Leadership EXAM2

Clinical incompetence is one of the more serious problems facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarah's peers are covering for her. Which of the following might Joyce include in her meeting with the nurses? (Select all that apply.) a. "It is a nurse's professional responsibility to maintain quality control." b. "All instances of clinical incompetence are to be reported." c. "It is not considered being disloyal when one nurse reports another for poor care." d. "Patient care is the number one concern. Meeting standards is mandatory and necessary."

a. "It is a nurse's professional responsibility to maintain quality control." b. "All instances of clinical incompetence are to be reported." c. "It is not considered being disloyal when one nurse reports another for poor care." d. "Patient care is the number one concern. Meeting standards is mandatory and necessary." ANS: A, B, C, D

As a manager, you are interested in developing behavioral questions for an interview. Knowing that there is team conflict at times on your unit, which of the following questions would satisfy your interest in behavioral questions? a. "Tell me about a time you were involved in a conflict related to a project. What was your role in the conflict? In the resolution of the conflict?" b. "If you were to employ one strategy for managing conflict, what would it be?" c. "What is your preferred style of conflict resolution?" d. "How effective are you in working in a group? In dealing with conflict?"

a. "Tell me about a time you were involved in a conflict related to a project. What was your role in the conflict? In the resolution of the conflict?" ANS: A

Which of the following would not be a characteristic of an effective team nurse leader? a. An autocratic perspective b. Excellent communication skills c. Awareness of everyone's abilities d. A genuine interest in team members

a. An autocratic perspective ANS: A

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

a. Assessment/Data collection ANS: A

Mobilizing others to accomplish extraordinary things requires what leadership behaviors? (Select all that apply.) a. Celebrating the successes of others b. Demonstrating exceptional technical skills c. Imagining possibilities d. Establishing a sense of "being in this together"

a. Celebrating the successes of others c. Imagining possibilities d. Establishing a sense of "being in this together" ANS: A, C, D

Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviors would most likely signal that Nathan is intending to resign from his position on the unit? a. Increased absenteeism over the past month b. Increased attempts to discuss his concerns with his colleagues c. Testing of workplace guidelines d. Frequent defensiveness

a. Increased absenteeism over the past month ANS: A

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

a. The task and the outcome are relatively simple and defined. 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.

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. 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. authoritative and liable. d. responsible and task-oriented.

a. accountable. ANS: A

From the information presented in this chapter, which of the following statements best defines an accomplished team? Effective teams: a. can create a form of synergism in which the outcome is greater than the sum of the individual performances. b. do not necessarily need goals, objectives, vision, and a clearly stated purpose. c. do not always have effective communication patterns. d. may or may not have a clear plan that is followed and revisited and has an ongoing evaluation scheme.

a. can create a form of synergism in which the outcome is greater than the sum of the individual performances. ANS: A

A survey of staff satisfaction is conducted. The survey indicates that staff members are satisfied, are loyal to the organization, and feel that they have reasonable control in their individual responsibilities. The findings best exemplify: a. clarity in roles and valuing of contributions. b. satisfaction but not empowerment. c. effective coaching of new staff. d. role attachment.

a. clarity in roles and valuing of contributions. ANS: A

The state of being emotionally impelled, demonstrated by a sense of passion and dedication to a project or event, describes: a. commitment. b. control. c. willingness to cooperate. d. communication.

a. commitment. ANS: A

During unit staff meetings, you observe that Marg rolls her eyes and snorts whenever Julia makes a comment. Your first response as a unit manager is to: a. discuss what you have observed with Marg. b. file immediate documentation in Marg's personnel file. c. ask Julie to monitor Marg's behavior during meetings. d. ignore the behavior, as Marg is one of your strongest nurses.

a. discuss what you have observed with Marg. ANS: A

All of the following are grounds for immediate dismissal except: a. failing to pursue further medical help for a patient; patient dies. b. selling narcotics obtained from the unit supply of narcotics. c. restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a staff member. d. grabbing the unit manager and threatening further physical harm after a poor performance appraisal.

