expressiveness when dealing with others in the workplace. This requires sensitivity and awareness of the emotions and moods of others and is known as: a. social awareness. b. self-awareness. c. self-management. d. relationship management.

ANS: A Social awareness is an intuitive skill of empathy and expressiveness in being sensitive and aware of the emotions and moods of others.

The best leadership style for unfavorable conditions is: a. leader-member relations. b. task-oriented structure. c. position power. d. laissez-faire.

ANS: B The need for task-oriented leaders occurs when the situation is extreme. The best leadership style for unfavorable conditions is task-oriented.

Which of the following statements are accurate descriptors regarding change? (Select all that apply.) a. Organization-wide change is more sustainable when leadership imposes the change. b. Change within an organization is often externally imposed. c. Change within an organization may originate internally. d. Nurses do not need to participate actively in the organizational changes. e. Change is often complex and irrational.

ANS: B, C, E Changes within an organization may be necessary due to external or internal demands. Change is seldom easy and may be complex and irrational.

Culture is best defined as (the): a. deviation from the majority. b. differences in likes and dislikes. c. shared beliefs and values. d. similar views and opinions.

ANS: C Culture is described as shared beliefs and values. It provides a common belief system among its members but is not expected to hold similar views and opinions of its members.

How is culture represented at the unit level, with an underlying belief in patient-centered care? a. Open visiting hours in the critical care unit (CCU) b. Strict visiting hours in the CCU c. Tape-recorded report d. Verbal handoff conducted at the nurses' station

ANS:A Open visiting hours in the CCU convey the importance of family as partners in care delivery. This is a representation of culture within a nursing unit where a relationship-based nursing care model is used, and it represents an underlying belief in patient-centered care.

a nurse renews her license every?

biennial-every 2 yrs NOT BIANNUAL

Leadership is best defined as: a. an interpersonal process of participating by encouraging fellowship. b. delegation of authority and responsibility and the coordination of activities. c. inspiring people to accomplish goals through support and confidence building. d. the integration of resources through planning, organizing, and directing.

c. inspiring people to accomplish goals through support and confidence building. Leadership is the process of influencing people to accomplish goals by inspiring confidence and support among followers.

what statue chpt is the fl nurse act?

chapter 464

there are 3 non-nursing residents on the florida nursing board

True

Which of the following is true of management activities? a. Inspiring a vision is a management function. b. Management is focused on task accomplishment. c. Management is more focused on human relationships. d. Management is more important than leadership.

b. Management is focused on task accomplishment. ANS: B Management is focused on task accomplishment.

Using RN illegally after your name is a

first degree misdeamenor

The nurse on a medical unit is caring for a 19-year-old with complications from a congenital heart defect. The client's mother is consistently at the bedside asking questions and attempting to direct the treatment plan. Which of the following shows how the nurse should communicate with the mother? a. Discuss personal information that the client shared with the nurse in confidence. b. Provide the mother with any information required for continuity of care. c. Explain that client confidentiality prevents the nurse from disclosing information. d. Ask the client if he gives permission for the nurse to share information with the mother.

"ANS: D" "It is the nurse's legal and ethical duty to protect the adult "child's" autonomy and not simply accept a parent's intervention, without lawful authority, just because it may seem easier at the moment. The nurse must obtain permission from the client before sharing information with the mother."

The definition of veracity is: a. being loyal and faithful to commitments and accountable for responsibilities. b. the norm of telling the truth and not intentionally deceiving or misleading clients. c. a prohibition of disclosure of information. d. a right of limited physical or informational inaccessibility

ANS: B Veracity is the norm of telling the truth and not intentionally deceiving or misleading clients.

A nurse manager is evaluating the efficiency of a process on the nursing unit. The manager believes that the unit could be more efficient if one aspect of this process were delegated to unlicensed personnel. To establish whether the delegation of this duty would be legal, he should check with the: a. ANA. b. current federal defense attorney. c. state nurse practice act. d. policy and procedure manual of the unit

ANS: C Nurse practice acts exist for each state and govern the legal practice of nursing, including standard of care, delegation, and supervision

The role of the _____ is to provide leadership and direction for all aspects of nursing services with a focus on integrating the system and building a culture. a. nurse manager b. care provider c. nurse executive d. senior leader

ANS: C The nurse executive's role and functions concentrate on long-term administration of an institution or program that delivers nursing services, focusing on integrating the system and building a culture.

How is culture measured within an organization? a. Through the use of time-motion studies b. Through the use of quantitative instruments c. Through the use of qualitative instruments d. With a combination of qualitative and quantitative measures

ANS: D The choice of a measurement instrument would be directed by definition, purpose, and context for the cultural assessment. It is likely that a combination of qualitative and quantitative measures would be the best means of capturing the culture of an organization.

A nurse manager recognizes that her staff's emotional responses to organizational change are similar to: a. adaptation techniques. b. integrative tactics. c. symptoms of mental illness. d. the grief model.

ANS: D The grief model is the most accurate, because change produces a longing for what is familiar, even if it is not what is best or realistic.

Determining the origin of errors with a focus on prevention is known as which of the following? a. A civil investigation b. A voluntary reporting program c. An administrative review d. A root cause analysis

ANS: D To change the culture from "who dunnit?" to an environment that is respectful and open to learning, it is necessary for the climate to change. It is essential to be able to discuss mistakes freely, with the intention of learning from them by doing a root cause analysis.

Which of the following responses may occur related to stress? (Select all that apply.) a. Increased heart rate b. Decreased blood glucose levels c. Emotional exhaustion d. Burnout e. Chronic health conditions

A Stress has a variety of induced changes, including increases in heart rate and blood glucose levels, emotional changes, and burnout, and it can lead to acute and chronic health problems.

The Primary Purpose of the Nurse practice Act is to protect___________? A)The public from unsafe nursing practice B)The nurse from lawsuits C)The hospital or healthcare agency D)The state from lawsuits

A)The public from unsafe nursing practice

A nurse can practice nursing in Florida even without a florida nursing license in which of the following circumstances? Select all that apply A)Giving assistance in an emergency B)Caring for a friend or family member without compensation C)Providing nursing care by students of an approved school of nursing D)Nurses married to military personnel who are relocating to FL. from another state.

A,B,C,D

The nurse manager is dealing with a situation between two nurses who disagree on patient assignments. The nurse manager decides to allow the two nurses to work out their differences between themselves because the patient needs and the needs of the unit are being met. After the situation is resolved, the nurse manager praises the two nurses for making autonomous decisions about staffing. What will be the likely outcome of praising the nurses in this situation? a. higher job satisfaction b. Lower job satisfaction c. Lower patient satisfaction d. Increased staff turnover

ANS: A A nurse manager's leadership style may affect how decisions are made throughout the organization. Decisions about the safety culture are a part of a nurse manager's role. Merrill (2015) found that a transformational leadership style contributed to a positive safety culture. Praising employees affects a nurse's job satisfaction.

Culture change within nursing homes was initiated by the: a. Nursing Home Reform Act. b. National Citizens' Coalition for Nursing Home Reform. c. Pioneer Network. d. Eden Alternative.

ANS: A A series of quality improvement programs were implemented in nursing homes following the passage of the Nursing Home Reform Act legislation in 1987

A staff nurse is facing a dilemma between meeting clinical ethical standards and meeting organizational goals. The nurse manager understands that the best way to assist staff members in resolving ethical dilemmas effectively is to focus on: a. doing the right thing and taking the right action. b. meeting clinical standards before organizational goals. c. meeting organizational goals before clinical standards. d. referring indecisive staff members for additional training

ANS: A Although the domain of clinical ethics is the care of clients, the domain of organizational ethics is a facility's business-related activities. Together, clinical and organizational ethics reflect a health care facility's concern that, whether related to the continuum of care or the continuum of services related to that care, ethical dilemmas should be resolved based on values-centered principles that focus on doing the right thing and taking the right action.

The postoperative patient with anterior cervical laminectomy is complaining of tightness in his throat. His voice is raspy. The staff nurse asks the unit secretary to page Dr. Julio stat. This is an example of _____ leadership. a. authoritarian b. democratic c. laissez-faire d. servant

ANS: A Authoritarian leadership uses directive and controlling behaviors in which the leader determines policies and makes decisions in isolation. The leader orders subordinates to carry out the tasks or work. This style is helpful in crisis situations.

A patient who is not fully informed about his or her health status is an example of a violation of which ethical principle? a. Autonomy b. Justice c. Utilitarianism d. Confidentiality

ANS: A Autonomy refers to the client's right of self-determination and freedom of decision making. A patient who is not fully informed is denied the freedom and access to make a decision.

The court has found that a registered nurse (RN) harmed a patient by violating his rights. The nurse is ordered to pay the patient a large sum of money. The court has determined that the nurse has committed a: a. civil act. b. criminal act. c. critical wrong. d. quality breach

ANS: A By definition, civil acts are wrongs that violate the rights of individuals by tort or breach of contract.

The first stage of planned change involves: a. accepting the need for change. b. cognitive redefinition. c. integration and stabilization. d. problem solving.

ANS: A Change must begin with an awareness of the need for change and end with a general acceptance of the necessity of change.

Characteristics of a Magnet hospital include: a. multidisciplinary collaboration. b. nursing leader authority. c. physician control. d. social worker retention

ANS: A Characteristics of a Magnet hospital include nursing autonomy, practice control, and collaboration. Nursing support, collaborative partnerships with physicians, and nursing practice are other aspects.

