Leadership exam 2
A busy neurologic ICU and step-down unit most likely would use which patient classification system? a. factor evaluation b. prototype evaluation c. hybrid system d. AHRQ system
ANS A
A charge nurse on a busy 40 bed medical/surgical unit is approached by a pts son, who begins to complain loudly about the quality of care his mother is receiving. His behavior is so disruptive that it is overheard by staff, physicians, and other visitors. the family member rejects any attempt to intervene therapeutically to resolve the issue. He leaves the unit abruptly, and the nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner? a. reflection to obtain insight into how the situation could be handled differently in the future b. trying to catch up with the angry family members to resolve the concern c. discussing the concern with the patient after the family member has left d. notifying the nursing administration of the situation
ANS A
A client requires an appendectomy. The surgeon explains the procedure and asks the client to sign the consent. The patient speaks very little English and looks worried. What is the appropriate action by the nurse? a. suggest that an interpreter explain the procedure to the client and answer any questions b. ask the client if he has any questions c. draw a picture to show the incision d. not intervene
ANS A
A family is keeping vigil at a critically ill patients bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with such situations. What role are you assuming through this action? a. manager b. leader c. follower d. laissez faire
ANS A
A nurse leader wants to be the best leader she can. The nurse takes classes, finds and leadership mentor, seeks input from her unit, and employs other strategies for leadership development. What is another strategy for the leader to develop and improve leadership skills? a. proactive learning b. ignoring feedback c. being in charge d. Authoritative position
ANS A
A nurse manager is implementing strategies to support the steps in the AHRQ document "five steps to safer health care". What does the manager include in the implementation? a. patients are activelty encouraged to make decisions related to care b. rules and decisions are made through centralized processes c. you monitor the performance of each staff member closely d. preference is given to increasing staff numbers rather than staff credentials
ANS A
As a manager in a nursing home where might you consult for guidance and evidence to support the development of safe patient practices? a. hospitals b. business c. industry d. outpatient clinics
ANS A
As a nurse manager, you are aware of leadership management, and followership principles. What is the first step to becoming an effective leader? a. being an effective follower b. taking a class on leadership c. taking a class on management d. getting an advanced degree
ANS A
As the unit manager, you post the staffing plan and compliance reports. This initiative is aimed at: a. Maintaining unit morale. b. Complying with national requirements. c. Demonstrating patient outcomes. d. Inviting staff participation in decision making.
ANS A
At the end of a shift, the charge nurse shares with the new nurse she had done an excellent job with a difficult patient that day. The new nurse was upset by the way the family of the patient had treated her. She shared her feeling with the charge nurse. The charge nurse offered to change the assignment the following day. What is the charge nurse displaying? a. emotional intelligence b. comportment c. compassion d. management of conflict
ANS A
During review of back injuries, it is determined that a large number of injuries are occurring in spite of mechanical lifts being used. Furthermore, it is determined that some lifts are outdated. In addressing this concern, the unit manager: a. Meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure. b. After consultation with the staff about the review, orders new lifts to replace older ones that are malfunctioning. c. Blames the system for inadequate funding for resources. d. Reviews the system of reporting incidents to ensure that appropriate reporting is occurring.
ANS A
In developing leadership skills, one should focus on authentic leadership. The theory of authentic leadership focuses on various factor. What is the top priority in development of authentic leadership? a. Honest relationships b. organizational task c. accomplishment of goals d. exploring others
ANS A
Pleasant Valley Hospital has amended its safety practices and policies. What has the hospital elected to emphasize accordance with changes by The Joint Commission (TJC)? a. Safety goals specific to Pleasant Valley b. Decision-making processes c. Sufficient staffing for safe care d. Increased numbers of baccalaureate-prepared RNs
ANS A
Sarah is a second-year nursing student. The clinical instructor overhears Sarah telling a patient that she "always" checks patients' bracelets before giving medication and she is not sure how the nurses on the unit "get away with" not making more errors than they do. The clinical instructor pulls Sarah aside and explores with her how her communication might affect the patient and what it reflects about her beliefs related to the team. The actions of the clinical instructor reflect competencies outlined by: a. QSEN. b. IHI. c. DNV/NIAHO. d. AHRQ.
