leadership exam 2

A demand management system is a better predictor of staff than patient classification systems. The demand management system focuses on: 1. Immediate client needs. 2. Historical data of expected client outcomes. 3. Allocation of staff throughout the organization. 4. Nursing care hours.

2. Historical data of expected client outcomes.

Which indicates an integral part of implementing a change? 1. Providing information and giving support for those undergoing the change 2. Ensuring there are no remaining pockets of disagreement when the change occurs 3. Pulling individuals who are not persuaded into a talk about the benefits of the change 4. Continually rewarding those working toward the change and ignoring those who are not

1. Providing information and giving support for those undergoing the change

A nurse manager finds it challenging to communicate among staff. The managerʹs director informs the manager this is due to: 1. Nursing shortage .2. Varied client mix. 3. Combined staffing patterns. 4. An overlap of staff between shifts.

3. Combined staffing patterns.

Which option best reflects a driving force in the process of change? 1. A financial deficit of millions of dollars 2. A staff composed of long-term employees 3. An ineffective nurse manager 4. An administration composed of long-term employees

1. A financial deficit of millions of dollars

Which of the following statements indicate exceptions to the blame-free environment? Select all that apply. 1. A nurse notices a colleague changing nursing notes after a client is discharged. 2. A housekeeper reports a nurse who switches syringes when giving client medications. 3. A nurse manager reports a staff nurse who continually miscounts narcotics. 4. A staff nurse falsely reports a colleague for mislabeling client medications. 5. A nurse reports an unlicensed assistant pull a client up too sharply.

1. A nurse notices a colleague changing nursing notes after a client is discharged. 4. A staff nurse falsely reports a colleague for mislabeling client medications.

An effective method to decrease absenteeism is to increase a nurseʹs responsibility because a person with: 1. An important job realizes others depend on them. 2. Additional duties may fear termination. 3. Higher responsibilities will have less stress. 4. Less responsibility is always less motivated.

1. An important job realizes others depend on them.

The medical surgical unitʹs census has decreased since the previous shift. The manager is reviewing the staffing grid. Which of the following factors is used to determine staffing mix? 1. Average daily census 2. Educational preparation of staff 3. Holidays and vacation time 4. Unit productivity

1. Average daily census

the nursing manager is comparing data on average length of client hospital stay for a total hip replacement between two hospitals in order to promote quality improvement. This comparison is an example of which process or step? 1. Benchmarking 2. An outcome standard 3. An indicator 4. A process standard

1. Benchmarking

A schedule must be created for labor and delivery with a set staff mix for every shift. Which type of staffing is best for a nursing unit that experiences peak workload hours? 1. Block staffing 2. Creative scheduling 3. Flexible scheduling 4. Self-staffing

1. Block staffing

Which of the following institutional policies would be likely to reduce absenteeism and promote satisfaction over a long period of time? Select all that apply. 1. Conversion of a specified number of unused sick days to vacation days 2. Credit for unused sick days 3. Placing no limit on the number of sick days that can be accumulated 4. Sanctions to discourage absenteeism

1. Conversion of a specified number of unused sick days to vacation days 2. Credit for unused sick days 3. Placing no limit on the number of sick days that can be accumulated

The night shift supervisor leaves a detailed report for the nurse manager of the shiftʹs activities on the unit. A family member complains about a night shift nurseʹs behavior as being rude. The manager reviews the night shift supervisorʹs notes and learns nothing regarding a nurseʹs behavior. The night shift supervisorʹs notes are vague. What other type of documentation should the manager review? 1. Critical incidents 2. Peer review evaluation 3. Group evaluation 4. The nurseʹs file

1. Critical incidents

The nurse manager of an ICU unit has several open shifts that require an RN to fill. Several ICU nurses have taken overtime shifts but there are still several uncovered shifts. The CNO (chief nurse officer) decides to fill these vacancies with agency nurses. The CNO realizes the agency staff must have these requirements prior to working in the facility. Select all that apply. 1. Current licensure to practice within the state 2. Orientation and required organizational competencies validated 3. Past work experience in an emergency room 4. Documentation of licensure, malpractice insurance, and certifications prior to working the shift

1. Current licensure to practice within the state 2. Orientation and required organizational competencies validated 4. Documentation of licensure, malpractice insurance, and certifications prior to working the shift

Which step is critical for change to be initiated? 1. Data collection and analysis 2. Minimize anxiety about the change 3. Develop operational indicators of success 4. Make people uncomfortable with status quo

1. Data collection and analysis

The nurse finds a client on the previous shift received 100 mg of Demerol intravenously instead of the ordered 50 mg of Demerol. Which statement should be documented in the clientʹs chart? 1. Demerol 100 mg given IV at 0800. Clientʹs vital signs unchanged. 2. Demerol 100 mg given IV instead of the ordered dose of Demerol 50 mg. 3. Demerol 100 mg given accidentally instead of Demerol 50 mg. 4. Demerol 100 mg given IV and client notified.

