Module 2

An employee is sabotaging the work of a newly oriented charge nurse, and the charge nurse has not been successful in addressing the problem. When the nurse manager addresses the issue, which is the most appropriate statement? 1. I know it must be frustrating working with a new charge nurse, but how can we make this situation better? 2. This is not professional behavior, and you need to stop it or you will lose your job the next time I hear about it. 3. I know the charge nurse is new to the role, but you should get used to it or there will be more changes. 4. I know the new charge nurse is difficult to work with, but please help make the job easier to do.

1 Rationale 1: Acknowledging the persons frustration validates his or her feelings, and asking for input helps makes him or her part of the solution. Rationale 2: This statement is confrontational and is unlikely to result in a positive response from the employee. Rationale 3: Threatening the employee, no matter how veiled the threat, is confrontational and is unlikely to result in a positive response. Rationale 4: Patronizing remarks are condescending and are not likely to result in a positive employee response.

When the nurse manager orders supplies for the unit, which communication mode is best? 1. Telephone 2. E-mail 3. In person 4. Voice mail

2

In order to organize services needed to achieve specific client outcomes, hospital administrators should consider what type of client care delivery system? 1. Functional nursing 2. Differentiated practice 3. Case management 4. Primary nursing

3 Rationale 1: Functional nursing does not focus on specific outcomes. Rationale 2: Differentiated practice does not focus on specific outcomes. Rationale 3: Case management organizes client care by major diagnoses and focuses on attaining predetermined outcomes within a specific time frame. Rationale 4: Primary nursing does not focus on specific outcomes.

A nurse is participating in time-management education. This week's assignment is to compile a list of personal goals. Which of these goals should the nurse include? A. "I will lose 10 pounds by Christmas." B. "My family will have more fun." C. "I will read for pleasure for 1 hour every day after work." D. "I will not be late for work." E. "We will save $200 monthly for the next 12 months for a car down payment."

A. "I will lose 10 pounds by Christmas." C. "I will read for pleasure for 1 hour every day after work." E. "We will save $200 monthly for the next 12 months for a car down payment."

Which statements indicate that a nurse manager is using time reactively? A. "We were so busy yesterday that I did not get the schedule completed." B. "I knew that we would be busy over the holiday, so I ordered extra supplies." C. "We have so many new graduates on our unit that our work is never caught up." D. "I am putting a summary of a research article on the board each week since I realize many of the nurses do not read journals." E. "I am really concerned about what the nursing supervisor said about our unit. I can't get it off my mind."

A. "We were so busy yesterday that I did not get the schedule completed." C. "We have so many new graduates on our unit that our work is never caught up." E. "I am really concerned about what the nursing supervisor said about our unit. I can't get it off my mind."

A nurse manager has felt overwhelmed by work the last few months. After putting in many hours of unpaid overtime, the workload is beginning to stabilize. The nursing supervisor asks the manager to take on a new task that is exciting and stimulating. What should the manager do? A. Consider how much work will be added to the current workload. B. Tell the supervisor no. C. Talk with the supervisor about decreasing another work responsibility if this project is accepted. D. Accept the assignment and plan to continue to work very hard until it is completed. E. Accept the assignment, but only if additional salary is offered.

A. Consider how much work will be added to the current workload. B. Tell the supervisor no. C. Talk with the supervisor about decreasing another work responsibility if this project is accepted.

A novice nurse manager is devising a schedule to meet the needs of the staff, clients, and other disciplines on the unit. Which is the most important method to counteract wasted time in nursing? A. Delegate routine activities to concentrate on other tasks. B. Assign a staff member to attend management meetings. C. Redesign the position so that the nurse manager works when the unit is not busy. D. Strictly adhere to a rule that the manager will see only staff members who make appointments.

A. Delegate routine activities to concentrate on other tasks

The nurse manager has planned a meeting that all staff nurses have to attend. Which method would most efficiently notify the staff members of the meeting time? A. E-mail B. Voice mail C. Memo D. Telephone call

A. E-mail

The nurse manager routinely experiences stress related to deadlines for projects. What should be the nurse's first action to control this stress? A. Identify the actual stressor and the precipitating factors. B. Plan activities to minimize time constraints to reduce stress. C. Set aside a block of time each day for stress reduction. D. Engage in distraction activities to minimize the stress.