ANS A
The chief nursing officer (CNO) is appointed for the local hospital in a rural area. The nursing committee agreed with the appointment of the new CNO offered the position. What is this type of leadership position considered? a. formal leadership b. informal leadership c. director leadership d. personal leadership
ANS A
The difference between staffing and scheduling is that staffing: a. puts the right person in the right position b. puts the right person in the right time and place c. refers to the number of nursing hours per patient per day d. looks after interpretation of benefits and compensation
ANS A
The manager is using self-reflection to gain insight into improving the leadership skills. By using self-awareness what does a leader develop? a. New knowledge b. Personal growth c. Improved self esteem d. Management skills
ANS A
The manager of a surgical area envisions a future that requires the addition of registered nurse (RN) assistants or unlicensed persons to feed, bathe, and walk patients. The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea. The best initial strategy in this situation would include a. exploring the values of the RNs in relation to this change. b. leaving the RNs alone for a time so they can think about the change before they are approached again. c. dropping the idea and trying for the change in another year or so. d. hiring the assistants and allowing the RNs to see what good additions they are
ANS A
The nurse is educating older adult patients on staying safe in the healthcare system. What information does the nurse include in the teaching? a. the need to understand and record all medications being taken b. bringing their own linens and other personal items to the hospital c. washing hands frequently while in a healthcare environment and using a hand sanitizer d. following closely the directions and orders of healthcare providers
ANS A
The nurse on the 7-7 shift is assigning a specific component of care to an unlicensed nursing personnel (UNP) employee. The night nurse would remain a. accountable b. responsible c. authoratitive and liable d. responsible and task oriented
ANS A
The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are angry and ask for a meeting to discuss the change. After hearign their concerns related to reduction in professional autonomy and care quality, you a. acknowledge the loss b. explain the reasons for change, emphasizing the needs to reduce cost c. repeat the information several times, giving detailes budget overviews d. adjourn the meeting and provide explanation through e-mail
ANS A
To achieve nurse-sensitive care standards developed by the NQF, you advocate for which of the following in your health facility? a. Evidence-based practice to reduce the prevalence of pressure sores b. Implementation of informatics at the bedside c. Staff-manager conferences to review reporting of adverse medical events d. Patient councils to review food, recreation, and nurse-patient relations
ANS A
To maintain patient safety, studies suggest that scheduling should avoid: a. rotating shifts b. weekends c. 8 hour shifts d. mandatory overtime
ANS A
To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages. To maximize patient safety and reduce costs, the healthcare organization: a. develops a centralized pool of float nurses b. assigns nurses from less busy units to ones with increased acuity levels c. floats nurses only between units on which the nurses have been cross-trained d. assigns float nurses to basic care only
ANS A
What does the SBAR approach to patient safety encourage? a. consistency in assessment and practices b. continuing education c. multidisciplinary approaches d. Patient feedback
ANS A
What would managers and staff review annually in order to ensure compliance with The Joint Commission (TJC) to improve patient safety? a. Appropriateness of charting terms and abbreviations b. Nursing hours per patient c. Acuity of patient admissions d. Wait times for care
ANS A
Which of the following would be most in line with Hersey model and concepts? a. the team of caregivers on day shift are familiar with their roles and with the patients. the nurse manager decides to work on the unit budget in her office b. After a year of working on the unit, Shari, an LPN, is still hesitant about many policies and procedures. The charge nurse decides to challenge Shari with more difficult patients c. The nursing supervisor asks one of her charge nurses to lead a technology integration project. The supervisor continuously demands involvement in decisions that the charge nurse is making in the project d. team members complain that Alysha, an RN, is unmotivated, and that she refuses assignments that are complex or difficult. The charge nurse suggests that Alysha is relatively new and that she needs time to adjust
ANS A
You notice that sally, a student on your unit, is giving information to an anxious young teen who seems very uncertain about preparation for an upper GI series. After sally leaves the room, you ask her how she thought her conversation with the patient went. What is the appropriate response for you to give sally? a. encourage her to ask the pt if he has questions or concerns about the procedure b. advise her to consider providing the patient with more information c. suggest that she leave some brochures on the procedure with the patients d, suggest that she also provide teaching to the adolescents parents
ANS A
You pull staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions. Staff members are becoming distanced from the family. After inviting the concerns of staff, you explain that the organization values patient-centered care and that evidence supports that acting as an advocate and a listener is helpful to families. You ask the staff for ideas as to strategies that are effectively patient-centered in these situations. In this situation, you are taking on which role? a. Leadership b. Management c. Follower d. Visionary
ANS A
a nurse manager must also consider a number of internal variables that will affect staffing patterns. An internal variables to be considered it: a. organizational staffing policies b. state licensing standards c. american nurses association d. consumer expectations
ANS A
what facilitate the development of decision-making skills related to safe patient care for a nurse manager? a. regular reflection on decisions b. a culture of perfectionism c. recognition of who should be held responsible for individual errors d. a culture of trust between the staff and you
ANS A
Sarah is concerned about your direction regarding management of incontinent, confused patients. She brings you evidence that she has found regarding incontinence interventions and asks you whether she and you could talk about the guidance that you have given after you have had an opportunity to read the articles. This is an example of... (select all that apply) a. leadership b. followership c. management d. insubordination
ANS A, B
As a nurse manager and the leader of the unit, you are aware of multiple avenues for learning leadership traits. Which avenues would you pursue for learning leadership traits? (select all that apply) a. attending professional conferences b. reading books on leadership c. joining professional organizations d. connecting with other leaders in the organization e. experiences from new nurses
ANS A, B, C, D
An example of a nursing care activity that would not be delegated by an RN to a UNP is: (Select all that apply.) a. teaching self-catheterization to a patient with paraplegia who has limited English. b. basic care for a patient with a head injury who is rapidly deteriorating. c. one-to-one observation with a suicidal patient. d. assessment of patients being admitted through the Emergency Department. e. basic hygienic care for a patient who is post MI and stable.