a. failing to pursue further medical help for a patient; patient dies. ANS: A

The biggest challenge in the recruitment of staff is: a. finding well-qualified candidates who can function well within your particular work culture. b. recruiting individuals with the appropriate qualifications and experience. c. screening out candidates who are unable to function well within a team. d. determining if candidates have had previous negative experiences in a work environment.

a. finding well-qualified candidates who can function well within your particular work culture. ANS: A

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

a. identified what assumptions were underpinning the issues. b. considered why it was important to make this change or the context for the change. c. considered how this change might affect staff relationships. ANS: A, B, C

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

a. identify the root causes of problems. ANS: A

A mediator suggested that the nurse manager and staff members decide on a method to resolve conflicts. It is important to have agreements about how team members will work together because: a. if there are no agreements, each member will make up rules about how to handle disagreements and relationships. b. people are naturally difficult and will not work well together without such agreements. c. people will naturally ask for agreements about how to be together. d. a way to eliminate nonproductive team members must be available.

a. if there are no agreements, each member will make up rules about how to handle disagreements and relationships. ANS: A

In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should: a. include a plan to correct them and to prevent future occurrences. b. state a detailed history of past problems that are related to the current one. c. be written at the convenience of the manager. d. not be discussed until the formal performance evaluation.

a. include a plan to correct them and to prevent future occurrences. ANS: A

The nurse manager of a rehab unit wants to purchase a new antiembolic stocking for use with patients. To make a high-quality decision, the nurse manager would: a. involve the rehab staff in the decision. b. involve the sales representative. c. make the decision alone. d. involve administration in the decision.

a. involve the rehab staff in the decision. ANS: A

Trust is an important aspect of helping relationships, therapeutic communications, and the positive communications model. Which statement does not involve or define trust? Trust: a. involves decisions to manipulate situations to gain advantage over another. b. is the basis by which leaders facilitate the activities and progress of a team. c. is low among members and leaders in poorly performing teams. d. involves what we say and not necessarily what we do.

a. involves decisions to manipulate situations to gain advantage over another. ANS: A

During the performance appraisal session, the manager should: (Select all that apply.) a. maintain a relaxed and professional manner. b. inquire about the employee's personal life and how it is affecting performance. c. allow the employee to express opinions orally and in writing. d. plan to give specific examples only for poor performance.

a. maintain a relaxed and professional manner. c. allow the employee to express opinions orally and in writing. ANS: A, C

The validity of comments and ratings related to performance is enhanced by: a. maintenance of anecdotal notes over the entire evaluation period. b. quantity of information gathered for appraisal purposes. c. agreement of the employee with the ratings and comments. d. whether or not other individuals have contributed to the observations.

a. maintenance of anecdotal notes over the entire evaluation period. ANS: A

Susan, a new graduate, is upset that so many staff have been absent lately from the unit. She declares to you that all absenteeism could be eliminated with proper management. Your response is based on understanding that: a. not all absenteeism is voluntary. b. high personal control contributes to absenteeism. c. direct discussions with employees who have high levels of absenteeism are not recommended. d. all absenteeism is related to personal issues and needs.

a. not all absenteeism is voluntary. ANS: A

The nurse manager schedules evaluations of staff members using a newly developed performance appraisal tool. The development of a performance appraisal tool should include: a. organizational mission, philosophy, and position requirements. b. a generalized overview of the duties of a position. c. a skills checklist and accreditation requirements. d. an ordinal scale that ranks all employees.

a. organizational mission, philosophy, and position requirements. ANS: A

An outpatient clinic advertised for RN positions. Before authorizing an open position, the nurse manager should: a. review the position description and performance expectations for the opening. b. place an ad in the local newspaper and on the telephone job line. c. review all current applications on file. d. look for employees within the system who might best fill the position.

a. review the position description and performance expectations for the opening. ANS: A

You have hired Chelsea as a new staff member on your unit. Although she is an experienced ICU nurse, this is her first educator role. A month into her new position, she confides that she feels really incompetent in her new position and bursts into tears. Your response is based on application of your understanding of: a. role acquisition. b. role conflict. c. role complexity. d. performance appraisal.

a. role acquisition. ANS: A

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.