A professor at the local college of nursing is teaching at a new clinical site. She notes that the nurses greet each other and their clients with warmth and a smile. She also notes that the policies and procedures encourage nursing autonomy. Nurses and physicians seem to have a collegial relationship. These observations best describe the _____ of the unit. a. climate b. culture c. interactions d. operation

ANS: A Climate is the perception that individuals have about a particular unit or environment.

How is decision making at the staff nurse level exemplified? a. The staff nurse adapts to a challenging patient assignment. b. The staff nurse refers issues to the performance improvement committee. c. The staff nurse accepts the status quo. d. The staff nurse questions current practice and refers to unit leadership for change.

ANS: A Decision making is the process of making choices from several courses of action in order to solve problems. The process of selecting one course of action from alternatives forms the basic core of the definition of decision making. The staff nurse who adapts to a challenging patient assignment is using decision making to affect the quality of patient care delivered

A staff RN is leading a quality improvement team on the care of the total hip replacement patient. The issue is an increased length of stay from 1 year ago. The nurse asks team members to reframe the problem statement from their perspective. Twenty different problem statements were developed. The team is focusing on four of the problem statements. This is an example of which of the following techniques? a. Decision making b. Evaluating the consequences c. Inclusive judgment d. Problem processing

ANS: A Decisions are made following the basic problem-solving process but also involve an evaluation of the effectiveness of outcomes that result from the decision-making process itself.

Nurse managers are in a position of impacting the stress levels of employees through improving work environments and creating a culture of enhanced staff satisfaction. Having structures and processes in place to prevent work-related stress from happening in the first place requires: a. genuine intention and corresponding action. b. additional evidence about the human and financial costs of work-related stress. c. more stability in the health care industry. d. decreased demands from payers, consumers, and regulators

ANS: A It has always been challenging to secure the necessary resources for prevention, even for patient care. However, failure to do so puts employees at risk, which in turn can jeopardize the lives of patients. It is no longer possible to wait for more evidence about the human and financial costs of work-related stress. Waiting for more stability in the industry, which may never come, wastes precious time. Once that is embraced and there is genuine intention, then design and creation can begin in earnest.

Which of the following are crucial leadership traits to exhibit in the nursing profession? a. The nurse leader needs to by dynamic b. The nurse leader shows good interpersonal skills c. The nurse leader is a visionary for the organization and the profession d. The nurse leader is able to inspire e. The nurse leader allows corporate executives to determine department goals

ANS: A Leadership is considered key to the success of health care organizations. A nurse leader needs to be dynamic, show interpersonal skills, and be a visionary for the organization and the profession. The ability to inspire and motivate followers to carry out the vision is crucial. Effective nurse leaders set department goals without micromanaging.

A staff nurse came in to work the 7 PM to 7 AM shift. She had met her friends for "happy hour" earlier in the evening. Her breath smells of alcohol. If this nurse is allowed to provide care for patients, she may be at risk for: a. maleficence. b. melange. c. nonmaleficence. d. nonmelange.

ANS: A Maleficence is doing harm to the patient whether it is intentional or unintentional, such as an omission. If the nurse is intoxicated, she may fail to meet the standard of care.

Organizational _____ affects the quality of nursing care and patient outcomes. a. culture b. climate c. fiscal stability d. case mix

ANS: A Organizational culture affects the quality of nursing care and patient outcomes. The manner in which staff perceives culture, manages boundaries, and translates values has an impact on patient care.

A nursing unit has demonstrated lower patient satisfaction scores during the last quarter. The manager of the unit has formed a small team to set long- and short-term goals for the unit with action plans to increase patient satisfaction. This is an example of which management process? a. Planning b. Organizing c. Coordinating d. Controlling

ANS: A Planning is the managerial function of selecting priorities, results, and methods to achieve results.

A nursing manager recognizes that the changes that she is expected by administration to implement will be met with staff resistance. She is committed to determining the root of the resistance and communicating positively with her staff. The nurse manager's actions characterize her as a(n): a. change agent. b. implementation expert. c. restructuring motivator. d. supervisory threat.

ANS: A The change agent needs to anticipate resistance, determine why it is occurring, and try to determine what the person who is resisting is trying to protect.

When a nurse leader is able to fully embrace the American Association of Critical-Care Nurses' (AACN's) Healthy Work Environment and engage others in its achievement, what is the leader demonstrating? a. Authentic leadership b. Meaningful recognition c. True collaboration d. Skilled communication

ANS: A The nurse leader is demonstrating authentic leadership when he or she is able to embrace and model the AACN's Healthy Work Environment.

A small critical care unit forms a team of nurses to implement bedside rounds at shift change. The nurses have researched the efficacy of bedside rounds and have determined that this evidence-based practice will lead to improved communication of patient status. Which type of change does this demonstrate? a. Transforming care at the bedside b. Second-order change c. Emergent change d. Organizational change

ANS: A Transforming care at the bedside was an initiative created to improve quality and safety on medical-surgical acute care units by engaging in changes to improve practice.

Nurses who must manage unplanned and regular responsibilities simultaneously may experience: a. complexity compression. b. resilience. c. moral distress. d. empowerment

ANS: A When unexpected conditions are added to regular responsibilities, nurses may experience what experts call complexity compression, which has been linked to burnout, turnover, and other types of work-related stress (Krichbaum et al., 2007). Nurses experience this when they must manage unplanned (complexity) and regular responsibilities simultaneously (compression).

Conflict and stress in the workplace can be managed through building relationships. Organizations can foster the building of relationships through: (Select all that apply.) a. social media. b. informal social gatherings. c. mentoring. d. confidential meetings.

ANS: A, B, C Building relationships can be fostered in organizations by formal and informal social gatherings, mentoring, social media, and deliberate culture creation (Moreland & Apker, 2016). Perceived supportive work environments are characterized by perceptions that supervisors are supportive, there is fairness, and there is open communication. Stress is reduced when nurses feel that win-win solutions occur in the work environment

Managers have a key role in mitigating stress in the workplace. Which strategies will assist the manager in creating a more healthy work environment? (Select all that apply.) a. Recognize nurses for the value they bring to the organization. b. Partner with the nursing staff to make policies and lead organizational operations. c. Keep information confidential regarding safety concerns or initiatives. d. Ensure staffing is an effective match between patient needs and nurse competencies. e. Ensure that the manager maintains responsibility for all aspects of unit functioning.

ANS: A, B, D A healthy work environment (HWE) is one that is safe, empowering, and satisfying. Nurse managers can foster an HWE by recognizing nurses for the value they bring to the organization, partnering with the nursing staff to make policies and lead organizational operations, and ensuring that staffing is an effective match between patient needs and nurse competencies

Which of the following traits describe a transactional leader? (Select all that apply.) a. Functions in a caregiver role. b. Surveys their followers' needs and sets goals for them. c. Uses charisma to produce greater effort in followers. d. Focuses on the maintenance and management of ongoing and routine work. e. Motivates followers to perform to their full potential.

ANS: A, B, D A transactional leader is a leader or manager who functions in a caregiver role and is focused on day-to-day operations. Such leaders survey their followers' needs and set goals for them based on expectations. They are also leaders who are focused on maintenance and management of ongoing and routine work. Transformational leaders use charisma to produce greater effort and are able to motivate followers to perform to their full potential over time.

A staff RN is writing an article for a prestigious nursing journal. The deadline is in 1 week, and she is feeling overwhelmed about completing her work. She is unable to keep up with home management, and she is beginning to procrastinate on the project. She also has other responsibilities, such as taking her elderly mother grocery shopping and to health care appointments. She is married to a busy executive and has three children, all of whom are active in high school sports. Which of the following stress management strategies would be helpful? (Select all that apply.) a. Schedule "think time" appointments at least once a week for a block of time; get out of the office for these times. b. Bring a water bottle to work and refill as needed to keep hydrated. c. Cut extra activities out of her schedule, such as her morning walk. d. Create a "getaway" place at work where she can spend a few minutes in silence and thought.

ANS: A, B, D Scheduling "think time" appointments and spending a few minutes in silence can help her clear her mind and regroup. Keeping hydrated will help keep energy levels up. Exercise is important to help the nurse deal with stress and would not be wise to delete from her schedule, if possible.

A nurse manager at Great Lakes Hospital is meeting with the dean of a well-recognized university who is the keynote speaker today at the nursing conference. He remembers that one of the RNs is interested in attending a well-known university to obtain a doctorate. The nurse manager arranges for the RN to meet with this dean. The nurse manager is exhibiting leadership behaviors consistent with: (Select all that apply.) a. feminist perspective. b. servant leadership. c. transactional leadership. d. transformational leadership. e. authoritarian leadership.

ANS: A, B, D This behavior nurtures personal growth (servant leadership) and assists the RN to attain his or her fullest potential (transformational leadership). This behavior also helps the RN build a connection with the dean, a representative of the university (feminist perspective).

Which ethical principle is violated when the RN tells the hospital accountant that the patient is HIV-positive? (Select all that apply.) a. Beneficence b. Veracity c. Confidentiality d. Autonomy e. Fidelity

ANS: A, C Beneficence means "doing good for clients and providing benefit balanced against risk." The hospital accountant had no need to know; therefore, there was no benefit for the patient for him to be told. Confidentiality prohibits disclosures of information gained in certain relationships to third parties without the consent of the original source of the information. Without the patient giving express consent, the hospital accountant has no need for this information, and it is a breach of confidentiality.