1. Demerol 100 mg given IV at 0800. Clientʹs vital signs unchanged.

Which are roles a manager might undertake when a change is necessary? Select all that apply. 1. Discussion leader 2. Support person 3. Fact manager 4. Liaison 5. Disciplinarian 6. Data collector

1. Discussion leader 2. Support person 3. Fact manager 4. Liaison 5. Disciplinarian 6. Data collector

Which is the most effective method of creating a blame-free environment? 1. Ensure all employees are knowledgeable about the reasons behind the policy. 2. Make sure all nurses know the reasons behind the policy and agree to comply. 3. Keep the system processes the same so everyone will know them well. 4. Ensure nurse managers keep a list of employees that shows how many mistakes each made.

1. Ensure all employees are knowledgeable about the reasons behind the policy.

A patient care services director is discussing past experiences while employed at other organizations with regard to staff evaluations. The director states forced distribution evaluations are usually used as a result of: 1. Evaluation inflation .2. Several exceptional employees. 3. Many unhappy employees. 4. Large numbers of staff.

1. Evaluation inflation

A new IV pump has just been purchased by the facility. According to Rogers, which is the first step in introducing this new pump to the staff? 1. Introducing the decision-making unit to the innovation 2. Seeking reinforcement that the decision to make an innovation is correct 3. Deciding to adopt or reject the innovation 4. Forming a favorable or unfavorable attitude toward the innovation

1. Introducing the decision-making unit to the innovation

Which indicate ways nurse managers can plan to reduce risks for the organization? Select all that apply. 1. Investigating a complaint from a clientʹs wife 2. Encouraging nurses to cut corners when possible 3. Talking to physicians about better ways to do things 4. Keeping staff on task throughout the work day 5. Making sure staff work minimal overtime 6. Enforcing staff discipline for wrongdoing

1. Investigating a complaint from a clientʹs wife 3. Talking to physicians about better ways to do things 4. Keeping staff on task throughout the work day 5. Making sure staff work minimal overtime

A collaborative team composed of members of the interdisciplinary health care team develops a set of goals and research-based standardized critical pathways. Of which is this an example? 1. Outcomes management 2. Risk management 3. Peer review 4. Six Sigma

1. Outcomes management

The nurse manager is explaining the organizational staffing policy to a newly hired nurse. The nurse will be scheduled on an as-needed basis. The manager explains this policy is a supplemental scheduling policy. Which other types of staffing would be included in this policy? 1. Outside agency 2. Part-time staff 3. Nurse extender 4. Internal float

1. Outside agency 2. Part-time staff 4. Internal float

nurse consultant reviews the nursing administrationʹs appraisal policies. The consultant notes the annual appraisal focuses on general performance. The consultant informs the CNO (chief nurse officer) this type of evaluation does not allow for: 1. Performance related to the job description. 2. Personality issues. 3. The nurseʹs ability to deal with stress. 4. Input from peers.

1. Performance related to the job description.

A nurse manager and an employee meet to discuss the employeeʹs appraisal. They disagree on the content of the employee evaluation. The disagreement turns into an argument. The best managerial strategy is to: 1. Postpone the interview. 2. Agree on arbitration. 3. Seek input from employee peers. 4. Report the employee to the human resources manager.

1. Postpone the interview.

In making a change in hospital policy, which best describes the nursing administrators first priority? 1. Research the options that will work best for the nursing staff and the hospital. 2. Ensure each nurse is aware of the change and why it is necessary to undertake. 3. Speak positively of the change to ensure the most ʺbuy-inʺ from the nurses. 4. Encourage the other administrators to choose the option easiest for the nurses.

1. Research the options that will work best for the nursing staff and the hospital.

Which is the most important reason resistance to change must be addressed? 1. Resistance can negatively impact future client care. 2. Resistance from the late majority can keep others from accepting the change. 3. Resistance will keep the change from occurring at all. 4. Resistance allows others to take power from managers.

1. Resistance can negatively impact future client care.

The Joint Commission requires organizations to provide criteria for appropriate nurse staffing. A new nurse manager asks a seasoned manager where to find this information. Which of the following would be an appropriate response? 1. Staffing policy specific to the unit 2. Human resources policy on employment 3. The organizationʹs self-staffing guidelines 4. The current unitʹs schedule

1. Staffing policy specific to the unit

The nurse is assigned to be a member of the Risk Management Team. Which events would be addressed by this team? Select all that apply. 1. The client has an allergic reaction to the preservative in the barium used in a barium swallow. 2. A clientʹs family is dissatisfied with the meals that are served. 3. The client leaves the hospital against medical advice (AMA). 4. The client claims he is not ready to be discharged. 5. The family does not want the client to be transferred from the intensive care unit (ICU).