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. d. assessment of patients being admitted through the Emergency Department. ANS: A, B, D

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

a. uses various models to guide the process based on the circumstances of the situation. ANS: A

The mediator noticed that tension was still evident between the nurse manager and staff members. He informed the chief nursing officer that to begin team building, it would be important that everyone: a. work together in a respectful, civil manner. b. use avoidance techniques when confronted with a conflict. c. develop a personal friendship with each other. d. socialize frequently outside of work.

a. work together in a respectful, civil manner. ANS: A

On your unit, despite efforts to build a strong sense of team, conflict between some of the staff is ongoing. Nonetheless, you want to proceed with developing a systematic and effective performance appraisal system. Which of the following approaches would be most appropriate for you to implement? a. Peer review b. A combination of tools c. Anecdotal notes d. Rating scale

b. A combination of tools ANS: B

Which of the following indicates safe delegation? two staff, and the replacement is inexperienced. 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 orientating. 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.

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. 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

b. Assigning ANS: B

The unit manager on 4E is concerned about the performance of Jean, a staff nurse. She is not involved directly with Jean, so she has not been able to determine whether the problem is one of motivation, ability, or both. If Jean lacks ability, which of the following strategies might the head nurse use? a. Dismiss or transfer Jean. b. Document all problem areas and then discuss them with Jean. c. Develop appropriate solutions and make recommendations to human resources. d. Smooth over the problems if they are minor in nature.

b. Document all problem areas and then discuss them with Jean. ANS: B

Which of the following strategies might be effective in empowering staff? a. Communication book in which new information on policies and processes is communicated and mistakes are highlighted. b. Monthly staff meetings during which a portion of the agenda is devoted to sharing ideas and presentations on best practices for implementation on the unit. c. Once-yearly summative evaluations based on what the manager best likes about the individual. d. Focus on discussion of errors in care with direction as to how errors are to be prevented in the future.

b. Monthly staff meetings during which a portion of the agenda is devoted to sharing ideas and presentations on best practices for implementation on the unit. ANS: B

A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems? a. Use of the performance appraisal on an annual basis b. Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up c. A tally sheet of medication errors and other specific problems that will be used at annual review d. Copies of reports, placed in his or her file, of all unusual occurrences involving the employee

b. Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up ANS: B

The unit manager discusses absenteeism with the unit clerk. She indicates that it is a serious problem on the unit. Which of the following points would they have likely discussed? a. Employee morale is at a high level. b. Patient care will be jeopardized and possibility below standards. c. Existing staff have experienced little effect from the absenteeism. d. Cost for the unit remains the same when new staff are hired.

b. Patient care will be jeopardized and possibility below standards. ANS: B

Sue, a nurse manager, discusses her concerns about the hospital's employee appraisal system with her work group, noting that it includes only one rating scale and that it means nothing unless the manager has effective relationship skills. Sue's concerns reflect which best practices associated with performance appraisal? a. Rating scales are too generalized to be considered valid or reliable. b. The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills. c. BARS is considered superior to simple rating scales in terms of performance appraisal. d. Rating scales need to be designed by users to be well accepted.

b. The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills. ANS: B

Nurse Stacey is a self-admitted drug addict and has been a heavy abuser of codeine. Stacey and the unit manager decide that changes have to occur. Stacey enrolls in an addiction program, and the manager has her transferred to a drug-free area. What other strategies might be appropriate? a. The manager could refer Stacey to the human resources department. b. The manager could assist in monitoring Stacey's progress. c. The manager could counsel Stacey if Stacey has formed a trusting relationship with her. d. Stacey needs to be asked not to involve her family in the recovery program because this is a work-related situation.

b. The manager could assist in monitoring Stacey's progress. ANS: B

John's performance was satisfactory during the first month, but after that time, he was found to be very inconsistent in the provision of nursing care. One month before the end of the rating period, he cared for a very wealthy and influential client, who is best friends with the clinical manager. This client donated new furniture for the staff lounge in John's name to show appreciation for his care. John's subsequent performance appraisal resulted in outstanding ratings in all areas. This is an example of: a. a performance rating based on justifiable evidence. b. a bias related to recent events. c. the impact of personality on the appraisal of performance. d. the effective use of a behaviorally anchored rating scale.