What drivers of change are impacting nursing care? (Select all that apply.) a. Transparent communication b. Overabundance of nursing staff c. Evidence-based practice d. Information technology e. Reduced acute care needs

ANS: A, C, D An explosion in information technology capacity is altering the speed and transparency of communication and information delivery. The impact of a nursing shortage, increased demand for nursing care, and the drive to incorporate evidence-based practice are changing the face of nursing care

Which of the following behaviors build trust between leaders and employees in an organization? (Select all that apply.) a. Sharing relevant information b. Encouraging competition via winners and losers c. Reducing controls d. Meeting expectations e. Avoiding discussion of sensitive issues

ANS: A, C, D Leadership is founded on trust. Behaviors that build trust include sharing relevant information, reducing controls, and meeting expectations. Trust-destroying behaviors include being insensitive to beliefs and values, avoiding discussion of sensitive issues, and encouraging competition.

Definitions of stress are: (Select all that apply.) a. a negative emotional experience that is associated with biological changes that trigger the body to make adaptations. b. the accomplishment of specified activities during an available time period. c. a physical, mental, psychological, or spiritual response to an experience. d. a response that is evaluated by the individual as a threat to one's sense of well-being.

ANS: A, C, D Stress is a negative emotional experience associated with biological changes that trigger the body to make adaptations. It can be a physical, mental, psychological, or spiritual response to an experience that is evaluated by the individual as a threat to one's sense of well-being.

Which of the following are examples of formal decision-making tools? (Select all that apply.) a. Shared governance b. Anchoring c. Pilot projects d. Evidence-informed decision making e. Simulation

ANS: A, C, D, E Examples of formal decision-making strategies include shared governance, the use of pilot projects, evidence-informed decision making, and the use of simulation.

Researchers study organizational climate in order to examine how the work environment influences behaviors. Which of the following characteristics are utilized to study climate? (Select all that apply.) a. Supervisor support b. Unit staffing and its effect on incident reporting c. Autonomy d. Peer cohesion e. Rewards and recognition

ANS: A, C, D, E Some characteristics that are used to study climate are decision making, leadership, supervisor support, peer cohesion, autonomy, conflict, work pressure, rewards, feeling of warmth, and risk.

To establish legal liability on the grounds of malpractice, the injured party must prove which of the following? (Select all that apply.) a. A duty of care was owed to the injured party. b. An agreement was made to assume another party's liability. c. There was a breach of duty. d. Causation was present. e. Actual harm or damages were suffered by the plaintiff.

ANS: A, C, D, E These four elements are required to establish legal liability on the grounds of malpractice

What are some methods that nursing staff can use to manage personal stress levels? (Select all that apply.) a. Take personal time each day. b. Take on extra shifts to keep the mind occupied. c. Get enough sleep. d. Pay attention to diet and exercise. e. Have a strong support network of friends and family.

ANS: A, C, D, E While stress management is unique to each person, some of the tools that may be effective include taking personal downtime each day, getting enough sleep, eating right, exercising, and having a strong network of friends and family for support

During periods of stress and change, which of the following strategies should managers use to provide emotional support to staff members? (Select all that apply.) a. Reframe difficult questions. b. Communicate facts through e-mail. c. Provide active listening. d. Promote action steps and solutions. e. Keep staff informed of decisions. f. Communicate with participation

ANS: A, C, D, E, F Emotional responses are an expected part of change, and managers need to be able to provide emotional support to staff during periods of stress. Some of the effective strategies are active listening, promoting action steps and solutions, keeping staff informed of decisions, soliciting input, encouraging participation, and reframing difficult questions

To reach Magnet status the nursing service in a hospital must attain competency in which of the following areas? (Select all that apply.) a. Professionalism b. Use of critical thinking skills c. Business skills and principles d. Leadership e. Communication and relationship management f. Knowledge of the health care environment g. Implementation of an acuity-based staffing system

ANS: A, C, D, E, F Magnet hospitals are recognized for the nurse's critical role in the business of health care. Professionalism, leadership, communication, and the ability to work with others as well as understanding the business and principles of running a hospital business and health care environment are required.

Hospitals and long-term care facilities wishing to achieve Magnet Recognition Program® must meet which of these components? (Select all that apply.) a. Transformational leadership b. Incident reporting c. New knowledge d. Actual staffing ratios e. Empirical outcomes

ANS: A, C, E Today, hospitals and long-term care facilities wanting to achieve Magnet Recognition Program® status must meet five key components identified by the ANCC (2016): transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and empirical outcomes.

Which of the following behavioral aspects are present in the feminist perspective leadership style? (Select all that apply.) a. Builds relationships. b. Focuses on completing tasks and achieving goals. c. Empowers others. d. Fosters an environment of mothering. e. Supports bargaining of tasks and roles. f. Promotes personal growth.

ANS: A, C, F Leaders using the feminist perspective build connections, empower others, and support personal growth to promote teamwork and to accomplish goals.

Two cognitive processes that nurses use in clinical reasoning include: (Select all that apply.) a. education. b. acuity. c. staffing ratios. d. experience.

ANS: A, D Clinical reasoning is the process of analyzing and synthesizing both objective and subjective cues about patients (Johansen & O'Brien, 2015). The nurse's level of analysis is influenced by experience and education.

The IOM report, To Err Is Human: Building a Safer Health System, recommends building a safety culture within an organization. This refers to keeping both patients and nurses safe. The organization supports nursing by: (Select all that apply.) a. moving from a reactive culture to one that is fair and just. b. demonstrating authoritarian behaviors. c. mandating nurses to meet patient needs. d. providing a safe and efficient workspace.

ANS: A, D Included in the concept of a safety climate is a focus on nurse's health and safety. Nurses working in hospitals have one of the highest rates of work-related injuries, especially back injuries and needlesticks. One major shift in an organization's safety climate is the move from a punitive and reactive culture to a fair and just culture. In a fair and just culture, expectations for system and individual learning and accountability are transparent.

A nurse manager at Morgan Hill Community Hospital is known to be an excellent nursing manager by the personnel working on her nursing unit. The nurse manager exhibits which of the following behaviors? (Select all that apply.) a. Knows the personnel and addresses them by name. b. Intervenes when she receives complaints. c. Has a consistent style that never varies. d. Is visible on the nursing unit by all shifts on a frequent basis. e. Evaluates a number of aspects of problems prior to making decisions. f. Uses decision by consensus to resolve conflicts. g. Fosters collaboration.

ANS: A, D, E, G These behaviors foster teamwork and positive morale.

Nurse managers in patient care areas must manage staffing on a daily basis. The degree of work needed for any patient is known as nursing intensity and includes which of these other variables? (Select all that apply.)? a. Severity of illness b. Complexity of patient's condition c. Amount of time needed with patient d. Complexity of care e. Patient's dependency

ANS: A,C,D,E The degree of work needed for any patient is called nursing intensity and is a combination of the severity of illness, the patient's dependency, the complexity of care, and the amount of time needed. The need-severity (physical and psychological) is called patient acuity, which is a rating of the complexity of the patient's condition.

The probability of effectiveness of the change process can be increased through several techniques. Which of the following actions will likely increase effectiveness? (Select all that apply.) a. Explain the rationale for a change so that individuals understand it. b. Simply announce the change without laying a foundation. c. Give participants all the information they need. d. Rely only on formal authority in implementing change. e. Help individuals cope with change.

ANS: A,C,E Announcing the change without laying a foundation and relying only on formal authority in implementing change are actions to be avoided when implementing change within an organization.

Almost all changes encounter: a. attitudes. b. resistance. c. knowledge. d. communication.

ANS: B Almost all changes encounter some resistance as a natural phenomenon. Resistance may be rooted in anxiety or fear.

A nurse manager has several complaints from her staff that she is inaccessible during the day. What is the best strategy the nurse manager takes to improve her staff satisfaction? a. Notify staff when she will be out of the office. b. Block time for daily rounds with staff. c. Set realistic follow-up deadlines for staff issues, questions, and concerns. d. Ask the staff to communicate with her through their supervisors.

ANS: B Blocking time to round with staff is the best way the nurse manager can be on the unit and visible to her staff. Notifying staff when she is out of the office, setting realistic deadlines for following up with issues, and delegating certain activities to the supervisors are good time management strategies, however they don't address the staff's issue of not seeing her

Climate is best defined as the: a. health and well-being of the structure of a facility. b. perceptions that individuals have about an environment. c. style in which individuals treat each other. d. temperature in the nursing units of an institution.

ANS: B Climate is defined as the perceptions that individuals have about a particular unit or environment

A nursing executive is leading a multidisciplinary team of professionals who have worked well together on prior initiatives. Which of the following leadership styles might work best in this situation? a. Authoritarian b. Democratic c. Transformational d. Transactional

ANS: B Democratic leadership would work best in this situation. This approach implies a relationship and person orientation and policies are a matter of group discussion and decision.

The identification of forces that drive and restrain change is called a(n): a. equilibrium evaluation. b. force field analysis. c. status quo analysis. d. refreezing system.

ANS: B Driving and restraining forces influence any situation. A force field analysis facilitates the identification and analysis of driving and restraining forces in any situation.