1. The client has an allergic reaction to the preservative in the barium used in a barium swallow. 3. The client leaves the hospital against medical advice (AMA).

The nurse manager is writing employee evaluations on the staff. To ensure fairness to the staff nurse, which of the following practices should be avoided? 1. The staff nurse is appraised every 18 to 24 months. 2. The appraisal is shared with the staff nurse in writing. 3. The staff nurse is required to sign the appraisal and may write comments. 4. The staff nurse may appeal an unfair appraisal.

1. The staff nurse is appraised every 18 to 24 months.

The team leader on the surgical unit has frequent absences from work on Fridays. She phones and reports herself sick, but in fact she has day-care issues on Fridays. This is an example of: 1. Voluntary absenteeism. 2. Absence frequency. 3. Total time lost. 4. Involuntary absenteeism.

1. Voluntary absenteeism.

which are questions or statements a nurse involved in an organizational change might say? Select all that apply. 1. What are the obstacles to implementing this change within the organization? 2. I would like to focus on completing this process so we can move on. 3. Are we including the opinions of all stakeholders in this decision? 4. Have we looked at all available data in order to make an informed decision? 5. I know nursing personnel will work diligently in understanding the need for change.6. I think it does not really matter when we institute this change, as long as it is over quickly.

1. What are the obstacles to implementing this change within the organization? 3. Are we including the opinions of all stakeholders in this decision? 4. Have we looked at all available data in order to make an informed decision? 5. I know nursing personnel will work diligently in understanding the need for change.6. I think it does not really matter when we institute this change, as long as it is over quickly.

Which statement indicates the nurse manager needs further assistance in learning about the change process? 1. ʺResistance to change is never a positive part of the change process.ʺ 2. ʺI know some people will resist but with support they will come around.ʺ 3. ʺFor those resisting this necessary change, assisting in the process will help.ʺ 4. ʺIf colleagues help each other, the resistance will lessen over time.ʺ

1. ʺResistance to change is never a positive part of the change process.ʺ

Which statements if made by the nurse manager would demonstrate effective change management? Select all that apply. 1. ʺWe cannot lose sight of the mission and values of our institution as we begin to integrate these changes.ʺ 2. ʺAlthough this task is going to be difficult, we have the full support of our hospital administration.ʺ 3. ʺIf this approach doesnʹt work, at least we can say weʹve tried.ʺ 4. ʺIn order for this plan to work, everyone must agree to be a participant.ʺ 5. ʺLetʹs wait until our administration has completed their reorganization before we implement change.ʺ

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

A newly hired registered nurse is orienting to the ICU unit. At the end of the orientation the preceptor reviews the new nurseʹs performance. The preceptor informs the nurse and the ICU manager of the necessity for further development of certain required skills. Which of the following would be appropriate? 1. Schedule the ICU nurse with a seasoned nurse. 2. Extend the nurseʹs orientation. 3. Send the nurse to another facility for additional training. 4. Assess the nurseʹs skills in 6 months.

2. Extend the nurseʹs orientation.

The client has been told that chemotherapy must be postponed until the client is hydrated. The client refuses the intravenous hydration and demands to go home. The nurse would report this occurrence as: 1. A reportable incident. 2. A medical-legal incident .3. Client dissatisfaction with care. 4. Medication error.

2. A medical-legal incident

An experienced ICU manager is orienting a medical-surgical nurse manager to the organization. Throughout the day the ICU manager has a note pad and pen in her pocket and makes notes. The new manager inquires as to why the ICU manager is taking so many notes. An appropriate rationale would be that taking notes: 1. Saves time in the long term. 2. Allows the manager to address issues immediately so they do not escalate. 3. Is the management style of the person. 4. Is useful to address issues during shift report.

2. Allows the manager to address issues immediately so they do not escalate.

Which of the following steps should be taken first when determining staffing needs? 1. Determine the nursing care hours needed. 2. Become familiar with the current classification system in use. 3. Modify the schedule to meet patientsʹ needs. 4. Supplement the current nursing staff as needed.

2. Become familiar with the current classification system in use.

A new nurse manager questions another manager as to the method of performance evaluation that focuses on personal traits and characteristics. The other manager explains it: 1. Is job related. 2. Can be used for a variety of job descriptions. 3. Can be useful in staff development. 4. Can help prevent legal accusation of discrimination.