ANS A, B, D
What patients would be considered "at risk" consumers during a healthcare visit? (Select all that apply.) a. Clyde requires an anticoagulant. He tells the nurse about his medications. He does not include an herbal supplement. b. George is very shy and withdrawn. He asks the nurse to leave him alone. c. Sarah is a new parent who finds that nurses on the children's unit are very helpful. She is eager to accept all suggestions, including those that she does not yet understand. d. Claude is booked for bowel surgery. His doctor explains about the colostomy. Later, Claude tells his wife that he really doesn't know what the doctor meant by colostomy.
ANS A, C, D
In reviewing the job description of a nurse manager, the staff becomes aware that a nurse manager's role is complex. Which of the following duties are required of a nurse manager? (SATA) a. ensure unit productivity reports b. develop policy and legislation to protect nurses well-being c. plan staffing of UNPs only d. prepare a unit budget that reflects unit staffing needs e. monitor nure sensitive indicators such as falls and incidence of infections
ANS A, D, E
A new nurse sees a flyer for a workshop on healthcare relationship building and recognizes that relationship building with those in current leadership positions is challenging for her. She decides to attend. By making the decision to attend what is the new nurse demonstrating? a. social awareness b. self-management c. strengths-based learning d. personal leadership
ANS B
A nurse manager uses many sources of data when planning the unit's workload for the year. Which of the following data must be considered in the planning? a. hours of operation of the unit b. trends in acuity on the unit c. maximum work stretch for each employee d. weekend requirements
ANS B
A nurse manager when in the formal leadership position attempts to translate the picture or vision of her facility across for the staff nurses. the manager is faced with a staff who is resistant to the vision of the facility. What is the theory the manager needs to incorporate to be effective? a. model the way b. inspire a shared vision c. challenge the process d. the four agreements
ANS B
A nurse staffing plan takes into account: a. specific nurse-to-patient ratios per shift b. participation of nurses in projecting staffing needs c. compensation and benefits for each level of staff d. the occupancy load of a unit
ANS B
A particular classification system assigns revenue according to the functional capacity of patients and the progression of patients during their stay in rehabilitation units. More independent patient activities, such as prompted voiding, require higher staff utilization than dependent activities but do not result in increased staff resources. This is an example of: a. Bureaucracy. b. Concern related to the validity of classification systems. c. Inadequate reliability of classification systems. d. Inappropriate subjectivity in making judgments about staffing.
ANS B
A small rural hospital has been designated as a critical access hospital. It has 40 beds and an average occupancy of 34 beds. To prepare the staffing, the chief nursing officer computes the occupancy as being: a. 90% b. 85% c. 75% d. 60%
ANS B
A staff nurse is taking leadership classes in an advanced degree program as the nurse wants to become a manager. the instructor requires the students to create a journal and make notes of their feelings when they experience conflicts at work over the next few weeks. the assignment calls for the use of reflection. What is the purpose of this assignment? a. log of conflicts which occur b. reflection for self-awareness in conflict situations c. assess the students conflict management skills d. analysis of student lead conflicts
ANS B
A staff nurse is the person on the unit everyone seeks for input and asks questions. What type of leadership position is the staff nurse displaying? a. position leadership b. informal leadership c. personal leadership d. formal leadership
ANS B
A staff nurse wants to become a charge nurse. What is one of the most effective methods for the stafff nurse ot incorporate to effectively transition to charge nurse? a. read a book on charge position b. integrate prior experience to nre role c. do things the way always done d. change units to be a charge on different unit
ANS B
As a leader on a rehab unit, you encourage all staff members to see themselves as having a role in decision making and quality care. You see your role as involving particular responsibilities in decision making but not as a hierarchal role. This view of decision making and leadership is consistent with: a. Trait theories. b. Complexity theory. c. Situated theory. d. Emotional intelligence.
ANS B
Chart audits have revealed significant omissions of data that could have legal and funding guidelines. As the unit manager, you meet with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. This is an example of: a. Leadership. b. Management. c. Decision making. d. Vision.
ANS B
During a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on: a. Supportive behavior by the leader and immature followers. b. The development level of the followers and the type of behavior of the leader based on the situation c. Well-developed followers combined with a strong leader who acts quickly. d. The leader's ability to evaluate personnel and communicate that evaluation.