There is evidence of a link between _____ employees with higher productivity and more satisfied customers. a. stressed b. empowered c. financially focused d. creative

ANS: B Employees who are empowered in their jobs are also more engaged and satisfied. Research indicates that structural empowerment leads to higher productivity and satisfaction for the employee, which translates to more satisfied customers.

On admission, the patient was found to have a blood glucose level of 218. The RN knows that except in emergency situations, it is hospital policy to obtain physician's orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. The nurse's actions are an example of: a. breach of contract. b. common negligence. c. intentional malpractice. d. medical oversight.

ANS: B Examples of common negligence allegations in nursing malpractice suits include patient falls, use of restraints, medication errors, burns, equipment injuries, retained foreign objects, failure to monitor, failure to ensure safety, failure to take appropriate nursing action, failure to confirm accuracy of physicians' orders, improper technique or performance of treatments, failure to respond to a patient, failure to follow hospital procedure, and failure to supervise treatment (Cooper, 2014).

The use of a new idea or method is the definition of: a. change. b. innovation. c. resistance. d. stereotyping

ANS: B Innovation is the use of a new idea or method

The nursing manager of a telemetry unit has developed a policy in which all nurses automatically are scheduled to have a day off from work on their birthday unless they request to work on that day. He also gives a small gift to each nurse who becomes certified in his or her specialty area. This manager's actions are positively affecting the _____ of the unit. a. climate b. culture c. interactions d. operation

ANS: B Key areas under the leader's control in which culture can be affected are staff recruitment and retention, welcoming new staff, orientation, celebrating and recognizing staff accomplishments, facilitating change, and promoting a learning environment

The decision support department has been asked to create balanced scorecards for each nursing unit. Nurse managers work with decision support on the data elements which will be useful in assessing financial, quality, and other measures in order to improve what? a. Staff turnover b. Organizational performance c. Physician satisfaction d. Reimbursement

ANS: B Managers in particular can use the data to develop a balanced scorecard that assesses financial, quality, and other operational performance measures. This scorecard should be available to all staff so that organizational performance can improve.

An internal obstacle that may contribute to moral distress is: a. lack of resources. b. lack of confidence. c. lack of structure. d. lack of processes.

ANS: B Moral distress occurs when an individual knows what ethical action should occur but is prevented from doing so by either internal or external barriers (Rushton, 2006). Internal obstacles include personal characteristics such as fear or lack of confidence. External obstacles include a lack of resources, structures, or processes that prevent taking the desired and right action (McCarthy & Deady, 2008).

The major responsibility for upholding patient care standards belongs to the: a. chief executive officer of the facility. b. nurse manager. c. on-call physician. d. staff nurse providing patient care.

ANS: B Nurse managers carry the major responsibility for developing and upholding the standards of care for staff nurses.

A hospital system is implementing an electronic health record. The facility conducts education and training for nursing staff, medical staff, and ancillary staff over a period of 6 months. This is an example of: a. emergent change. b. planned change. c. transformation. d. innovation.

ANS: B Planned change is a decision to make a deliberate effort to improve a system.

A nurse manager has ordered equipment for a new unit. The company has sent two notices that the equipment is on back order. The nurse manager is debating whether to wait for the equipment on back order or to cancel the order and go with another company. She discusses this issue with another nurse manager and they determine that the equipment is urgent for patient safety in the new unit. The manager orders the necessary equipment from another company even though it is slightly more expensive. This is an example of: a. clinical decision making b. prioritization c. triage decision d. clinical reasoning

ANS: B Prioritization occurs not only in triage situations, but also across the care spectrum. Thus decisions have to be made regarding what care has to be delivered and when the care is to be delivered. All nurse managers and leaders need to consider the implications of their decisions. Each decision made involves financial, ethical, and human resources. Furthermore, reimbursement and other regulations must be taken into account.

The nurse in a medical-surgical unit is working short-staffed due to a sick call. Which of these is an example of prioritization? a. Charting by exception b. Omitting personal hygiene in favor of timely medication administration c. Timely medication administration without scanning the patient armband d. Deploying a rapid response team when a patient condition changes

ANS: B Prioritization occurs not only in triage situations, but also across the care spectrum. Thus decisions have to be made regarding what care has to be delivered and when the care is to be delivered. For example, nurses implicitly make decisions to ration care when time and staffing are short (Jones, 2015). On a day-to-day basis nurses must decide if such things as routine hygiene activities are omitted in favor of administering critical treatments, including medications

A quality improvement team is working to enhance teamwork among the staff in a newly developed Alzheimer's program. Which of the following statements would be an expected behavior that illustrates quantum leadership? a. "After the meeting today, each member on this team will be a role model of good communication techniques to other staff members." b. "How would you describe an ideal collaborative practice environment?" c. "What do you think about sharing our opinions today in a mutually respectful manner as we move around the table?" d. "You folks are highly motivated and smart enough to develop a plan on your own. I'll support you as needed."

ANS: B Quantum leadership fosters an environment of curiosity, questioning, and exploration. Answer A depicts an authoritarian leadership style.

Which of these concepts is key to refining clinical judgment capabilities? a. Critical judgment b. Reflection c. Management experience d. Nursing expertise

ANS: B Reflection is key to refining the capabilities of clinical judgment. As a nurse gets more experience, the intuitive component of judgment follows. Nurses do not require management experience or nursing expertise to refine clinical judgment.

A nursing unit has discovered a series of medication errors with regard to a particular computerized physician order set and the calculation within the order. The unit manager has a theory on changes that should be made within the order to decrease the confusion for nursing staff. However, the nurse manager realizes that changes would need to be made with pharmacy input as well as other nursing units within the facility and the multihospital system. Which of the following management theories is exemplified when the nurse manager considers the impact of change on the organization as a whole? a. Contingency theory b. Systems theory c. Complexity theory d. Chaos theory

ANS: B Systems theory helps managers recognize their work as being embedded within a system. Managers use this theory to learn that changing one part of a system inevitably affects the whole system.

The Institute of Medicine (IOM) report, Crossing the Quality Chasm, was useful in describing the challenges related to moving from _____-centered to _____-centered care. a. patient; provider b. provider; patient c. patient; facility d. provider; financially

ANS: B The IOM report, Crossing the Quality Chasm, describes challenges in care provision and details the shift of moving from provider-centered care to patient-centered care. The need for patient and family participation is a dominant force in treatment decisions.

A patient has arrived at the critical care unit with a head injury. On admission, the patient is talking and is a little drowsy but oriented. Two hours later, the nurse discovers that the patient is talking at a rapid pace and keeps repeating his words. When the nurse recognizes the change and deploys the rapid response team and physician, which skill is being demonstrated? a. Leadership b. Clinical judgment c. Clinical decision making d. Management

ANS: B The competent nurse uses the information about head injury, change in mental status from talking and drowsy but oriented to talking at a rapid pace, and the potential for the patient to deteriorate to discern that the patient is experiencing cerebral edema or increased intracranial pressure. The nurse is demonstrating clinical judgment, which is the interpretation of the information of patient problems and needs.

An experienced nurse has recently taken a position on a telemetry unit in the local hospital. After 2 weeks on the job, he finds that the staffing is not what was discussed during his employment interview with the nurse manager. Which approach would be most appropriate for the nurse to take? a. Give 2 weeks' notice and begin seeking employment at another hospital. b. Discuss the situation with the nursing manager who interviewed him. c. Talk to other employees about the staffing situation. d. Notify the charge nurse that this was not what was explained to him prior to employment

ANS: B The nurse should discuss the situation with the nursing manager who interviewed him before quitting. Perhaps there is a temporary problem affecting staffing that could explain the situation. If after this discussion it is believed that the staffing is not now or ever will be as it was relayed to him in the interview, then he should seek employment elsewhere.

The charge nurse of a small nursing unit would like to gain staff acceptance of a time-intensive, budget-imposed change required by the hospital administration. She plans to emphasize several evidence-based research projects that have shown improved patient health outcomes as a result of implementing this change. This is an example of which of the following organizational change concepts? a. Budget-oriented change b. Transformation c. Resistance d. Emergent change

ANS: B Transformation is the use of new ideas, innovation, and creativity to change fundamental properties of the state of a system.

The nurse manager in a large emergency department utilizes agency nursing for staffing. Which of the following should the nurse manager do to help the facility avoid corporate liability? (Select all that apply.) a. Assume that the agency has reviewed the license status of the individual. b. Ensure that those who report to them remain competent and qualified and have current licensure. c. Report incorrect mixes of staff for effectively meeting the health care needs of clients. d. Assign the staff members to the role of mentor and educator

ANS: B, C Nurse managers can help the facility avoid corporate liability by, among other things, ensuring that those who report to them remain competent and qualified and have current licensure. Nurse managers should also report dangerously low staffing levels, incorrect mixes of effective staff, and incompetent, illegal, or unethical practices.

A Middle Eastern man has just been diagnosed with terminal cancer. The family has asked the medical and nursing staff to keep this information from the patient because in their culture they are fearful of delivering bad news as it may cause the patient to give up hope. Which ethical principles and dilemmas might be faced by nursing staff? (Select all that apply.) a. Justice b. Autonomy c. Veracity d. Confidentiality

ANS: B, C Autonomy refers to the rights of the patient to participate in decision making. Veracity refers to telling the truth. The nurses caring for the patient may feel that they are not being truthful about the treatment plan and decision-making process in this case.