A. Identify the actual stressor and the precipitating factors.

A nurse manager is working on several projects and is stressed most of the time. This manager prefers working at the unit desk instead of in the office to be certain nothing on the unit is missed. Which would be the most effective method to decrease this manager's stress? A. Keep a structured schedule for "work time" on each project in the office. B. Elicit assistance from employees to help complete the projects. C. Allow one project to fall behind while finishing up the others. D. Take a sick day to work on the projects uninterrupted at home.

A. Keep a structured schedule for "work time" on each project in the office.

What are reasons that nurses fail to manage time effectively? A. Nurses do tasks they enjoy doing before the ones they do not enjoy. B. Nurses do things that bring the most immediate closure first. C. Nurses respond on the basis of who wants something. D. Nurses do uninteresting jobs before interesting jobs. E. Nurses work on things in the order of their arrival.

A. Nurses do tasks they enjoy doing before the ones they do not enjoy. B. Nurses do things that bring the most immediate closure first. C. Nurses respond on the basis of who wants something. E. Nurses work on things in the order of their arrival

The nurse manager has decided to work on personal time-management skills. What should this manager do first? A. Review patterns of time use. B. Purchase a new notebook system for time management. C. Identify essential job activities. D. Set a goal of prioritizing tasks every morning.

A. Review patterns of time use.

A colleague frequently forwards funny e-mails to everyone on her contact list. The nurse manager does not have time to look at the e-mails and is aggravated when they appear. How should the manager handle this situation? A. Set the e-mail filter to divert the messages to a spam folder. B. Tell the sender that the manager is not allowed to get personal e-mails at work. C. Forward the e-mails back to the sender. D. Send the colleague an e-mail that reads, "Stop wasting my time with these e-mails." E. Delete the messages without opening them.

A. Set the e-mail filter to divert the messages to a spam folder. B. Tell the sender that the manager is not allowed to get personal e-mails at work. D. Send the colleague an e-mail that reads, "Stop wasting my time with these e-mails." E. Delete the messages without opening them.

A nursing supervisor has a report due and just cannot seem to find the time to get it completed. One day before it is due, the supervisor turns it in. This situation best exemplifies which time waster? A. The supervisor waited for the deadline pressure to increase the priority. B. The report was one of the last tasks on the "to-do" list. C. The supervisor has no interest in the topic of the report. D. The report format is unfamiliar to the nursing supervisor.

A. The supervisor waited for the deadline pressure to increase the priority.

A nurse frequently has to work late and has no time to do required training while at work. She has to do it on her days off. Choose the work-related time waster that commonly puts nurses in this position. A. Unscheduled tasks delaying those that are scheduled B. An overwhelming amount of work to do C. Taking longer-than-scheduled breaks D. Volunteering for extra responsibilities

A. Unscheduled tasks delaying those that are scheduled

How can a nurse who is consistently falling behind at work improve to become more organized and disciplined? A. Use the same system every day to organize client care and required activities such as paperwork. B. Ask the nurse manager to grant permission for fewer client assignments until more experience with organization is achieved. C. Ask the unit secretary to do required paperwork to decrease the amount of time required. D. Practice a shorter client assessment technique to minimize the time required for this activity.

A. Use the same system every day to organize client care and required activities such as paperwork.

A newly appointed nurse manager has just completed education on time-management skills. Which statement would the instructor evaluate as indicating this nurse understands the basic concepts of time management? A. "My job as a nurse manager is so dynamic that I probably will not be able to attain true time management." B. "The key to using time management is to respect my time as well as the time of others." C. "If I am going to be able to manage time, the hospital will need to invest in a computer-based time-management system." D. "The most important aspect of time management for me is to manage paperwork flow."

B. "The key to using time management is to respect my time as well as the time of others."

A nurse manager must place a telephone call to a colleague who always wants to chat socially for several minutes. The manager does not have time for a social call. What is the best time for the manager to make this call? A. At 9:00 a.m. after physician rounds are complete B. A few minutes before the colleague usually goes to lunch C. In the middle of the afternoon D. First thing in the morning, just after shift report

B. A few minutes before the colleague usually goes to lunch

When driving towards a meeting, the nursing supervisor gets a call explaining the meeting is to be delayed for about 30 minutes. Which activity is the best use of this supervisor's waiting time? A. Listen to music on the radio. B. Drive to the meeting place and read the minutes from the last meeting. C. Stop by the closest store and get doughnuts to share with everyone. D. Use the time to make some personal phone calls.