ANS B
During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is a. empowering b. a leadership tag c. a symbol d. a management task
ANS B
During staff development programs, staff nurses verbalize their frustration about their workloads and having to delegate so many tasks to others. One of the main reasons that delegation has emerged as an issue is because of: a. The amount of paperwork required to complete care. b. The complexity of client care. c. Earlier discharge practices. d. The numbers of other disciplines present on a given unit.
ANS B
Functions such as "delegates tasks to assistive personnel" that are outlined in a position description for an RN Team Leader would be considered: a. Active delegation. b. Passive delegation. c. Passive accountability. d. Active responsibility.
ANS B
Marie-Claire, the nursing unit manager, finds it difficult to work with Thomas, a new graduate. Thomas has many ideas, and his manner of presenting them irks Marie-Claire. After reflection and discussion with others, Marie-Claire recognizes that she also feels threatened by his behavior. She comes to understand that Thomas is trying to establish his own role on the unit, is not trying to challenge her, and needs guidance, coaching, and affirmation. Marie-Claire is demonstrating a. a positive self-concept. b. deepening self-awareness. c. leadership. d. acquiescence.
ANS B
Staff members on your unit raise concern that there is rising acuity on the unit and lack of responsiveness in addressing these needs through appropriate staffing. They point to increased incidences of adverse and sentinel events on the unit. To address this concern, your hospital organization would do best to: a. Implement a patient classification system immediately. b. Participate in databases that compare the outcomes and staffing levels versus those of institutions similar to yours. c. Provide increased numbers of staff to the unit. d. Ignore such concerns because acuity is variable.
ANS B
The NQF provides a model for advancement of healthcare quality that could be used in healthcare organizations. What does the use of this model by the Centers for Medicare and Medicaid Services specificity link with adverse pt events for healthcare facilities? a. staffing b. funding c. composition of executive councils d. composition of consumer based councils
ANS B
The charge nurse of a unti is asking the staff what patients they have had the day before to make assignments for the day. A new nurse complains about having the same patients every day. The charge nurse considers the new nurse request at an assigned to different patient for today. What type of leadership is the charge nurse displaying? a. informal leadership b. formal leadership c. favoritism d. no leadership displayed
ANS B
The day shift nurse asks an LPN/LVN to complete a task for a patient. The day shift nurse is engaging in what function? a. delegating b. assigning c. sharing d. authorizing
ANS B
The manager of a nursing unit is having difficulty working with a new graduate nurse. The new graduate nurse is excited and full of ideas she wants to try. The manager decides to journal her feelings regarding the new nurse and her feelings. what is the nurse manager practicing in this situation? a. Leadership b. Reflection c. Knowledge d. Action
ANS B
The nurse manager is working with a group of new nurses. The new nurses ask questions about leadership and the role of a manager in leading nurisng. The manager shares she has incorporated her core values and beliefs into her role and responsibilities as a nurse manager. What type of leadership had she described? a. positional leadership b. personal leadership c. formal leadership d. information leadership
ANS B
To project staffing needs and to avoid understaffing, it is important that nurse managers consider which of the following? a. Maximum productive hours b. Average nonproductive hours c. minimum benefit hours d. maximum vacation time
ANS B
What did the IOM Health Professions Education report highlight as a concern for patient safety? a. A normal risk in professional practice b. A result of disciplinary silos c. A reflection of frontline staff d. Related to systems errors
ANS B
Which of the following indicates safe delegation? a. the nurse supervisor for a large urban acute care department asks the unit manager to accept two new acutely ill patients, which the manager does. the unit is short two staff, and the replacement is inexperienced b. a unit manager agrees to release a staff from her unit to unit B. The staff member she agrees to release is experienced on unit B and is agreeable to the change. The unit manager's unit is fully staffed and patients are stable c. the nurse supervisor asks the head nurse for Unit A to make do without a replacement for an ill staff member because unit A was originally overstaffed anyway. Patient acuity levels are very high on Unit A and two staff are orienting d. The nurse supervisor asks the charge nurse on unit B to cover unit F, which is two floors up, because the charge nurse for unit F is ill. The charge nurse for unit B is an experienced manager but has no experience with the nursing care required on unit F
ANS B
With delegation, responsibility and accountability remain with the: a. Physician. b. Professional who delegates. c. Individual who receives the delegation. d. Individual who previously performed the task.
ANS B
You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Before assigning Evelyn to Mrs. N's care, the most appropriate action of the care coordinator would have been to: a. determine Evelyn's educational background and preparation for this role b. ask Evelyn if she has worked with inhalers before and to describe what she knows about them c. advise that if Evelyn has any questions about what to do with the enhaler, she should come to the coordinator d. advise Evelyn that working the inhaler is not really complicated and that she should ask the patient how to check the medication levels in the inhaler
ANS B
You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Determination of Evelyn's educational preparation and certification is related to the concept of: a. Accountability. b. Authority. c. Role performance. d. Assignment.