Which of the following are examples of intentional torts that may occur in the health care field? (Select all that apply.) a. Slip and fall in the hospital cafeteria b. Patient restrained by the neck utilizing the nurse's arm c. Ovary removal against the patient's signed consent d. Restraining a patient without a physician's order e. Hospital-acquired pressure ulcer

ANS: B, C, D Common intentional torts within the health care setting include assault and battery, medical battery, and false imprisonment

Which of the following statements reflects just culture within an organization? (Select all that apply.) a. Just culture is a punitive reaction to patient errors. b. Just culture occurs when the organization is transparent about its mistakes. c. Interpersonal learning is balanced with personal accountability and discipline. d. Expectations for system and individual learning are apparent. e. Serious safety events are reported to senior leadership and kept confidential.

ANS: B, C, D In a just culture, organizational, individual, and interpersonal learning are balanced with personal accountability and discipline. In a fair and just culture, expectations for system and individual learning and accountability are transparent. The organization freely discusses mistakes with the intention of learning from them.

Learning organizations adapt to change through their ability to be open, dynamic, and responsive to changes in the environment. Which of the following learning disciplines are true of these types of organizations? (Select all that apply.) a. Learning is conducted in individual parts rather than in groups. b. Viewing the organization as an interrelated system is known as systems thinking. c. Individuals utilize mental models to understand how their vision affects their decisions and actions. d. Shared vision is conducted within a group to determine plans to get to the preferred future. e. Personal mastery encourages individuals to create results as they see fit.

ANS: B, C, D Mental models allow individuals to develop, create, and project a personal vision and understand how these views affect their decisions and actions. Shared vision is encouraged within a group for development of plans. A sharing of learning skills is encouraged as a group so that learning can occur as a group. The organization is viewed as an interrelated system, rather than in unrelated parts, in systems thinking.

Which of the following patient-related events may be considered as examples of common negligence allegations in a nursing malpractice suit? (Select all that apply.) a. Staffing levels in the medical unit b. Patient fall with injury c. Heparin error d. Failure to utilize rapid response team with change in vital signs e. Failure to ensure telemetry monitor is on the correct patient

ANS: B, C, D, E Examples of common negligence allegations in nursing malpractice suits include patient falls, use of restraints, medication errors, burns, equipment injuries, retained foreign objects, failure to monitor, failure to ensure safety, failure to take appropriate nursing action, failure to confirm accuracy of physicians' orders, improper technique or performance of treatments, failure to respond to a patient, failure to follow hospital procedure, and failure to supervise treatmen

Which of the following definitions apply to management? (Select all that apply.) a. It is a process of inspiring people to accomplish goals through support and confidence building. b. It is the process of coordination and integration of resources to accomplish specific goals. c. It includes the activities of planning, organizing, coordinating, directing, and controlling. d. It is a process of planning and directing human effort to achieve established objectives. e. It is the directing of the organizations' money, facilities, and supplies to achieve results.

ANS: B, C, D, E Management is defined as the process of coordination and integration of resources through planning, organizing, coordinating, directing, and controlling to accomplish specific goals. Management is a process of planning and directing human effort to achieve established objectives while ensuring that the organizations' money, facilities, and supplies are directed in a manner that achieves the best results

Professional safeguards that protect the nurse from being wrongfully accused of malpractice include which of the following? (Select all that apply.) a. Code of Ethics b. Statute of Limitations c. Affidavit of Merit d. Standard of Proof e. Sources of Law

ANS: B, C, E Civil law controls those circumstances when an individual, the plaintiff, feels that he or she has been harmed by another. If the other person is a professional, the law provides for professional liability, also known as malpractice. Professionals are provided with many safeguards to avoid them being wrongfully accused of malpractice. The Statue of Limitations is a statutory time limit (most commonly 2 years) by which a plaintiff must file a lawsuit against a professional or lose that opportunity forever. An affidavit of merit is a sworn document by a like kind of professional (a doctor for a doctor defendant and a nurse for a nurse defendant) who reviews the injured patient's chart, and, based upon the reviewer's education and experience, makes a statement that the case has merit and should be permitted to go to trial. Laws are found in case books, as well as online in official reports and legal research services. A reported case is one that can be found in an official reporter. There are state as well as federal reporters. When entered into a reporter, the case is printed and becomes part of the ever-growing body of case law.

Which of the following statements are true regarding job stress? (Select all that apply.) a. Job stress is related more to external demands that are brought into the workplace. b. Job stress can lead to burnout. c. Job stress is manifested as emotional and/or physical exhaustion. d. Job stress increases productivity. e. Levels of job stress that are too low or too high decrease individual productivity.

ANS: B, C, E Job stress is a tension that arises related to the environmental demands of a person's role or job. Job stress can accumulate to levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion. Levels of job stress that are too low or too high decrease individual productivity

A group of nurses is showing resistance to changes the manager is making with regard to staffing. Which of the following ways can the manager deal with the emotionality of the situation? (Select all that apply.) a. Use persuasion. b. Give the nurses adequate notice of change. c. Avoid discussion. d. Explain the rationale and patient impact. e. Inform staff that senior leadership made the decision.

ANS: B, D A factor in determining how change is accepted depends upon how it is managed. The way to deal with emotionality is to avoid persuasion and to allow people to express their feelings. Staff should be given as much notice as possible when making changes in staffing or scheduling, and discussion is encouraged. Staff should be informed about the rationale for the decision as well as patient impact. Effective managers possess self-confidence to explain the change without blaming.

An elderly client becomes confused after surgery. He is in a room farthest away from the nurse's station. The client has been trying to get out of bed several times during the shift. The nurse documents this very well. The client falls out of bed and breaks his hip. Who can possibly be held negligent? (Select all that apply.) a. Client's wife b. Nurse manager c. Pharmacist d. Staff RN

ANS: B, D It is possible that the nurse and nurse manager could be held negligent. The nurse could be held negligent for not moving the patient closer to the nurse's station, calling the physician or nurse practitioner for medications or change in medications, or obtaining an order for a vest restraint. The nurse manager may be held negligent because of 24-hour accountability for the care of patients on his or her unit and possible lack of supervision.

The nurse manager of a medical-surgical unit realized that there are differences in dealing with the varied generations of her nursing staff. How does the nurse manager communicate effectively with the Generation Y staff members (those born after 1980)? a. Typewritten memos b. Staff meetings held monthly for 2 hours c. E-mails or text messages d. Face-to-face interactions

ANS: C A work environment supportive to each generation is an important retention strategy. Tailoring the work environment to meet generational and life needs is a recurrent theme in being able to address staff retention.

One mechanism that ensures autonomy in the nursing profession is the: a. American Nurses Association (ANA). b. Department of Health Professionals. c. Nursing Code of Ethics. d. Professional Regulatory Board.

ANS: C American Nurses Association's (ANA) Nursing's Social Policy Statement: The Essence of the Profession (2010, p. 25) indicates "competence is foundational to autonomy," with the profession ensuring nursing competence through professional regulation of nursing practice via standards and ethical codes of practice, legal regulation of nursing practice via state licensure requirements and law pertaining to criminal and civil wrongdoing, and self-regulation in which all nurses retain personal accountability for their own practice (Cooper, 2014).

The personal leadership skill for nurses that consists of self-awareness, discipline, motivation, social awareness, and relationship management is known as what? a. Leadership. b. Management. c. Emotional intelligence d. Vision

ANS: C Among the important personal leadership skills for nurses is emotional intelligence (EI). EI traits are emotional factors consisting of five defining attributes: self-awareness, self-regulation or discipline, motivation, social awareness, and relationship management.

"To do good for others" is an example of which ethical principle? a. Nonmaleficence b. Fidelity c. Beneficence d. Confidentiality

ANS: C Beneficence means doing good for clients and providing benefit balanced against risk.

A nurse is caring for an elderly patient who was admitted after sustaining a fall at home. When creating a care plan for the patient, she requests that the doctor order a home health visit to assess for home safety and medication compliance. In addition, the nurse is concerned about the nutrition of the patient and requests a dietitian evaluation. The nurse is demonstrating which of the following leadership skills? a. Care provider b. Business principles c. Care coordination d. Change management

ANS: C Care coordination is the delivery of nursing services that involves the organization and coordination of complex activities. The nurse uses managerial and leadership skills to facilitate delivery of quality care.

The nurse manager on a medical-surgical unit wants to change to "walking rounds" in the patients' rooms for change of shift report. In the past, it has been "face to face" at the nurses' station. The nurse manager is meeting resistance from the staff, because they think that it will take longer, and the nurses will not finish their shift on time. What could the manager do to increase the nurses' acceptance of this change? a. Inform all shifts that there have been some lapses in communication regarding patient needs and that involving the patient in the report will help alleviate this. b. Inform all nurses that to reach Magnet status, this type of change of shift report is required. c. Ask the nurses to participate in the planning and implementation of the change. d. Ask the nurses to try this type of change of shift report for 1 week and then have them evaluate it.

ANS: C Change is always difficult, especially when it has been forced on people, threatens their security, or seems unnecessary. Change is more palatable when nurses participate in the planning and implementation and see that it is worthwhile.

The nursing manager wants to change the culture of the nursing unit. Some of the older nurses are bullying the newer nurses, which seems to be affecting self-confidence in their new nursing roles. Which of the following strategies would be helpful in this endeavor? a. Assign mentors to the new nurses. b. Determine the roles of each nurse. c. Interview each nurse about his or her perspective. d. Suspend the bullying nurses for harassment.