2. Can be used for a variety of job descriptions.

A nurse from the quality improvement committee is assigned to review a clientʹs chart throughout the hospitalization and determines that discharge teaching has not been initiated. This finding is discussed with the primary nurse who will follow through with the teaching. This process is an example of which review or audit method? 1. Peer review 2. Concurrent audit 3. Utilization review 4. Retrospective audit

2. Concurrent audit

The hospital is experiencing high acuity clients due to the recent flu endemic. The ICU and medical-surgical units have a large number of elderly clients. The chief nurse officer (CNO) instructs the manager to schedule more registered nurses for the weekend. This is a result of: 1. Patient classification systems management. 2. Demand management system. 3. Institutional-related system management. 4. Staff-related systems management.

2. Demand management system.

Which indicates the aspect similar between the different methods of quality management? Each method: 1. Uses all staff in the organization. 2. Does not blame. 3. Provides clinical information 4. Focuses on cost containment.

2. Does not blame.

Computerized charting will be initiated on select units of the hospital. Orientation to this new system will be provided to each nurse by a team of nurses educated in nursing informatics. Of which is this an example? 1. Power-coercive strategies 2. Empirical-rational model 3. Lippittʹs Phases of Change 4. Normative-reeducative strategies

2. Empirical-rational model

The following documentation was written on a chart: ʺThe client was found lying on the floor. Dr. X was notified. Apparently the restraints were improperly applied.ʺ Which statement best describes this documentation? The documentation is: 1. Appropriately written. 2. Inappropriate because it places blame on an individual. 3. Inappropriate because it does not include that the client was notified. 4. Appropriately written because it only documents the facts.

2. Inappropriate because it places blame on an individual.

A new chairperson of the nursing department has been appointed and plans to institute new programs for faculty development with a focus on innovative teaching strategies. According to Lewin, which is the first step in initiating this plan? 1. Ask staff to assist in the development of a plan for implementing new teaching strategies. 2. Include the staff in actively participating in the identification of problems related to teaching strategies. 3. Implement interventions to improve the teaching strategies currently used. 4. Reinforce the efforts of faculty as they begin to use new teaching strategies.

2. Include the staff in actively participating in the identification of problems related to teaching strategies.

A new nurse manager is discussing the orientation process with the ICU manager. The ICU manager informs the manager skills week is done during one full week in the month of September. The new manager is confused as to why the organization is conducting a ʺskills week.ʺ The ICU manager informs the new manager that: 1. It allows for the nursing staff to enhance their skills. 2. It is required by accrediting and regulatory organizations. 3. Nursing administration has required this training on an annual basis. 4. It allows nurse managers to assess other nursesʹ skills from other nursing departments.

2. It is required by accrediting and regulatory organizations.

A nurse manager gives a staff nurse an exceptional appraisal. The other nurses learn of the appraisal and are upset because this nurse has had numerous complaints from peers regarding laziness. The manager informs a colleague the nurse obtained an exceptional appraisal because, ʺThey will always work for me when I need them.ʺ This is an example of: 1. Recency error. 2. Leniency error. 3. Causing poor morale amongst staff. 4. Halo error.

2. Leniency error.

Which indicates the priority nursing diagnosis for handling a change made difficult by laggards or rejecters? 1. Knowledge Deficit related to lack of willingness to discuss planned change 2. Noncompliance related to lack of willingness to comply with new policy 3. Social Isolation related to antagonistic behavior when change discussed 4. Risk for Role Performance Alteration related to antagonistic behavior

2. Noncompliance related to lack of willingness to comply with new policy

The nurse manager is explaining her staffing budget to the hospital administration. The manager has developed a flexible staffing grid. The administration questions the nurse as to why this grid was developed. Which of the following is appropriate? 1. Staff would prefer to make out their own schedules. 2. Nursing shortages and salary constraints have affected staffing patterns. 3. Higher client acuity has contributed to increased staffing. 4. Block staffing allows for peaked workload hours.

2. Nursing shortages and salary constraints have affected staffing patterns.

A health care clinic is considering providing employees with on-site day care and a fitness room. This is an example of motivating employees through: 1. The job itself. 2. Organizational practices. 3. The absence culture. 4. Supervision.

2. Organizational practices.

Which is the most effective method by which a nurse manager can help reduce organizational risk? 1. Quickly confront the person or persons who put the organization at risk. 2. Personally discuss the issue with the person affected or who made the complaint. 3. Handle every aspect of the issue on the unit to protect the privacy of all parties. 4. Develop a blame-free environment regardless of mistake made to encourage reporting.

2. Personally discuss the issue with the person affected or who made the complaint.

Absenteeism may be reduced or controlled by which of the following? Select all that apply. 1. Adoption of an institutional policy whereby unused sick days will be lost. 2. Rewarding good attendance with salary increases and other rewards. 3. Evaluation of attendance during the employeesʹ performance appraisal. 4. Enforcing absenteeism control policies.

2. Rewarding good attendance with salary increases and other rewards. 3. Evaluation of attendance during the employeesʹ performance appraisal. 4. Enforcing absenteeism control policies.