ANS B
You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. This incident is an example of: a. incompetence of the UNP b. Failure to follow-through c. skills but no motivation d. lack of accountability
ANS B
You overhear a newly graduated RN telling one of your colleagues that leadership and management belong to the unit manager and not to her. Because you are a nursing colleague, your response demonstrates understanding that the perception ot the new graduate a. is accurately reflected in the new graduates statement b. would benefit from further understanding of her role as a professional in relation to decision-making c. has been influenced by nurse leaders and managers who leave for other positions d. is related ot the general perception that nurse leaders and managers are not satisfied in their jobs
ANS B
as the charge nurse on the night shift in a small long-term care facility, you have found that there is little turnover among your licensed practical nurse and nursing assistant (NA) staff members, but they are not very motivated to work beyond their job descriptions. which of the following strategies might motivate the staff and lead to greater job satisfaction? a. ask the director of nursing to offer higher wages and bonuses for extra work for the night licensed practical nurses and NAs b. allow the licensed practical nurses and NAs greater decision-making power within the scope of their positions in the institution c. help the licensed practical nurses and NAs with their work, whenever possible d. ask the director of nursing to increase job security for night staff by having them sign contracts that guarantee work
ANS B
shortly after being informed of fetal death, a laboring woman asks why she is not able to hear her babies heartbeat on the monitor anymore. Although the monitor folume had been turned off so the that the patient would be able to sleep between contractions, the nurse responded that there was no heartbeat to hear because the baby had died in tuero; then the nurse asked whether the patient would like to talk about how she was feeling. this response demonstrates a. lack of empathy b. ethical leadership c. complexity science d. a coercive relationship
ANS B
the core of leadership is awareness. the text by DOn Miguel, The Four Agreements, presents a set of agreements to enhance personal growth and awareness. What is NOT one of the four agreements a. be impeccable with your word b. take things personally c. do not make assumptions d. always do your best
ANS B
A factor evaluation system: a. utilizes financial data to determine number of staff-to-patient rations b. utilizes DRGs to determine acuity on a unit c. combines interventions and time required for interventions to determine level of care required d. combines financial resources and nursing interventions to determine patient contact hours
ANS C
After meeting with members of the family of a dying patient, the nurse manager discusses with you the family's desired approach to care, and you support the manager's decision. You indicate that you are acting in what role? a. leadership b. management c. followership d. evidence-informed
ANS C
An RN colleague, who is a long-standing and collaborative member of your team, is performing a complex dressing with new orders written for the first time for the patient to whom she has been assigned. Which of the following would be the most appropriate communication with her? a. "How do you usually do this kind of dressing?" b. "The dressing needs to be done today and tomorrow with the supplies on this cart." c. "Here is what you need for the dressing, and I will show you what needs to be done." d. "I know you know what you are doing. Let me know if you have any problems."
ANS C
An important aspect of managing the costs of a unit is to plan accurately for staffing needs. Nurse managers use staffing plans to: a. assign staff on the unit on a daily basis b. ensure that days off are planned for the staff c. outline the number of individuals by classification on a per-shift basis d. predict the numbers and classification of float staff needed to augment regular staff
ANS C
As a leader in nursing, one must seek new insights and establish personal tools to improve their lifelong learning. Which behavior by manager would be a concern for a chief nursing executive? a. Journaling for self-reflection b. Authentic relationships c. Complacent behavior d. Improved knowledge of staff
ANS C
As a nurse manager, you are a leader in health care and on the unit you manage. Looking at the larger picture of health care and patient environment on the unit, what is your primary role when evaluating the care provided on your nursing unit? a. focus on cosst outcomes b. assess staff for contentment on unit c. ensure quality patient care on unit d. provide education to the staff on the unit
ANS C
County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah provides Colleen, her RN colleague with details regarding the patients to whom Colleen has been assigned on the day shift. This is an example of: a. Accountability. b. Responsibility. c. Assignment. d. Delegation.