ANS: C Changing the culture requires the following to be done: (1) identify the desired change; (2) assess the current status of the group; (3) create a shared need and group commitment to change; (4) use appropriate communication skills and personal contact to establish open discussion; (5) identify shared values and mission so that the group knows where it is going; (6) determine strategies; and (7) develop an action plan for change. Interviewing each nurse would provide an opportunity for personal contact and attempt to establish open discussion.

Which of the following scenarios is an example of clinical reasoning? a. A nurse ignores a client's requests to stop his dialysis. b. A nurse is scheduled to work over the weekend, and she has a family outing to attend. c. A nurse is counseling a woman with breast cancer about terminating her pregnancy and receiving chemotherapy or completing the pregnancy and possibly not surviving. d. A nurse has been offered an exciting new position with a dramatic increase in salary, but she would have to move out of state, away from her ailing parents.

ANS: C Clinical reasoning is the process of analyzing and synthesizing both objective and subjective cues about patients. Levett-Jones and colleagues (2010) defined five steps for clinical reasoning. They stated that clinical reasoning involved five rights: the right cues or clinical data, the right patient or setting priorities, the right time or capability of identifying high risk patients, the right action or clinical decision that results from the clinical reasoning process, and the right reason. The right reason incorporates legal and ethical considerations. For example, the clinical process may lead a nurse to recommend that a patient needs respiratory support in the form of a ventilator. However, the patient may have an advance directive that would cause the clinician to make a different decision.

What is the purpose of culture in an organization? a. To provide a perception of what it feels like to work in the organization b. To provide an organization's response to economic, social, and financial challenges c. To provide a common bond so that members know how to relate to one another and show others outside the organization what is valued d. To provide a small geographic area within the organization where nurses provide care

ANS: C Culture is the set of values, beliefs, and assumptions that are shared by members of an organization. The purpose of culture is to provide a common bond so that members know how to relate to one another and to show others outside the organization what is valued

Nurses working on the intermediate care unit have had many hours of overtime in the last 6 months. Before forming a team, the nurse manager gathers data about patient condition severity, staffing ratios, educational levels of staff, and personality mixes on each shift. What level of decision making is this process? a. Establishment of solution evaluation criteria b. Evaluation of the alternative solutions c. Identification of a problem, issue, or situation d. Search for alternative solutions or actions

ANS: C Data should be collected to identify properly the actual problem, issue, or situation. The five core elements to decision making are the following: (1) identification of a problem, issue, or situation; (2) establishment of the criteria to be used to evaluate potential solutions; (3) search for alternative solution or actions; (4) evaluation of the alternative; and (5) selection of a specific alternative.

What is the definition of the process of making choices that will provide maximum benefit? a. Critical thinking b. Problem solving c. Decision making d. Leading

ANS: C Decision making is the process of making choices that will provide maximum benefits.

On admission, the patient was found to have a blood glucose level of 218. The RN knows that except in emergency situations, it is hospital policy to obtain physician's orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. Being aware of the hospital policy for medication administration, the patient's blood glucose level presented the nurse with a(n): a. assessment option. b. clinical choice. c. ethical dilemma. d. moral decision

ANS: C Ethical dilemmas require that decisions be made about what is right and wrong in situations in which an individual has to make a choice between equally unfavorable alternatives.

The most common source of legal liability for nurse managers is a(n): a. medical malpractice suit. b. organizational nursing issue. c. tort. d. vicarious liability

ANS: C In nursing, harm related to clinical practice commonly arises from negligent acts or omissions (unintentional torts) and a variety of intentional acts (intentional torts), such as invasion of privacy or assault and battery

A staff nurse has a concern about a co-worker who may be diverting medications. The staff nurse would like to report the concern to a supervisor, but she is fearful of retaliation from her colleagues. The staff nurse knows that the ethical thing to do is report the concern for the sake of patient safety. This nurse is experiencing: a. stress. b. procrastination. c. moral distress. d. burnout.

ANS: C Moral distress occurs when clinicians know what is the ethical action to take, yet are prevented by either external or internal obstacles. Moral distress will contribute to stress and eventual burnout if the staff nurse does not take action.

A new RN is observed breaking sterile technique by the perioperative nurse. This is an example of a violation of which ethical principle? a. Autonomy b. Justice c. Nonmaleficence d. Confidentiality

ANS: C Nonmaleficence means doing no harm to clients. A break in sterile technique could cause significant harm to a patient by causing an infection.

A team consisting of preoperative, operative, and postoperative health care professionals and ancillary staff is examining the turnaround time from the preoperative area to discharge for patients having tonsillectomies. The goal is to decrease waiting times for clients. The team comes up with a solution and wants to test it on a small group of patients before rolling it out to the rest of the department. What type of decision-making tool is exhibited? a. Shared governance b. Evidence informed c. Pilot project d. Trial and error

ANS: C Pilot projects are critical for implementation for evidence-informed decision making. Pilot projects or carefully defined trials are used to experiment by trying out a solution alternative on a small or restricted basis to reduce risk and to see whether major problems will occur. Pilot project strategies may resemble research projects, and these projects may also be linked to quality improvement initiatives.

A long-term care facility has been busy for several months with patients who have a very high acuity. Nurses have been working double shifts. The nurses have been given the task of determining whether they would like to implement an on-call program and determine guidelines for implementation, if most nurses believe that it is the best solution. This example depicts which type of decision-making tool? a. Pilot project b. Simulation c. Shared governance d. Data analytics

ANS: C Shared governance is an organizational structure that promotes empowerment and autonomous decision making at the point of care, accountability that is shared among all parties in a decision, and organizational processes that promote an egalitarian environment in decision-making processes

Effective managers utilize a wide array of data in making decision. Which of these techniques is used to build process improvement models? a. Incrementalism b. Scenario planning c. Six Sigma d. Budgetary model

ANS: C Six Sigma is a quality and decision support technique that uses data to build process improvement models. The goal is to eliminate defects in safety and quality in health care delivery (American Society for Quality Improvement, n.d.). Essentially Six Sigma is a variant of the plan-do-study-act (PDSA) cycle promoted by the Institute for Healthcare Improvement.

The chief nursing officer (CNO) of a hospital system works with senior leadership for approval to initiate an electronic health system. He recruits a nursing informaticist and a chief medical informatics officer to begin the process of planning the education and rollout of the new electronic system. The CNO could be viewed as the: a. resister. b. innovator. c. change agent. d. strategist.

ANS: C The change agent is a person or thing that produces a particular effect or change. The change agent can be a person who functions as a change facilitator.

Patient surveys reveal that patients do not know which caregiver is the registered nurse (RN). A task force consisting of nursing staff is formed to develop a plan to address this issue. Many ideas are discussed to reinforce the role of the professional nurse and to make it easy for patients to recognize the RN, such as changing the dress code. Decisions resulting from this task force will mostly reflect the: a. goals. b. mission. c. climate d. values

ANS: C The climate of the unit is evident in policies, unit norms, dress code and appearance, environment, communication, and teamwork.

The development of new practices in response to new evidence is called: a. altered direction. b. organizational flux. c. planned change. d. status revision.

ANS: C The development of new practices in response to new evidence or best practices occurs regularly and falls under planned change. One example is the broad adoption of evidence-based protocols and practices as a way of making sure that desirable outcomes are achieved.

A small geographic area within a larger hospital system, where nurses work interdependently to care for a group of patients, is known as the: a. nurses' station. b. subculture. c. nursing work group. d. community

ANS: C The nursing unit, or nursing work group, is a small geographic area within a larger hospital system, where nurses work interdependently to care for a group of patients.

A nurse is interviewing for a position at a prominent hospital in her community. She notes a separate physicians' dining room, but all other professionals and visitors eat in the same dining area. The physicians have a separate parking area. Nurse practitioners and physician assistants are asked to park in the staff lot. What might these observations suggest? a. The mission statement supports collaborative care. b. The philosophy of the organization depicts inequality. c. The values and actions may not be congruent. d. The vision for nursing is defined clearly.

ANS: C The values drive the way that resources are distributed. In this case, the values of nursing and actions of the organization may not be congruent

What is the final step in the clinical reasoning process? a. The right cues b. The right patient c. The right reason d. The right time

ANS: C There are five steps for clinical reasoning, which involves five rights: the right cues or clinical data, the right patient or setting priorities, the right time or capability of identifying high risk patients, the right action or clinical decision that results from the clinical reasoning process, and the right reason. The right reason incorporates legal and ethical considerations.

A new nursing manager is falling behind on the staffing schedule, the monthly budget, and employee evaluations. She says to her director, "I'm working 60 hours per week and I still don't have enough time to do it all." The nursing director suggests which of the following to her? a. Setting priorities b. Obtaining additional preceptoring. c. Scheduling blocks of time for each activity to be accomplished. d. Giving up management and returning as a regular staff nurse.

ANS: C Time management involves a deliberative process of identifying, focusing, and completing activities needed to accomplish specific tasks and achieve goals. Blocking time to get tasks done is a strategy that can be used to for time management at work.

_____ is defined as the accomplishment of specified activities during the time available. a. Stress b. Mismanagement of resources c. Time management d. Self-management

ANS: C Time management is defined as the accomplishment of specified activities during the time available. It is the process of managing the things an individual does with his or her available time. At its core, time management is self-management.