b. a bias related to recent events. ANS: B

By following a shared leadership model, the nurse manager believes that staff members will learn to function synergistically. Some teams function synergistically because members: a. do not volunteer unwanted information. b. actively listen to each other. c. listen to the person who believes he or she is an expert. d. do not speak unless they are absolutely sure they are correct in their views.

b. actively listen to each other. 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 inhaler, 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 medication levels in the inhaler.

b. ask Evelyn if she has worked with inhalers before and to describe what she knows about them. 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.

b. authority. ANS: B

Anecdotal notes: a. should be completed only when there are performance concerns. b. can be used to support and justify fairness in termination discussions. c. are unnecessary if the evaluation instrument is thorough. d. need to be completed at the end of a performance period.

b. can be used to support and justify fairness in termination discussions. ANS: B

Decision making is described by the nursing educator as the process one uses to: a. solve a problem. b. choose between alternatives. c. reflect on a certain situation. d. generate ideas.

b. choose between alternatives. ANS: B

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

b. crisis situations. ANS: B

You are charged with developing a new nursing curriculum and are committed to developing a curriculum that reflects the needs of the profession and of the workplace. To address deficits that may already be present in nursing curricula related to the workplace, you include more content and skills development related to: a. therapeutic communication with patients. b. effective communication in the workplace. c. increased emphasis on sender-receiver dyads. d. generational differences in communication.

b. effective communication in the workplace. 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.

b. failure to follow-through. ANS: B

Before terminating an employee, a nurse manager must: a. be an expert in all legal aspects of termination and discipline practices. b. follow the organization's specific policies for addressing disciplinary problems and termination. c. function as a counselor for problem employees. d. do everything to assist and protect the employee by adjusting standards and policies.

b. follow the organization's specific policies for addressing disciplinary problems and termination. ANS: B

The mediator suggested to the unit staff that a group agreement needed to be made so meetings could become productive. For example, the group agreement, "We will speak supportively," prevents: a. expression of opposing ideas. b. gossip and making negative comments about absent team members. c. efforts to ensure that everyone thinks alike. d. votes that oppose motions.

b. gossip and making negative comments about absent team members. ANS: B

John, a new graduate, reviews the employee evaluation for his new position. The first section requires that he list his own specific objectives to be accomplished. This is an example of: a. the traditional rating scale. b. learning goals, or management by objectives. c. a forced distribution scale. d. a behavior-anchored rating scale.

b. learning goals, or management by objectives. 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.

b. passive delegation. 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.

b. professional who delegates. ANS: B

Joanne, a new nurse manager, writes certain assumptions regarding the organization's objectives into her budget. Her supervisor tells her that the objectives implied in her assumptions are not entirely consistent with the organization, and that she needs to clarify these objectives with her supervisor. Joanne apologizes and says she had more latitude with the budget where she previously worked. This is an example of: a. role complexity. b. role ambiguity. c. role conflict. d. time-dependent roles.

b. role ambiguity. ANS: B

The chief nursing officer establishes a shared governance model to help empower the nursing staff, thus empowering the organization. Common characteristics of empowered organizations are: a. shared values, high salaries, and a human focus. b. shared values, flexibility, and a human-capital focus. c. commitment to communication, high salaries, and flexibility for evaluations. d. creation of community and of effective stress management in the midst of divergent goals.

b. shared values, flexibility, and a human-capital focus. ANS: B

The education consultant for the hospital is presenting a workshop titled "Documentation: A Manager's Responsibility." Which of the following points would she not include in her PowerPoint presentation? Documentation: a. cannot be left to memory. A notation must be placed in the personnel file. b. should avoid discussion of the problem. c. should include what was done about the problem when it occurred. d. needs to include date, time, and place.

b. should avoid discussion of the problem. 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 care required by patients. c. earlier discharge practices. d. the numbers of other disciplines present on a given unit.

b. the complexity of care required by patients. 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 behavior 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.