ANS C
County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah's activity in the example described is termed: a. passive delegation b. passive accountability c. active delegation d. active responsibility
ANS C
How would the nurse executive begin to increase safety in patient care areas of the valley hospital? a. Asking the community what the safety issues are b. consulting with a management expert about staffing schedules c. ensuring that the senior nursing officer attends the board meetings d. instituting improved practices to reduce neeldestick injuries
ANS C
In a job interview for a staff position, which of the folllowing indicates your knowledge of patient safety? a. will I be able to get overtime hours on your unit? b. if there is an opportunity to work extra shifts, I would really like that c. is there a strategy in place to reduce the number of overtime hours on the unit d. I see no reason why I wouldnt be able to work overtime
ANS C
In evaluating weekend mortality rates, the head nurse on the cardiac unit is surprised to find that they are higher than on weekdays. In exploring the reasons for this apparent anomaly, the head nurse focuses on: a. availability of diagnostic personnel b. avialability of physicians c. communication with on-call providers d. acuity level of patients
ANS C
Mary, an 85-year-old patient with cognitive impairment and gross instability, wanders continuously. Lately, she has fallen twice, and the family demands that she be restrained. As the unit manager, you have initiated a least restraint practice. An appropriate action in this situation would be: a. Setting up a nursing team meeting to review practices. b. Calling the family to inform them of the practice. c. Initiating a multidisciplinary and family meeting to focus on Mary's needs. d. Restraining Mary to satisfy the family's wishes.
ANS C
Scheduling is a function fo implementing the staffing plan by assigning unit personnel to work specific hours and specific days of the week. To retain nursing staff, the nurse manager must incorporate in to the schedule plan: a. all weekends off b. all holidays off c. a variety of scheduling options d. rotating shifts
ANS C
The charge nurse is making patient assignments for the next shift on the unit. There is one critical patient on the unit, who is going to require more care than the other patients. Before delegating this patient in an assignment, what is the appropriate action by the charge nurse? a. delegate the admission to the LPN b. review the employees performance assessment for the most recent period c. assess the amount of guidance and support needed for the nursing care of the patient d. create a task analysis of critical behaviors for the individual
ANS C
The rehabilitation unit at pleasant valleyhospital has a high number of falls. What interventions might assist to reduce the number of falls on the unit? a. determining who is responsible for the falls b. strengthening unit policies to avoid inappropriate admisisons c. encouraging involvement for nurse in education related to falls and safety d. ensuring that patients are appropriately restrained if they are at risk for falls
ANS C
The unit manager is working in a large metropolitan facility and is told that two UNPs are to be assigned to work with her. Delegation begins with a. acknowledging the arrival of the second UNP on the unit b. providing clear directions to both UNPs c. Matching tasks with qualified persons d. recieving reports from the prior shift
ANS C
To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time. When calculating paid nonproductive time, the nurse manager considers: a. Work time, educational time, and holiday time. b. Paid hours minus worked hours. c. Vacation time, holiday time, and sick time. d. Paid hours minus meeting time.
ANS C
Which of the following exemplifies accountability? Karen, the nurse manager on 5E a. consistently submits her budgets on time b. gets along well with her staff and with other managers c. outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury d. actively solicits ideas regarding scheduling from her staff
ANS C
Which of the following is an example of a formal leadership position on a nursing unit? a. staff nurse b. unit secretary c. unit manager d. nursing assistant
ANS C
You recently acquired a position as a unit manager. During your time on the unit, you have formed a strong social network among your staff, have promoted the development of relationships between your staff and workers in other areas of the organization, and have formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, you are engaging which principle? a. Empowerment b. Systematic thinking c. Development of networks d. Bottom-up interactions
ANS C
a grievance brought by a staff nurse against the unit manager requires mediation. at the first mediation session, the staff nurse repeatedly calls the unit managers actions unfair, and the unit manager continues to reiterate the reasons for the actions. what would be the best course of action at this time? a. send the two disputants away to reach their own resolution b. involve another staff nurse in the discussion so as to clarify issues c. ask each party to examine her own motives and issues in the conflict d. continue to listen as the parties repeat their thoughts and feelings about the conflict
ANS C
as the nurse manager, you want to increase motivation by providing motivating factors. which action would you select? a. collaborate with the human resources/personnel department to develop on-site daycare services b. provide a hierarchical organizational structure c. implement a model of shared governance d. promote the development of a flexible benefits package
ANS C
excellent leaders need to have or develop the skills of empathy and expressiveness when dealing with others in the workplace. This is also known as understanding and managing own feelings and emotions as well as discerning the emotions of others. What is this an example of required by good leaders? a. Social awareness b. Self-awareness c. Emotional intelligence d. intellectual ability
ANS C
which category is unique to leadership but is not part of management? a. initiate change b. personal qualities c. developing people d. information management
ANS C
you walk into a patients room and find him yelling at the licensed practical nurse. the patient is obviously very upset, and after you speak with him regarding his behavior, you determine that he has not slept for 3 nights because of unrelieved pain levels. The licensed practical nurse is very upset with him and calls him and "ugly, old man." you acknowledge her feelings and concerns and then suggests that the patients behavior was aggressive but is related to lack of sleep and to pain. You ask "can both you and the patient together determine triggers for the pain and effective approaches to controlling his pain?" This approach demonstrates a. lack of empathy and understanding for the licensed practical nurse b. concern with placating the patient c. leadership behavior d. management behavior