A new nurse manager is provided with a smartphone in order to efficiently manage her time. What is the most effective method of managing stress related to e-mail? a. Create an auditory cue that alerts the manager to incoming messages so they can be processed immediately. b. Set aside time during meetings to read and respond to messages. c. Schedule blocks of time to tackle e-mail. d. Delete e-mails that require a lengthier response.

ANS: C Time management will not be effective if the manager is expected to respond to messages as soon as they arrive. Managers can set a rule to check e-mails two to three times per day rather than constantly and should use a sorting a flagging methodology to effectively manage the need for follow-up. Managers should not utilize meetings in order to read and respond to messages.

Job stress can accumulate into: (Select all that apply.) a. better time management skills. b. feelings of elation. c. burnout. d. physical exhaustion.

ANS: C, D Chronic stress can lead to acute and chronic health problems. Job stress is a tension that arises related to the person-in-environment demands of a person's role or job. Job stress, or "disquieting influences," can accumulate into levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion and lowered job productivity. Levels of job stress that are too low or too high decrease individual productivity.

Utilizing the DECIDE acronym for the process of decision making, what are the first and final steps in the process? (Select all that apply.) a. Develop and implement an action plan for problem solution. b. Establish criteria for what you want to accomplish. c. Define the problem and determine why anything should be done about it. d. Evaluate the decision through monitoring, troubleshooting, and feedback. e. Determine the best choice or alternative.

ANS: C, D The first step in the decision-making process using DECIDE is to define the problem and determine why anything should be done about it and explore what could be happening. The final step in the process is to evaluate the decision through monitoring, troubleshooting, and feedback.

Why is it important for nursing staff to have insight into the culture of their unit? (Select all that apply.) a. So they can understand religious practices b. To allow time for peers to access the Internet more often c. To enable nurses to understand staff behaviors d. To improve staff communication e. To allow nursing staff insight into expectations and norms

ANS: C, D, E Nurses' insight into culture enables them to better understand staff behaviors and relationships, norms, change processes, expectations, and communication

Creating a safe, empowering, and satisfying work environment can be accomplished through implementation of: a. Institute of Medicine Coalitions. b. health care reform. c. the Troubled Asset Relief Program. d. Healthy Work Environment (HWE) standards.

ANS: D A Healthy Work Environment (HWE) is one that is safe, empowering, and satisfying. The American Association of Critical-Care Nurses (AACN) has established six standards that support Healthy Work Environments (AACN, 2005). Although developed for nurses, they are applicable for all types of employees.

An intravenous infusion center is considering switching intravenous pumps to another vendor. A team of nurses is gathered to examine the benefits and uses and to conduct a cost analysis of various intravenous pumps. After thoroughly reviewing the data and piloting several intravenous pumps, the team votes to determine which pumps to use. The nurses selected the pump which provides them with the most safeguards for safe infusion delivery. Which type of decision-making tool was used in this process? a. Simulation b. Pilot project c. Data analytics d. Evidence informed

ANS: D All nurses are familiar with evidence-based practice for clinical standards of practice. In the management realm, using evidence to make decisions is as important as is using evidence for clinical decisions.

The nursing education department is revising its orientation curriculum for nurse externs. The curriculum includes a module on clinical reasoning skills. What is the expected time frame for mastery of clinical reasoning? a. Nurse externs should master clinical reasoning within 6 months. b. Clinical reasoning is mastered in nursing school. c. Clinical reasoning is never mastered. d. Clinical reasoning is a career-long process.

ANS: D Clinical reasoning is a career-long development process. This process must carry over from skills learned during a nurse's education to the workplace. Nurse residency programs are one way to help newly licensed nurses develop their clinical decision-making abilities.

Interpersonal communication and the ability to apply _____ are two critical skills every nurse needs to enhance professional practice. a. vision b. supervision c. delegation d. problem solving

ANS: D Every nurse needs two critical skills to enhance professional practice. One is a skill at interpersonal relationships. This is fundamental to leadership and the work of nursing. The second skill is applying the problem-solving process. This involves critical thinking, problem identification, and the development of objectivity.

On admission, the patient was found to have a blood glucose level of 218. The RN knows that except in emergency situations, it is hospital policy to obtain physician's orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. Because of the nurse's actions, the admitting hospital may be found to be: a. a judicial risk. b. an ostensible authority. c. indemnified. d. vicariously liable.

ANS: D If a nurse negligently injured a client during the course of and within the scope of employment, not only would the nurse be directly liable for damages, but also the health care organization would be vicariously liable

A process used to achieve and internalize knowledge, skills, and behaviors of professional nursing in order to belong and participate is referred to as professional: a. actions. b. conduct. c. ownership. d. insight

ANS: D Insight can be described as a process used to achieve knowledge, skills, and behaviors of a certain group to belong and participate. Nurses' insight enables them to better understand behaviors, relationships, norms, change processes, expectations, and communication

Nurse managers are able to respond better to ethical dilemmas when they have access to the organization's: a. mission and vision. b. patient safety plan. c. medical staff bylaws. d. ethics committee.

ANS: D It is critical that nurses and administrators have access to and inclusion on the health care organization's ethics committee. Nursing professionals are ideal members because of their responsibilities and experiences associated with patient care.

Which ethical principle is violated when there are insufficient community resources to meet the needs of low-income families? a. Nonmaleficence b. Autonomy c. Beneficence d. Justice

ANS: D Justice is the norm of being fair and giving all equal treatment. When low-income families do not get the same community resources as others, justice is not being served

Which of these clinical decisions poses the greatest risk for committing an error? a. Verifying medication dose prior to administration b. Charting by exception c. Prioritizing patient care activities d. Independent interpretation of a medication order

ANS: D Medication administration involves many decisions. In order to protect the patient, the nurse must deliver medications safely while managing the environment in order to preserve safe medication administration (Dickson & Flynn, 2012). According to Dickson and Flynn's study, medication administration involves decisions regarding managing distractions, interpreting orders, and documenting errors and near-misses. In addition, Sitterding and colleagues (2012) found that work-flow interruptions can interrupt the cognitive processes necessary for decision making

Jay, a nurse in the intensive care unit, has been caring for a patient with end-stage renal disease, congestive heart failure, and a stroke. The client has had four cardiac arrests in 4 days. Despite the grave prognosis, the client's family continues to want resuscitation at all cost. Jay knows that further medical care is futile. Jay is at risk for: a. confrontational conflict. b. resilience. c. burnout. d. moral distress.

ANS: D Moral distress is linked to issues related to patient care, including ethical dilemmas that can put professionals in difficulty and give rise to feelings of unease. It occurs when an individual knows what ethical action should occur but is prevented from doing so by either internal or external barriers (Rushton, 2006).

Individual members of a group will adapt to change at different rates. Which of the following groups would take the longest to accept change? a. Early adopters b. Late majority c. Innovators d. Laggards

ANS: D Nurse leaders need to recognize that change will be accepted at varying rates and target interventions accordingly. The five categories in order are innovators, early adopters, early majority, late majority, and laggards.

A memo sent to the unit nurse manager reads that beginning next week; all nursing staff will be expected to conform to a new dress code selected by the hospital board of directors. The nurse manager understands that change will be more effective through which manner of communication? a. Storytelling b. E-mail c. Discussion d. Open communication

ANS: D Open communication within the change process, early involvement of staff, listening to their input and concerns, and engaging them in the change may be the most effective means to assess readiness for change.

A medical-surgical unit utilizes a group of nurses and patient care assistants to determine ways to reduce the number of falls in the unit. They conduct Internet research to locate best practice interventions. They create fall risk alerts in the unit, and they implement hourly rounding to assess the need for toileting. After putting these small changes into place, they will evaluate the data to determine effectiveness. This project is an example of: a. rapid response teams. b. Failure Modes and Effects Analysis. c. root cause analysis. d. Rapid Cycle Change.

ANS: D Rapid Cycle Change is used in health care to improve patient safety and quality. It is based on the idea that changes are tried on a small scale to see how they work.

An organization has encountered a serious patient safety event that was reported to the state, The Joint Commission, and the Centers for Medicare & Medicaid Services (CMS). An extensive plan of correction was received, and the organization had to make some immediate changes in practice. Additionally the organization anticipates a costly lawsuit. What is the best method of educating staff about the practice changes that were issued? a. "These changes need to be made because the state and CMS require it." b. "We understand this is a knee-jerk reaction, but please change the practice while the surveyors are in the building." c. "We need to make this change because it will help our lawsuit." d. "This change is being made so that there is no further harm to another patient."

ANS: D Rapid Cycle Changes or those that are emergent are put into place to improve patient care, with the emphasis on patient safety and quality goals. Staff should not be educated that the changes are made based upon regulatory requirements or the avoidance of litigation. Misconceptions or inaccurate information can create resistance to change.

How is the refreezing stage of change similar to the nursing process? a. Refreezing is similar to the assessment phase of the nursing process. b. Refreezing is similar to the problem identification phase of the nursing process. c. Refreezing is like the planning and implementation phase of the nursing process. d. Refreezing is like evaluation in the nursing process.

ANS: D Refreezing is like evaluation in the nursing process.

Which of the following factors is used to describe the degree to which successful planned change is thought to be better than the status quo? a. Complexity b. Compatibility c. Trialability d. Relative advantage

ANS: D Relative advantage is one of the factors that helps determine successful planned change. It is the degree to which the change is thought to be better than the status quo.