b. the development level of the followers and the behavior based on the situation. ANS: B

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

b. the policy made decisions for other departments in the company. ANS: B

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

b. use a decision-making tool to evaluate brands. ANS: B

During a performance appraisal, Joanne, the nurse manager, indicates that Alysha has difficulty mentoring students on the unit. Alysha responds that this is not her responsibility. In responding to Alysha, Joanne needs to consider: a. Alysha's level of confidence. b. whether mentoring is included in the position description. c. whether mentoring is an essential component of the position description. d. whether mentoring can be accurately observed and measured.

b. whether mentoring is included in the position description. ANS: B

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 assigned patient. 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."

c. "Here is what you need for the dressing, and I will show you what needs to be done." ANS: C

Which of the following might best conclude an interview? a. "Thank you for your interest. Someone will be in touch with you soon." b. "Before you go, we will make sure that we have your contact information. Thank you for coming." c. "I will be in contact with all candidates by telephone by next Friday. It has been a pleasure to meet you." d. "We have several excellent candidates so I am not sure about the outcome of the interview, but I will let you know. Thank you for coming."

c. "I will be in contact with all candidates by telephone by next Friday. It has been a pleasure to meet you." ANS: C

In determining the fit of a candidate with the culture on your unit, which of the following interview questions might be asked? a. "Could you review your résumé for us, highlighting your certifications and experience?" b. "If we were to ask your references, what would they list as your strengths? Weaknesses?" c. "We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?" d. "Tell us about your work and academic experiences and qualifications."

c. "We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?" 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 assessment to the LPN. b. Review the employee's 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.

c. Assess the amount of guidance and support needed for the nursing care of the patient. ANS: C

Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement the following steps that help to alleviate uncivil behavior on a unit. (A) Suspending the staff member from work, (B) Providing written admonishment that is discussed and placed in the employee's file, (C) Providing verbal admonishment, (D) Terminating the staff member a. A, B, C, D b. B, A, C, D c. C, B, A, D d. C, A, B, D

c. C, B, A, D ANS: C

Nurses generally experience difficulty in identifying behaviors and actions that could signal chemical dependency in a co-worker. Which of the following is not a behavioral change that occurs with chemical dependency? a. Personality and behavioral changes b. Job performance changes c. Changes in educational involvement and pursuit d. Absenteeism

c. Changes in educational involvement and pursuit ANS: C

A nurse manager must be familiar with the agency's policies regarding termination. Termination procedures include which of the following? a. Following specific procedures from other organizations b. Having an attorney present at the termination meeting c. Having adequate written documentation to support the action d. Having a friend present during the termination meeting

c. Having adequate written documentation to support the action ANS: C

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

c. Optimizing model ANS: C

The nurse manager places a staff member on probation because of reports of chemical dependency. The nurse manager should be aware that which of the following statements is true regarding chemical dependency? a. The chemically dependent employee usually hides any changes in behavior. b. When confronted with the issue, the affected employee is usually relieved to have someone to talk to about the problem. c. The chemically impaired nurse affects the entire healthcare organization. d. Hospital policy, state laws, and nurse practice acts address procedures for the chemically dependent employee in the most general terms.

c. The chemically impaired nurse affects the entire healthcare organization. ANS: C

As a nurse manager, you notice that one of your new nurses has provided exceptional care for a patient with especially complex needs. What would be the MOST effective way of recognizing the nurse's performance? a. At the next performance review, note specifically what the nurse did to make the patient comfortable. b. To avoid embarrassing the nurse in front of others, find a way to compliment the nurse in private. c. When the nurse comes out of the room, tell the nurse specifically what you appreciated about the care that was provided. d. Encourage the patient to note the care on the patient feedback form so that the institution can recognize the nurse's efforts.

c. When the nurse comes out of the room, tell the nurse specifically what you appreciated about the care that was provided. ANS: C

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

c. accurate identification of the problem. 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.

c. active 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 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.

c. assignment. ANS: C

The most important approach that a nurse manager can take with an emotionally troubled employee is to: a. act as a therapist for the employee. b. adjust the standard of care to assist the employee. c. assist the employee in obtaining professional help. d. adjust the employee's work schedule to decrease stress.