ANS C
A key advantage that a charge nurse has in terms of delegating is that a. clients recieve less attention because too many staff make it difficult to coordinate care b. nurses report less pressure to perform necessary tasks themselves c. administration can predict overtime more accurately d. team skills can be used more effectively
ANS D
A new graduate nurse has accepted a position in an intensive care unit. The nurse is assigned a preceptor with several years of experience. The new nurse also notices the other staff seek this nurse out for answers to questions and as a resource to the unit. What does the new nurse consider the role of the mentor nurse? a. a formal leader b. a positional leader c. an official leader d. an informal leader
ANS D
A new nurse works on a busy medical-surgical unit. While the charge nurse keeps the unit organized and runnign smoothly, the nurse notices that another experienced nurse is the nurse to whom most of the other nurses ask questions and seek information. How does the new nurse view this experienced nurse? a. a formal leader b. a positional leader c. an official leader d. an informal leader
ANS D
A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the units staffing needs. An external variable to be considered is: a. organizational staffing policies b. staffing models c. changes in services that will be offered d. department of health licensing standards
ANS D
A strategy to increase RN staff retention at velley hospital includes: a. Better compensation and benefits b. clearer position descriptions c. lay-offs of nursing assistants d. adequate staffing ot meet acuity levels
ANS D
According to complexity science, which of the following should be the focus of measurement? a. cost per hospital day b. bed utilization c. infection rates d. staff morale and budgets
ANS D
After consulting with practice environments about quality and safety concerns in health care, a dean in a health care program implements what to improve quality and safety in health care? a. a nursing program that emphasizes the development of a strong disciplinary identity b. programming that stresses discipline-based research c. partnerships with health care to develop software for the reporting of adverse events d. an interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizes collaborative learning teams
ANS D
An RN staff member had to inform a licensed practical nurse on the unit nursing team that the care that she was providing needed improvement. The RN provided her with some practical examples of ways to improve her nursing care. After the discussion, the licensed practical nurse thanked the RN for the constructive criticism, and the two nurses proceeded to the cafeteria to have a coffee break together. Which of the follower characteristics did the RN display during this encounter? a. being a team player b. willingness to learn c. Active participation d. being an effective communicator
ANS D
As a nurse manager on the west surgery unit, you are interested in increasing patient safety and reducing morbidity and mortality on yhour unit. what recomendations would be consistent with the IOM the future of nursing report? a. careful screenign of nursing staff for substance use and abuse b. increased RN staffing on the unit c. salary and benefits that reflect nursing accountabilities d. increase in the percentage of baccalaureate prepared nurses to 80%
ANS D
As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas. You are employing _____ leadership. a. Situational b. Trait-based c. Contingency-based d. Transformational
ANS D
As the manager on an acute care medical unit, you note that the incidence of medication errors has increased since the implementation of staffing changes. As part of your strategy to reduce errors, it is important to a. Re-visit reporting standards for medication errors in your organization. b. Ensure that medication errors are consistently reported. c. Provide staff with additional education related to safe practice in medication administration. d. Involve RN staff in determining reasons for errors and practice solutions to increase the safety of medication administration.
ANS D
How would a nurse manager and the staff prepare for redesignation as a magnet hospital? a. commit staff resources over a 6 month period to updating procedure manuals b. educate staff through meetings and training sessions regarding appropriate answers to questions c. prepare a manual that outlines orientation procedures and ensure that all safety issues are addressed d. ensure that there are empirical data to support review of patient outcomes, actions take, and results of actions
ANS D
In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital reduced the number of its managers and increased the number of units for which each manager was responsible. Within a year, the number of adverse events on the units had doubled. How do the increase in adverse events relate to decreased managers? a. The overload of staff nurse duties b. Resistance to change by staff. c. A change in reporting system for everyone d. Fewer clinical leaders facilitate best practice
ANS D
In delegating to a UNP in a home health setting, which of the following represents the most appropriate delegation communication? a. "You will be taking care of Mrs. S., who needs assistance with her bath." b. "You will need to help Mrs. S. get into and out of her shower. Ensure that you check the condition of her feet, and let me know if you have any concerns when you check in." c. "I am not sure that you know how to do this, but I am giving you Mrs. S. She is quite obese and needs skin care." d. "Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness."
ANS D
In the past year, you have noticed an increase in patient falls on your unit. In reading studies related to staffing and patient outcomes, you realize that you will need to plan for: a. higher patient care hours b. safer facilities c. institution of a patient-classification system d. an increased number of RN positions
ANS D
Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and as a result, a suit is launched in which both Sarah (the delegator) and Leslie (the delegatee) are named. Sarah is named in the suit because she: a. Retains accountability for the care of the patient. b. Worked the same shift as Leslie. c. Has passive accountability for delegation. d. Retains accountability for the outcomes of care for the patient.