A nurse manager is conducting an annual performance of a registered nurse. The appraisal listed several areas for improvement. The manager and the nurse discuss methods in which the nurse can improve performance. Which action would be appropriate at this time? 1. Reschedule the annual appraisal. 2. Set a follow-up date to reevaluate the nurseʹs performance. 3. Set a follow-up appointment in which the nurseʹs peers evaluate the nurseʹs performance. 4. Have the human resources department conduct the appraisal.

2. Set a follow-up date to reevaluate the nurseʹs performance.

The nurse manager is planning to initiate new policies in the department. According to Havelockʹs Model, which behavior is characteristic of the moving stage? 1. Resources are acquired to facilitate change. 2. Solutions are identified to create change. 3. Relationships are formed among all participants. 4. Self-renewal among all participants occurs.

2. Solutions are identified to create change.

The ICU unit has open shifts even after staff have signed-up for overtime. The CNO (chief nurse officer) does not want to hire agency nurses to cover these shifts. The nurse manager does not understand why the CNO is offering staff an incentive versus hiring agency nurses. Which would be a reasonable conclusion? 1. It takes a significant amount of time to orient agency nurses. 2. The agency nurses are costly. 3. There is a significant amount of documentation required for agency nurses. 4. The physicians are not comfortable with agency nurses.

2. The agency nurses are costly.

A director performs an annual appraisal on the ICU manager. The appraisal reflects several issues with regard to the managerʹs attitude. At the end of the interview the manager informs the director that she disagrees with the appraisal. The director instructs the manager to sign the appraisal and ends the interview. The manager reports this situation to the human resources director because: 1. The interview was conducted in an unprofessional manner. 2. The appraisal was discriminatory. 3. The appraisal was not a fair evaluation. 4. The director appraised the managerʹs attitude, which is unprofessional.

2. The appraisal was discriminatory.

An ICU nurse manager prefers to utilize a ʺresults-oriented systemʺ when evaluating employees because: 1. It allows for comparison between employees. 2. The employee knows in advance what is expected. 3. It is apparent when an employee stands out against peers. 4. Not all employees are excellent and not all employees can receive an ʺexcellentʺ evaluation.

2. The employee knows in advance what is expected.

During a three-month period, a registered nurse has missed work on 6 occasions due to an unreliable car or an ill child. Another nurse has missed 10 days due to minor foot surgery. Which nurse is the more reliable employee? 1. The nurse who has missed due to voluntary absence 2. The nurse who missed because of involuntary absence 3. The nurse who missed voluntarily because she is healthier 4. Neither, because of excessive absenteeism

2. The nurse who missed because of involuntary absence

A registered nurse has just entered the hospitalʹs float pool. The nurse has worked on various nursing units and today is working in the outpatient surgery unit. The nurse asks another staff nurse why the unit is not staffed as heavily on the weekend. The best answer would be: 1. The unit is busy on the weekends but the management provides a skeleton crew to manage the census. 2. The unit is not busy on the weekends because surgeons do not schedule procedures on the weekend. 3. The surgeons only schedule emergency procedures on the weekends. 4. The unit is open to non-emergent procedures on the weekends.

2. The unit is not busy on the weekends because surgeons do not schedule procedures on the weekend.

A nurse manager looks through a file that contains information regarding critical incident reports filed within the past year. The manager reviews and utilizes this information to educate staff for what purpose? Select all that apply. 1. To increase leniency error 2. To decrease lawsuits 3. To increase employee communication 4. To decrease recency error 5. To increase accuracy in evaluation 6. To decrease constructive criticism

2. To decrease lawsuits 3. To increase employee communication 4. To decrease recency error 5. To increase accuracy in evaluation

The hospital organization has developed a philosophy based on the client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. In which process are these characteristics typically seen? 1. Continuous Quality Improvement (CQI) 2. Total Quality Management (TQM) 3. Plan, Do, Check, Act (PDCA cycle) 4. Six Sigma

2. Total Quality Management (TQM)

A critical care nurse has reported off because of an illness. In order to provide continuity of quality nursing care, the nurse manager utilizes a nurse from a (an): 1. Outside agency. 2. Unit with a low census. 3. Decentralized internal float pool. 4. Centralized external float pool.