c. assist the employee in obtaining professional help. ANS: C

The nurse manager used a mediator to help resolve conflicts on the unit. During the mediation process, the nurse manager saw signs of potential team building. One key concept of an effective team is: a. conflict. b. task clarity. c. commitment. d. a designated leader.

c. commitment. ANS: C

The mediator asked each staff member to reflect on his or her communication style. Which of the following best describes communication? Communication: a. is a reflection of self-analysis. b. is a result of thoughtful consideration. c. consists of thoughts, ideas, opinions, emotions, and feelings. d. focuses on the sender of the message.

c. consists of thoughts, ideas, opinions, emotions, and feelings. ANS: C

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

c. decision making is a goal-directed effort; problem solving is focused on solving an immediate problem. ANS: C

Team Member A and Team Member B engage in heated disagreements on a frequent basis in team meetings. Their behavior is characterized by insistence on their points of view and refusal to back down or to negotiate alternative solutions once their ideas have been expressed. This behavior is characteristic of: a. autocratic leadership. b. constructive conflict. c. dualism. d. creativity.

c. dualism. ANS: C

The chief nursing officer decided that the nurse managers need a series of staff-development programs on team building through communication and partnerships. She understood that the nurse managers needed to build confidence in ways of handling various situations. The greatest deterrent to confidence is: a. lack of clarity in the mission. b. lack of control of the environment. c. fear that one can't handle the consequences. d. fear that the boss will not like one's work.

c. fear that one can't handle the consequences. ANS: C

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

c. generate as many solutions as possible. ANS: C

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

c. group size is neither too small nor too large. ANS: C

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

c. high-level cognitive process that includes creativity, problem solving, and decision making. ANS: C

The SBAR system of communications is one of the most used communication systems in health care because: a. it deals with all aspects of communications in patient care except communication with the physician. b. the nurse is on the same communication level as administration. c. it honors a familiar, structured transfer of information among health professionals. d. it honors an unstructured transfer of information.

c. it honors a familiar, structured transfer of information among health professionals. 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. receiving reports from the prior shift.

c. matching tasks with qualified persons. 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.

c. outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury. ANS: C

A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a: a. verbal reprimand. b. written reprimand. c. reminder of employment standards. d. day off without pay.

c. reminder of employment standards. ANS: C

After staff meetings lately, Sharon, the head nurse, observes her staff in small groups, having animated discussions that end abruptly when she approaches. Sharon reflects on this observation and realizes that: a. two very outspoken members tend to dominate discussions in meetings. b. this behavior is indicative of a high level of communication among her staff. c. staff members are very committed to the team and have strong opinions. d. ongoing discussion outside of meetings is conducive to creativity.

c. staff members are very committed to the team and have strong opinions. ANS: C

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."

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

As the nurse manager on a rehab unit, you are asked to come to the tub room immediately because two nursing assistants are having a loud disagreement in front of a patient. You ask the nursing assistants to meet you outside and after ensuring that a third nursing assistant is able to care for the patient, you speak with the two nursing assistants. Which of the following would you ask first? a. "How long have you two been working together?" b. "Have you experienced disagreements like this before?" c. "How do you think this patient's perception of her care has been changed?" d. "What happened to bring on this disagreement today?"

d. "What happened to bring on this disagreement today?" ANS: D

The nurse manager was upset with the staff nurse and said, "You did not understand what I said." Which element in the communication process was she referring to? a. Feedback between receiver and sender b. A message channel c. A receiver who decodes the message d. A set of barriers that may occur between sender and receiver

d. A set of barriers that may occur between sender and receiver 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 does 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.