How is SBAR used in decision making? a. Prevents cognitive errors b. Data management tool c. Financial tool d. Effective communication technique

ANS: D SBAR is a communication technique that helps members of the health team communicate effectively so that appropriate decisions can be made. Because hands-off communication is so crucial to decision making about patient care, SBAR is used to clarify and organize essential but complex patient care information.

Which of the following exemplifies a safety climate within a nursing unit? a. Asking nursing staff to work a double shift b. Encouraging nurses to take the blame when a medication error occurs c. Asking staff to report medication errors only d. Asking staff to report near-misses of adverse events

ANS: D Safety climate refers to keeping both patients and nurses safe. Part of a safety culture encourages nurses to report adverse events as well as near-misses of adverse events. Factors that influence avoidance of errors include staffing levels, excess fatigue, education, and experience.

The nursing manager has assumed responsibility for ensuring that tasks within her department are delegated legally and are performed appropriately. In so doing, she has accepted which of the following nursing roles? a. Ethical b. Ombudsman c. Paralegal d. Supervisor

ANS: D Supervision includes monitoring the tasks performed, ensuring that functions are performed in an appropriate fashion, and ensuring that assigned tasks and functions do not exceed competency or require a license to perform

Nursing management is defined as: a. delegation of authority and responsibility and the coordination of tasks. b. the integration of resources through planning, organizing, and directing. c. the process of influencing patients to accomplish goals. d. the coordination and integration of nursing resources by applying the management process to accomplish nursing care and service goals and objectives.

ANS: D The coordination and integration of nursing resources by applying the management process to accomplish nursing care and service goals and objectives is the definition of nursing management.

What is the purpose of a mission statement? a. To provide a method of achieving success and a competitive advantage b. To aid recruitment c. To guide members on problem solving and relationship management d. To offer a snapshot of strategic priorities

ANS: D The mission statement for an organization offers a snapshot of strategic priorities and is an important way to get a sense of organizational values. A deeper understanding of cultural issues in an organization helps people understand how to improve outcomes.

Nurses who are successful at time management: a. display an ability to set measurable goals and objectives. b. frequently volunteer for new and creative projects. c. hesitate to delegate because of perfectionist characteristics. d. tend to accomplish specific activities within a time frame.

ANS: D Time management is accomplishing specific activities during the time available. It is a process of managing the things an individual does with his or her available time

The first critical step in creating an environment to prevent and address work-related stress is: a. delegation. b. motivation. c. innovation. d. intention.

ANS: D To prevent and address work-related stress, creation and innovation are needed. A creation is something new that did not previously exist in that form and occurs in a multitude of fields, not just the arts (Creation, n.d.). Experts who study creativity may differ on the requisite attributes of creative individuals and exact steps in the creative process. However, most agree that intention is the critical first step (Ditkoff, 2010). Without intention, no action is ever taken.

_____ are vital to good leaders because they are able to take the vision of the leader and achieve the determined goals. a. Managers b. Motivators c. Visionaries d. Followers

ANS: D Without followers, there is no leadership. Followers are vital because they accept or reject the leader and determine the leader's personal power.

Nurses on the midnight shift are experiencing difficulty with receiving materials from the central supply department. Last night a patient was admitted to the unit from the emergency department with a heart dysrhythmia. The nurse requested that a temporary pacemaker kit be placed in the unit as a standby in case the patient required its use. The central supply unit did not comply until the patient required its emergent use. The nurse was stressed. This is an example of which type of stress? a. Job stress b. Overload of role c. Moral distress d. Role conflict

ANS:A Job stress is a tension that arises related to the person-in-environment demands of a person's role or job. Job stress, or "disquieting influences," can accumulate into levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion and lowered job productivity

A client becomes confused after surgery. He is in a room farthest away from the nurses' station. The client tries to get out of bed several times during the shift. The nurse informs the physician and obtains an order for soft restraints. In addition she moves the client close to the station and assigns a sitter to watch him. Which of the following did the nurse utilize? (Select all that apply.) a. Clinical judgment b. Clinical decision making c. Autocratic decision d. Financial decision

ANS:A,B Clinical judgment and clinical decision making were utilized in determining the measures that would promote patient safety and prevent a fall.

In setting boundaries it is important to do which of the following? a. Set rigid boundaries. b. Set boundaries based on individual needs. c. Consider where one is in the lifespan when setting boundaries. d. Set boundaries even if it produces more stress than not having boundaries at all.

ANS:B Boundaries need not be exceedingly rigid and may change over time. Boundaries should be set based on individual needs, not gender, stereotypes, or even where someone is on the lifespan. The most important thing is that setting them should not induce more stress on the individual than not having them at all.

A multidisciplinary team makes a decision to develop a plan for the use of thrombolytics in the emergency medical service system. Questions are asked such as, "Is the client a candidate for thrombolytic therapy? Does the client have a history of gastrointestinal bleeding? Has the client ever had a stroke? Does the client have any bleeding disorders?" Which of the following decision-making strategies would work best in this situation? a. Fishbone diagram b. Decision tree c. Flowchart d. Data analytics

ANS:B Diagrams such as decision trees can be invaluable in understanding complicated alternative solutions. These diagrams are useful in assessment and problem definition and in considering the available alternatives for dealing with a problem. Once the alternative is chosen, a plan must be formulated for implementing the approach chosen. The choice implemented must be evaluated.

_____ is an expected part of change and is often related to fear and anxiety. a. Depression b. Resistance c. Acceptance d. Denial

ANS:B Resistance to change should be expected as integral to the process of change. It may be rooted in anxiety or fear.

According to the ___________ people move through a series of states when modifying their behavior. a. Organizational Change-Readiness Scale (OCRS) b. Transtheoretical Stages of Change Model c. Rapid Cycle Change d. plan-do-study-act model

ANS:B The Transtheoretical Stages of Change Model used research to show that people move through a series of stages when modifying their behavior. Readiness to change is a key aspect.

A family member of a patient files a complaint that her mother's dentures were lost when the patient was transferred from one unit to another. The risk management department interviews the patient and the staff nurses who cared for the patient. Which of the following problem-solving techniques was used? a. Delegation b. Direct intervention c. Indirect intervention d. Purposeful inaction

ANS:B The focus of leadership and management decision making is more closely related to the nurse's role as care coordinator and systems problem solver. Some decisions, such as those requiring disciplinary action, do require the manager's direct intervention.

What are some potential reasons that nurses experience higher levels of stress? (Select all that apply.) a. Nurses are skilled at setting boundaries. b. Nurses often put others' needs ahead of their own. c. Staff nurses are under pressure to do more with less. d. There are support staff cuts. e. There are fluctuations in staffing levels.

ANS:B,C,D,E Staff nurses are under constant pressure to do more with less, and this can cause professional and personal stress for staff as well as managers. Support staff have been cut, jobs are fewer, and staffing levels fluctuate. Nurses may have a difficult time dealing with stress, because they often put others' needs ahead of their own and need to be able to create healthy boundaries.

Max is a nurse on the 7 PM to 7 AM shift on the orthopedic floor. He is the most experienced nurse on the unit during this shift, with 6 years of nursing experience. Max usually acts as charge nurse during his shift while caring for a group of patients. Recently there has been an influx of new graduates working on his shift. Some nights, he is expected to orient a new nurse, act as the charge nurse, and mentor other new nurses working on the floor. He is concerned that with all the new nurses, there are not enough mentors for all of them, resulting in less-than-optimal care delivery. Which factors have been shown to decrease stress for nurse leaders? (Select all that apply.) a. Support from others b. Autonomy c. Predictability d. Transparency

ANS;A,B,C High stress is experienced by nurse leaders and stems from the challenges of a multifaceted job with myriad sources of stress. Having support from others (e.g., supervisors, comanagers, and coworkers) is a factor that decreases stress (Kath et al., 2012; Shirey et al., 2010). The amount of autonomy and predictability in the job mitigates the negative effects of stress as well (Kath et al., 2012).

A medical-surgical unit reports higher rates of patient satisfaction coupled with high rates of staff satisfaction and productivity. Which of the following is attributed to the data findings? a. Effective leadership b. Management involvement c. Mentoring d. Rewards and recognition

a. Effective leadership Effective leadership is important in nursing because of the impact on nurses' work lives, it being a stabilizing influence during change, and for nurses' productivity and quality of care.

A staff registered nurse (RN) is leading a multidisciplinary clinical pathway team in the development of care for patients with total knee replacement. Which of the following statements exemplifies leadership behaviors in a clinical pathway team meeting? a. "Nursing is responsible for pain control of the total knee replacement patient." b. "Our pharmacist has provided some excellent pain control literature." c. "Physical therapy's expertise is in rehabilitation, not pain control." d. "Total knee replacement patients require optimal pain control."

b. "Our pharmacist has provided some excellent pain control literature." Leadership is the process of influencing people to accomplish goals by inspiring confidence and support among followers. The correct answer is supportive of a team member's work and depicts some skill at interpersonal relationships.

During a staff meeting, a group of RNs has complained that medications are not arriving to the unit in a timely manner. The nurse manager suggests that the group resolve this issue through the development and work of a multidisciplinary team led by one of these RNs. This scenario demonstrates: a. adaptation. b. empowerment. c. flexibility. d. relationship management.

b. empowerment. Empowerment is the giving of authority, responsibility, and the freedom to act. In this situation, the manager has given authority, responsibility, and the freedom to act in the investigation and resolution of this issue.