3. Decentralized internal float pool.

Which strategy is most accurate about creating effective change? 1. Providing information addresses the motivation to change 2. Educating people opposed to change creates new opinions 3. Disseminating information is a prerequisite to change 4. Terminating people opposed to the idea of change if necessary

3. Disseminating information is a prerequisite to change

the state board of health has arrived for its annual visit. The nurse reviewer requests the employee file of all agency nurses utilized within the past year. The human resources (HR) director gives the nurse reviewer those files. At the end of the review the organization has suffered a penalty because the HR file of an agency nurse lacked which of the following? 1. Current address 2. Past-employment history 3. Evaluation of the organizational competencies. 4. Past certifications

3. Evaluation of the organizational competencies.

Which of the following choices allows for greater staff flexibility? 1. Maximizing the availability of nursing staff 2. Communicating among staff 3. A high RN-skill mix 4. Overlapping between shifts

3. A high RN-skill mix

The registered nurse evaluation reads, ʺThe nurse completes client care in a safe and timely manner, documents well, and attends required staff meetings.ʺ The nurse manager is using what type of rating scale? 1. Results-oriented system 2. Traits-and-personal-characteristics system 3. Behavioral criteria system 4. Comparative judgment system

3. Behavioral criteria system

The registered nurse has had recent difficulty finishing and documenting client care during the assigned shift. The nurse manager has repeatedly discussed overtime abuses with the nurse. The nurse has historically had very good appraisals. Which of the following would be the best approach to correct recent behaviors? 1. Provide education .2. Simplify tasks. 3. Clarify expectations. 4. Reassign the nurse to another unit.

3. Clarify expectations.

If the nurse is working on a unit with a blame-free environment, which is the initial action when the nurse makes an error? 1. Discuss it with the other nurses on duty. 2. Immediately report the incident to the supervisor. 3. If there is a client involved, ensure the clientʹs safety. 4. Make sure no one saw the incident and say nothing.

3. If there is a client involved, ensure the clientʹs safety.

Which is the expected outcome when acting as a change agent? 1. Demonstrating management skills 2. Encouraging nurses to stick together 3. Improving client care 4. Guiding nursing practice

3. Improving client care

A nurse manager has noticed a decrease in morale with the night shift nursing staff. The manager has had numerous complaints regarding a nurse who has worked several hours of overtime in the past month. The manager realizes the morale issues should be: 1. Addressed in a timely manner. 2. Communicated to the human resources department. 3. Investigated regarding the impact of poor performance among the staff. 4. Addressed by changing the staffing mix on the night shift.

3. Investigated regarding the impact of poor performance among the staff.

Which of the following groups determines the level of nursing care and hours of care necessary to meet the needs of the hospitalized patient? 1. American Nurses Association (ANA) 2. Joint Commission 3. Nurse managers 4. Hospital administrators

3. Nurse managers

Why are nurses in a prime position to act as change agents? 1. Nurses are always acting in the clientʹs best interest. 2. Nurses are role models for positively reacting to change. 3. Nurses often function as intermediaries between other disciplines. 4. Nurses thrive on transitions and work best in such circumstances

3. Nurses often function as intermediaries between other disciplines.

A small rural hospital has open shifts on its medical-surgical unit. The manager has listed open shifts on the hospitalʹs intranet. This type of scheduling is an example of: 1. External pools. 2. Internal pools. 3. Open shift management. 4. Float pools.

3. Open shift management.

An emergency room manager is looking over the next monthʹs schedule and decides to supplement the schedule due to vacations. The manager decides to use centralized staffing. Which of the following is an example of centralized staffing? 1. PRN staff from the internal pool of nurses 2. Agency nurses 3. PRN staff from the emergency room nurses 4. PRN staff from the medical-surgical nurses

3. PRN staff from the emergency room nurses

the client noticed hives and a feeling of shortness of breath immediately following a barium swallow. Although there were no known allergies to food or drugs prior to this incident, the client was diagnosed as having an allergic reaction to the preservatives in the barium. Which is the correct risk category for this incident? 1. Medication error 2. Medical-legal incident 3. Procedure complication 4. This incident is not a risk

3. Procedure complication

Which is the most important role in which a manager should function during a necessary change? 1. Information giver 2. Power player 3. Process coordinator 4. Energy booster

3. Process coordinator

A nurse manager has discussed unprofessional behaviors with a nurse. During the performance appraisal the manager addresses these issues. What would you expect the managerʹs next course of action to be? 1. Take notes of the nurseʹs behavior during the appraisal. 2. Inquire as to the nurseʹs perception of the appraisal. 3. Schedule a follow-up session to determine if the nurse has made progress in the areas specified. 4. Schedule the next annual appraisal.

3. Schedule a follow-up session to determine if the nurse has made progress in the areas specified.

A manager has conducted a nurseʹs evaluation. The manager has focused a large portion of the appraisal on the nurseʹs personality. The nurse does not agree with the appraisal and contacts the human resources director. What basis does the nurse have to dispute the appraisal? 1. The appraisal is incomplete. 2. The appraisal is unfair. 3. The appraisal is not valid. 4. The nurseʹs perception of the appraisal is unjustified.