d. Advise her that you are available if she needs you. ANS: D

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

d. All listed are appropriate to consider. ANS: D

You have hired a new RN to replace a well-respected and experienced nurse in your outpatient department. The new RN recently graduated and is nervous about stepping into a role that was previously filled by someone who was so competent. You recognize anxiety and set up regular, frequent meetings during which you explore how she is dealing with her anxiety, provide feedback, and discuss strategies/ideas that will enhance her performance. What development approach are you using? a. Performance appraisal b. Counseling c. Empowerment d. Coaching

d. Coaching ANS: D

The unit manager was addressing nursing students in the lounge area and was discussing team leadership and team effectiveness. She stated, "One can agree to disagree with another team member's perspective even when one doesn't necessarily see that perspective as being the correct one." In being creative, what did she mean? a. Championing one's own opinion b. Being compassionate c. Being flexible d. Committing to resolution

d. Committing to resolution ANS: D

The staff development educator developed strategies to help nurse managers actively listen. Guidelines for active listening include which of the following? a. Speed up your internal processes so that you can process more data. b. Realize that the first words of the sender are the most important. c. Be prepared to make an effective judgment of the communication sender. d. Cultivate a desire to learn about the other person.

d. Cultivate a desire to learn about the other person. ANS: D

Sue, a nurse manager, has a staff nurse that has been absent a great deal for the past 3 months. A whistleblower gives some information to Sue indicating that the staff nurse will be resigning and returning to school. Because of this, Sue decides to do which of the following? a. Immediately fire the staff nurse. b. Speak to the whistleblower and elicit more information. c. Speak to the staff nurse and ask her to resign. d. Do nothing.

d. Do nothing. ANS: D

Ellen is a novice nurse on your unit. Even though she has come to you highly recommended, as her supervisor, you have noticed some knowledge and skill deficiencies. These deficiencies have been noticed by her peers as well, who cover for her because she is new and they like her. Which of the following is likely to be the greatest asset to Ellen in improving her performance? a. Ignore Ellen's errors until she has more experience. b. Instruct staff to avoid working with Ellen until she learns to how do things herself. c. Ask Ellen to complete a self-assessment, using a standard skills checklist. d. Encourage staff to report every behavior of Ellen's that is different from theirs.

d. Encourage staff to report every behavior of Ellen's that is different from theirs. ANS: D

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

d. Incorrect problem identification ANS: D

In the cardiac intensive care unit, there has been simmering discontent about the new nurse manager, who avoids any discussion about her scheduling and practice decisions. The staff have begun to sort into "different camps" depending on how they feel about the manager or the decisions. Which of the following statements MOST accurately describes this situation? a. The tension that has been generated will result in creative solutions. b. Staff will become a cohesive group that takes a stand against the manager. c. The conflict will result in increased dialogue about practice and scheduling options. d. Patient care may suffer because attention and energy is being diverted toward the unit relationships.

d. Patient care may suffer because attention and energy is being diverted toward the unit relationships. ANS: D

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

d. Post a blank schedule, and ask staff members to fill in their times by a given date. ANS: D

Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement steps that help to alleviate uncivil behavior on a unit. Which of the following would not be an appropriate first step? a. Suspending the staff member from work b. Providing written admonishment that is discussed and placed in the employee's file c. Providing verbal admonishment d. Terminating the staff member

d. Terminating the staff member ANS: D

The final section of a performance appraisal is a rating scale. This scale is very detailed and relates to competency standards specific to surgical clients. The scale is a summary of performance directly observed or documentation reviewed and is specific to client care situations in which the employee has been involved. This type of evaluation is most commonly known as: a. a traditional rating scale. b. management by objectives/learning goals. c. a forced distribution scale. d. a behaviorally anchored rating scale.

d. a behaviorally anchored rating scale. ANS: D

The turnover rate for RNs in the ICU is high. You discuss this situation with existing staff and you find out that because of the rapid turnover, new staff are frequently required to assume full responsibilities soon into the position and before training is completed. In considering approaches that will reduce turnover rates, the staff and you decide to implement: a. an employee recognition program. b. coaching for new staff. c. a new performance appraisal system. d. a committed orientation and training program.

d. a committed orientation and training program. ANS: D

John notes that the next section is specific to the organizational philosophy and has a 4-point ordinal scale that describes performance from "always meets expectations" to "does not meet expectations." This type of evaluation is most commonly known as: a. a behavior-anchored rating scale. b. management by objectives/learning goals. c. the forced distribution scale. d. a graphic rating scale.