B. Drive to the meeting place and read the minutes from the last meeting.

A nursing supervisor warns the nurse manager, "Having access to electronic communication is not always a blessing." How should the manager interpret this warning? A. Electronic communication wastes more time than it saves. B. The manager does not have to be physically present in the facility for communication to take place. C. If not used effectively, electronic communication can prevent the manager from getting rest. D. Along with a flatter organization and easy access, the nurse manager's job responsibilities have increased. E. In today's health care environment there is pressure to do more with less.

B. The manager does not have to be physically present in the facility for communication to take place. C. If not used effectively, electronic communication can prevent the manager from getting rest. D. Along with a flatter organization and easy access, the nurse manager's job responsibilities have increased. E. In today's health care environment there is pressure to do more with less.

A staff nurse frequently interrupts the nurse manager with problems that the staff nurse could solve. What should the manager say to correct this behavior? A. "I am no longer going to interrupt my work for you." B. "Let me see what I can do about the problem you are having." C. "Is this a problem you can handle yourself?" D. "You have the skills to solve this issue." E. "I trust you to solve this problem."

C. "Is this a problem you can handle yourself?" D. "You have the skills to solve this issue." E. "I trust you to solve this problem."

During a job interview the nurse manager asks, "What are your short-term goals?" Which statement by the applicant addresses this question? A. "I want to become a nurse anesthetist within 10 years." B. "I will be available to come in for extra shifts if needed." C. "My brother and I want to go to on a mission trip in the next year." D. "I want to get this job so I can move on to the next part of my life."

C. "My brother and I want to go to on a mission trip in the next year."

The nurse manager has several tasks that need to be accomplished. Which task is the manager likely to do first? A. A large job that holds little interest to the manager B. A difficult task that is going to require several days to complete C. A task that has been assigned by the supervisor instead of a task that the manager thinks will benefit the unit D. A task that will have little impact on the unit

C. A task that has been assigned by the supervisor instead of a task that the manager thinks will benefit the unit

The nurse manager must attend to several tasks this afternoon. Which tasks would the manager categorize as urgent? A. Waiting for pharmacy to call back about a meeting time B. Planning a staff meeting for next week C. Assisting a family whose child is in the emergency department D. Finding replacements for two staff members on the next shift who called in sick E. Trying to organize the visitor take-out menus

C. Assisting a family whose child is in the emergency department D. Finding replacements for two staff members on the next shift who called in sick

As part of a new time management initiative, the nurse manager is creating a "to-do" list. How should the manger structure this list? A. Focus on the events that are planned for each day. B. Focus on the activities the manager expects for the day. C. Block out time for the unexpected. D. Be certain the list is flexible. E. Do not create a "to-do" list for more than one day at a time.

C. Block out time for the unexpected. D. Be certain the list is flexible.

The nurse manager is writing annual evaluations for each nurse. In order to promote professional development, it is vital for the nurse manager and nurse to become involved in which activity? A. Personal organization B. Priority setting C. Goal setting D. Limit setting

C. Goal setting

In the morning care conference, the nurse instructs the assistant to feed breakfast to the clients in beds 2234, 2230, and 2241. The assistant indicates understanding of the assignment and repeats the bed numbers back to the nurse. What is the nurses next step? 1. Check with the assistant to see how the assignment is going during the time breakfast is served. 2. Check the clients breakfast trays before they are returned to dietary. 3. Check with the clients to see if they had breakfast. 4. At the end of the shift ask the assistant how the clients ate.

Correct Answer: 1 Rationale 1: Checking with the assistant while the tasks are being done is the best plan. If there is a misunderstanding or problem, this is the best time for the nurse to intervene. Rationale 2: Simply seeing an empty breakfast tray does not guarantee that the instructions were carried out correctly. Rationale 3: Checking with the clients does not allow for the nurse to amend the instruction or correct the actions being taken. Rationale 4: Waiting until the end of the shift does not allow the nurse to amend the instruction or correct actions being taken.

Regardless of which delivery system or combination of delivery systems is appropriate, which skill is required for effective use? 1. Flexibility 2. Strict adherence 3. Persistence 4. Resistance to change

Correct Answer: 1 Rationale 1: Flexibility is a skill imperative when choosing a delivery system(s) for nursing care. The system must meet client and staff needs and organizational and unit-specific goals, as well as remain within cost constraints. If not, flexibility allows for change to occur to alter the system as necessary to achieve the desired effects. Rationale 2: Strict adherence to a set of rules or structure is not appropriate in todays health care environment, where adaptability is essential. Rationale 3: The nurse should be persistent in learning new roles, but persistence is not the best answer to this question. Rationale 4: Resistance to change is not a desirable skill in todays health care environment.