3. The appraisal is not valid.

An emergency room nurse manager is preparing for a night-shift nurseʹs annual appraisal. The manager is apprehensive because there are issues to address regarding rudeness and unprofessional behavior. How should the manager prepare for conducting this appraisal? 1. Place the evaluation in an envelope with specific details in addressing the nurseʹs behavior and allow the nurse to review it during his next shift. 2. The manager should complete the evaluation and ask a peer to review it and provide feedback. 3. The manager should schedule a time to conduct the appraisal in private. 4. The manager should allow the human resources manager to conduct the appraisal.

3. The manager should schedule a time to conduct the appraisal in private.

The nurse manager is interviewing a potential unit clerk. The manager is looking for the most reliable employee. Which of the following is inappropriate to ask during the interview? 1. ʺTell me about your last job.ʺ 2. ʺMay I contact your past employers?ʺ 3. ʺDo you have young children?ʺ 4. ʺWhat are your professional goals?ʺ

3. ʺDo you have young children?ʺ

The nursing supervisor identified ineffective communication as a problem among the managers. According to Lippittʹs Phases of Change, which is the final stage of the improving this problem? 1. Develop the action and evaluation plan .2. Determine the role of the change agent .3. Communicate often to maintain the change. 4. Withdraw from the role of change agent gradually.

4. Withdraw from the role of change agent gradually.

The hospital administration has changed from a traditional nursing system to self-governance. This change was recognized by nursing personnel as a positive change and is an example of which strategy? 1. Power-coercive strategy 2. Empirical-rational model 3. A driving force 4. A normative-reeducative strategy

4. A normative-reeducative strategy

the medical-surgical unit is at capacity and the clients have a high acuity, which require much care, such as turning, bathing, toileting, and eating. Which of the following would be a cost-effective choice to supplement the staffing need? 1. Additional registered nurses 2. Additional secretarial staff 3. Additional licensed practical/vocational nurses 4. Additional unlicensed assistive personnel

4. Additional unlicensed assistive personnel

A nurse manager needs to supplement the staff for the next schedule. Which of the following types of supplemental staffing would be most costly to the organization? 1. PRN nurse 2. Internal float nurse 3. Per diem staff 4. Agency nurse

4. Agency nurse

The nurse manager is describing reduction of risk of the organization and uses a nursing care plan to illustrate. Which is the priority? 1. Anxiety related to unclear medical prognosis 2. Disabled family coping related to seriously ill family member 3. Family decisional conflict related to varying physician opinions 4. Altered communication related to unwillingness to discuss concerns

4. Altered communication related to unwillingness to discuss concerns

A nurse manager to the OB unit is having issues with a staff nurse who is rude to clients. In the past year the OB staff have complained to the manager regarding this staff nurseʹs rudeness to clients. Other departments have also filed similar complaints. The manager pulls the staff nurseʹs employee file and finds last yearʹs appraisal as exceptional. What course of action should the manager take with this nurse? 1. Terminate the staff nurse immediately. 2. Notify nursing administration of the issues and complaints. 3. Instruct the OB staff nurses to maintain a log of the nurseʹs behavior. 4. Document the issues, confer with the staff nurse, and provide a plan of action.

4. Document the issues, confer with the staff nurse, and provide a plan of action.

An OB registered nurse is caring for a client who is in the first stage of labor. The client has requested an epidural, which the anesthesiologist is about to perform. The anesthesiologist is having difficulty in accessing the epidural space. The anesthesiologist states, ʺYou are too obese and that is why Iʹm having trouble.ʺ The client is offended and the nurse determines a critical incident form must be completed. Which of the following would be appropriate to document on the form? 1. The anesthesiologist was rude to the client. 2. The anesthesiologist was rude and incompetent when caring for the client. 3. The client is obese, and epidural catheter placement was attempted but unsuccessful due to the clientʹs size. 4. Dr. ________ attempted to place an epidural catheter on this client and stated, ʺYou are too obese and that is why Iʹm having trouble.ʺ

4. Dr. ________ attempted to place an epidural catheter on this client and stated, ʺYou are too obese and that is why Iʹm having trouble.ʺ

When faced with the prospect of change, the nurse states, ʺWe have always done it this way and never had any problems.ʺ A few weeks later, the same nurse remarks, ʺThis new way seems to work better than the old way did.ʺ This statement is characteristic of which type of change response? 1. Laggards 2. Innovators 3. Early adopters 4. Early majority

4. Early majority

n order to prevent recency error in staff appraisals, the nurse manager should: 1. Be careful not to overrate employees. 2. Evaluate each behavior separately and fairly. 3. Carefully define performance standards. 4. Evaluate staff every 6 months.