d. a graphic rating scale. ANS: D

A nurse manager is experiencing conflicts between herself and staff members. She had tried to develop a team by using a shared leadership model to empower the staff. Staff members are functioning: a. as a team. b. independently. c. interdependently. d. as a group.

d. as a group. ANS: D

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

d. assess the risk to the client and the agency before proceeding. ANS: D

A nurse manager in the ICU works with his staff to develop an appraisal instrument that includes quantitative data and respects standards for an RN working on that unit. This type of appraisal is a: a. rating scale. b. collaboratively based appraisal system. c. narrative instrument. d. behaviorally anchored rating scale.

d. behaviorally anchored rating scale. 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.

d. complexity of the task and the potential for harm. ANS: D

As part of orientation to your unit, you decide to administer Kolb Learning Style Inventory (LSI) to new staff. The most likely reason for your decision is that the use of Kolb LSI: a. reduces the cost of orientation. b. determines if there is fit between learner and organizational values. c. develops the strengths of the new staff member. d. enables individualization of learning to the learner's needs.

d. enables individualization of learning to the learner's needs. ANS: D

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

d. encouraged equal participation among members. ANS: D

The chief nursing officer understands that clinical incompetence is best prevented by a(n): a. flexible protocol for evaluating competency skills. b. standardized clinical skills checklist. c. administration of personality tests and competency assessments at point of hire. d. formalized competency program with established standards for practice.

d. formalized competency program with established standards for practice. ANS: D

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

d. identify the problem. ANS: D

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

d. informative. 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 two 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 arrival at their first patient care site. b. ask another RN to supervise the two experienced assistants so you can be with 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.

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

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 team's 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.

d. provide minimal direction and let them come to you with questions. 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.

d. retains accountability for the outcomes of care for the patient. ANS: D

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

d. satisficing. ANS: D

The nursing director calls a meeting with one of the new unit managers. She is very concerned about a report of substance abuse on the manager's unit, and she reviews the procedures involved in dealing with chemically dependent staff. Which of the following statements would NOT be included in the discussion? "As a manager, you: a. need to be aware of ADA issues." b. should check with human resources regarding chemically dependent employees and employment practices." c. check the nurse practice acts for the state in which the nurse resides." d. should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff."

d. should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff." ANS: D

The chief nursing officer reviews the policy about "progressive discipline process." The progressive discipline process includes which of the following? The manager: a. acts as a counselor and friend to the employee. b. should reprimand and suspend the employee as a last resort. c. should rehire the employee after a reasonable length of time. d. should terminate the employee if the problem persists.

d. should terminate the employee if the problem persists. ANS: D

A key advantage that a charge nurse has in terms of delegating is that: a. clients receive 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.

d. team skills can be used more effectively. ANS: D

When progressive discipline is used, the steps are followed progressively only for repeated infractions of the same rule. On some occasions, rules that are broken are so serious that the employee is: a. transferred to another unit. b. suspended indefinitely. c. asked to attend a union grievance meeting. d. terminated after the first infraction.

d. terminated after the first infraction. ANS: D

Sally (RN) and Melissa (RN) have shared an ongoing conflict since the first day that Melissa worked on the unit. Sally has confided to another colleague that she doesn't even know why the conflict started or what it was about. This is an example of: a. how expectations and objectives need to be made clear in team situations. b. the need to encourage open discussion of disagreements in opinions. c. the importance of involving all staff in discussions in group settings. d. the enduring nature of first impressions.

d. the enduring nature of first impressions. ANS: D

"I really wish that my supervisor would realize and acknowledge all the things I do well." In nursing, this has been identified as a problem. Which statement is part of the solution? Focus on: a. new staff. b. care assignments with which the individual is not familiar. c. making corrections. d. the strengths of the individual rather than the weaknesses.

d. the strengths of the individual rather than the weaknesses. ANS: D

The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that: a. using replacement personnel with new ideas may be beneficial. b. salary costs are lower because personnel are fewer, and outcome is favorable. c. absence on the part of the rest of the staff is decreased. d. unacceptable patient care may result.

d. unacceptable patient care may result. ANS: D