ANS D
On the West Surgery unit, you want to institute a new system for checking armbands that evidence suggests may increase safety in medication administration. The system involves technology. Which of the following strategies may assist with rapid adoption of the technology and system? a. Employ a centralized decision-making approach. b. Use simulators for initial practice to build confidence. c. Bring in a nurse consultant who is familiar with the technology. d. Use early adopters among the staff as leaders and role models in implementation.
ANS D
Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She is assigned David, a patient who has been admitted with a severe head injury. In communicating with Sally, what is an appropriate action by the charge nurse? a. Provide a detailed explanation of what she needs to do with ICP monitoring. b. Tell her when she needs to provide an update about David's status. c. Ask her to tell you what she knows about ICP monitoring and share expectations about reporting. d. Advise her that you are available if she needs you.
ANS D
The American Nurses Association has advocated for the RN safe staffing act. This legislation is based on ANA safe staffing principles and takes what factors into consideration for planning staffing on a nursing unit? a. patient acuity and complexity b. education and training of the nurses c. technology available and use on the unit d. all factors listed are to be considered
ANS D
The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility. while making rounds on the unit, the staff development coordinator overhears RN staff complaining that they believe it is insulting to be required ot participate in a compentency program. Which behavior by the staff development coordinator is most appropriate in this situation? a. disregard staff concerns and continue with development of the program b. inform the nurses that this program is a requirement for accreditation by the joint commission on accreditation of healthcare organization c. scheduling a meeting with the chief nurse executive to apprise her of the situation d. facilitate a meeting so nurses can articulate their values and concerns about a competency program
ANS D
The core of nursing leadership incorporates integration of unique qualities to include us as individuals. Which is not considered part of leadership integration? a. Person b. Leader c. Nurse d. Position
ANS D
The number of adverse events such as falls and pressure ulcers on the unit is increasing. An ideal staffing plan to address this issue would include which of the following? Increasing the: a. total number of staff on the unit b. staff and RN hours per patient c. total number of staff and inplementing 12 hour shifts d. number of RNs and number of RNs with experience on the unit
ANS D
You are a member of a team assigned to care for 15 general medical/surgical clients. You have all worked well together in the past in this same type of care. If you are assigned to coordinate this teams work, your best strategy, based on the Hersey model, would be to: a. Have a list of tasks to be accomplished and tell each member of the team what he or she must do b. encourage people to discuss their frustrations in providing this care c. ignore them- they've done it before d. Provide minimal direction and let them come to you with questions
ANS D
You are working in a home health service and have three unlicensed nursing personnel (UNPs) assigned to your team. You have worked with 2 of them for 2 years; the third is new. The two experienced UNPs have patients with complex illnesses for whom they provide basic care. The third member of the team has been assigned to patients with less complex illnesses. Your best approach to supervising their care is to a. remain in the office and ask each UNP to check in with you upon arival at their first patient care site b. ask another RN to supervise the 2 experienced assistants so you can be wiht the new person full time c. meet the new staff member at the first patient care site and ask the others to call if anything is unusual d. meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual
ANS D
Your healthcare organization has a decentralized system for scheduling. As part of this process, after you developed a draft schedule, you may need to: a. seek budgetary approval b. balance personal schedules against institutional needs c. negotiate the schedule with unit staff d. submit the schedule to a centralized staffing office for review
ANS D
a unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick 5 times in the past month. He tells the manager that he very much wants to come to work when scheduled but must often care for his wife, who is undergoing treatment for breast cancer. in practice of a strengths-based nursing leader, what would be the best approach to satisfying the needs of this nurse, other staff, and patients? a. line up agency nurses who can be called into work on short notice b. place the nurse on unpaid leave for the remainder of his wife's treatments c. sympathize with the nurse's dilemma and let the charge nurse know that this nurse may be calling in frequently in the future d. work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife's treatments
ANS D
the night nurse understands that certain factors need to be considered before delegating tasks to others. These factors include the a. complexity of the task and the age of the delegatee b. potential for benefit and the complexity of the task c. potential for benefit and the number of staff d. complexity of the task and the potential for harm
ANS D
what would be the primary emphasis in designing and implementing a quality, safe healthcare environment? a. evidence based practice b. informatics c. staffing d. the patients
ANS D
which category is unique to management but is not part of leadership? a. initiating change b. personal qualities c. developing people d. information management
ANS D
A nurse manager of a 20 bed unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of older adult patients. According to complexity principles, what would be the best approach to take in making this change? a. leverage the hierarchical management position to get unit staff involved in assessment and planning b. engage in volved staff at all levels in the decision making process c. focus the assessment on the unit, and omit the hospital and community environment d. hire a geriatric specialist to oversee and control the project
ANS: B