4. Evaluate staff every 6 months.

A medical-surgical nurse manager is preparing the next monthʹs schedule. The manager has reviewed the surgery schedule for the corresponding month and notes there are several high acuity surgeries. Which of the following staff would the manager schedule to anticipate the postoperative clientsʹ needs? 1. Increase the number of unlicensed assistive personnel 2. Increase the number of licensed practical/vocational nurses 3. Increase the number of registered nurses 4. Increase the number of baccalaureate-prepared nurses

4. Increase the number of baccalaureate-prepared nurses

A medical-surgical nurse manager has been informed by other nursing staff of a nurseʹs lack of certain unit-specific skills. The manager informs the staff the matter will be addressed. Which of the following would be an appropriate action by the manager? 1. Inform the nursing staff the matter is none of their concern. 2. Address the matter with the staff development nurse. 3. Address the matter during the nurseʹs annual appraisal. 4. Meet with the nurse to discuss the matter and develop a plan of action.

4. Meet with the nurse to discuss the matter and develop a plan of action.

Which change strategy is most appropriate when administration needs cooperation from all parties involved in the change? 1. Empirical-rational 2. Power-coercive 3. Empirical-reeducative 4. Normative-reeducative

4. Normative-reeducative

The nurse manager is analyzing the client population of the unit and determining staffing levels when making the next schedule. This is an example of which type of principle? 1. Staff related 2. Organizational related 3. Client related 4. Patient care unit related

4. Patient care unit related

The OB manager is looking at staffing for the night shift. The post-partum unit is busy and the labor-delivery unit has four clients in labor. The manager collects data from the nursing staff regarding the acuity of their clients. These data assist the manager in determining the staff for the next shift. This is an example of which type of system? 1. Client-care related 2. Staff related 3. Organizational related 4. Patient classification

4. Patient classification

the nursing task force is developing measurable goals for each client on the orthopedic unit. Of which is the statement: ʺEach client will have a written assessment and plan of care document within eight hours of admissionʺ an example? 1. Indicator 2. Structure standard 3. Benchmark 4. Process standard

4. Process standard

Which of the following would not be appropriate for a manager to write on an employeeʹs performance appraisal? 1. ʺThe nurse has a positive attitude.ʺ 2. ʺThe nurse seeks learning experiences.ʺ 3. ʺThe nurse is frequently tardy.ʺ 4. The nurse is shy and quiet.ʺ

4. The nurse is shy and quiet.ʺ

Which of the following statements is an example of the overall goal of quality management in todayʹs health care activities? 1. The nurse manager realizes a policy was ineffective in reducing incidents. 2. The administrator walks around making a list of potential problems. 3. The human resources department lets nonproductive employees go. 4. The nurse wipes up a spilled drink before clients are allowed to enter.

4. The nurse wipes up a spilled drink before clients are allowed to enter.

Which best illustrates the methods of Lean Six Sigma for quality management? 1. The emergency department manager looks at the monthʹs patient usage totals before deciding on how to change staffing. 2. The charge nurse of the ICU sets a goal for the day that every patient call light will be answered in less than 1 minute. 3. The floor manager does a small study to find out patient satisfaction ratings for January before deciding about staffing. 4. The team leader encourages the floor staff to turn off lights and water when not in use.

4. The team leader encourages the floor staff to turn off lights and water when not in use.

The nurses on a medical-surgical unit are requesting 10-hour shifts. The manager explains their type of unit would not function well with this staffing pattern because: 1. There is no overlap of staff. 2. There are not enough nurses working during a 24-hour period of time. 3. This would create discord and confusion with other health care departments. 4. This staffing pattern would not be cost efficient.

4. This staffing pattern would not be cost efficient.

Which statement indicates a need for further training? 1. ʺAs we go through this process, I think I need to be flexible but persistent.ʺ 2. ʺI must not get so bogged down in details that I lose focus on the ultimate goal.ʺ 3. ʺThose who are resistant will probably accept it sooner or later with my support.ʺ 4. ʺI think the implementation will go much better if I stay available the whole time.ʺ

4. ʺI think the implementation will go much better if I stay available the whole time.ʺ

the nurse manager is discussing the blame-free environment in place at the organization with new hires. Which statement indicates understanding of the policy? 1. ʺIf I make any mistake, if I report it I will not be reprimanded or punished.ʺ 2. ʺWhen I make a mistake, I should immediately fill out an incident report.ʺ 3. ʺIt is left up to each employee to self-monitor, and we do not report othersʹ mistakes.ʺ 4. ʺWhen I make a mistake, I should report it and look for ways to prevent it from reoccurring.ʺ

4. ʺWhen I make a mistake, I should report it and look for ways to prevent it from reoccurring.ʺ

The nurse manager is determining nursing care hours (NCHs) by analyzing the client workload. The unit census is 30 and a total 220 of nursing care hours. What are the average nursing hours per client per day (NHPPD)?Formula: NCH/Census = Nursing hours per patient

7.33