The nurse manager tells a newly hired nurse that the unit practices functional nursing. What should the new nurse expect? 1. One nurse has responsibility for all the medications on the unit. 2. One nurse has responsibility for all the needs of three clients. 3. One charge nurse and one respiratory therapist have responsibility for all clients. 4. One nurse and one nursing assistant have responsibility for ten clients.

Correct Answer: 1 Rationale 1: Functional nursing breaks down client care into tasks assigned to the appropriate professional or skilled caregivers. This may result in one nurse (the med nurse) administering all the medications on the unit. Rationale 2: Total patient care is given by one nurse assigned to a few clients. Rationale 3: Team or modular nursing uses a variety of skilled caregivers to provide care to an assigned group of clients. Rationale 4: Team or modular nursing uses a variety of skilled caregivers to provide care to an assigned group of clients.

The staff nurse is unsure of the correct protocol for calling in sick to work. The nursing supervisor told the nurse to call the nursing office; however, the nurse manager told the nurse to call the unit. This issue is likely the result of which distorted communication? 1. Intersender conflict 2. Intrasender conflict 3. Metacommunication 4. Downward communication

Correct Answer: 1 Rationale 1: Intersender conflict occurs when a person receives two conflicting messages from different sources. Rationale 2: Intrasender conflict occurs when a verbal message differs from the nonverbal message; the recipient has difficulty interpreting the intended meaning. Rationale 3: Metacommunication is the combination of oral messages with nonverbal messages. Rationale 4: Downward communication occurs from manager to staff and is often directive.

The person who has just been promoted to nurse manager is male. If this nurse communicates in a way that is considered typical for men, what can the staff expect? 1. He will focus more on the issue than on personal experience. 2. He will strive to reach consensus within the group. 3. He will strive to avoid conflict within the group. 4. He will prefer to ask questions rather than make statements.

Correct Answer: 1 Rationale 1: Men have been socialized to remain focused on the issue and avoid self-disclosure about personal experiences. Rationale 2: Men can tolerate disagreement within the group. Rationale 3: Men may be more apt to tolerate conflict than women. Rationale 4: Women are more apt to ask questions to seek input.

During an evaluation conference, the nurse manager observes nonverbal messages, including nodding in agreement and smiling. These behaviors are examples of which aspect of communication? 1. Metacommunication 2. Intrasender conflict 3. Fogging 4. Intersender conflict

Correct Answer: 1 Rationale 1: Metacommunications are nonverbal messages conveyed by body language and environmental factors. Rationale 2: Intrasender conflict occurs when there is a difficulty in the interpretation of an intended message due to disparity between verbal and nonverbal communication. Rationale 3: Fogging is a communication technique in which one partially agrees with what was said. Rationale 4: Intersender conflict occurs when there is a difficulty in the interpretation of an intended message due to disparity between different sources.

One of the nurse competencies of the synergy care delivery model is moral agency. Which action is an example of that trait? 1. The nurse commits a medication error and reports it to the charge nurse. 2. The nurse collaborates well with the rest of the health care team. 3. The nurse is able to think ahead to the clients next need. 4. The nurse who does not have good baseline knowledge of a clients disease process researches it on a day off work.

Correct Answer: 1 Rationale 1: Moral agency is doing the right thing. Reporting a medication error is the right thing to do. Rationale 2: Collaboration is a desirable characteristic but does not describe moral agency. Rationale 3: Systems thinking is a desirable characteristic but does not describe moral agency. Rationale 4: This is a description of clinical inquiry, not moral agency.

What is the primary belief behind the evolution of the clinical microsystem as a nursing care delivery system? 1. Those who deliver the nursing care make the most educated decisions for a particular unit. 2. Clinical decisions are best made by the clients who are served by a particular unit. 3. Clinical decisions are best made by nursing leaders for all units within that particular hospital. 4. Nurses working in a particular service area are best suited to make decisions for the clients in that area.

Correct Answer: 1 Rationale 1: The clinical microsystem method allows those who are involved in the smallest unit of care to make the decisions for that unit. Rationale 2: Clinical decisions should be made by professional health care providers, with client input. Rationale 3: Decision making from the top is not reflected in the clinical microsystem structure. Rationale 4: Clinical microsystems involve a core team of caregivers, not all the nurses working in a particular service area.

The nurse manager has determined the need to hire two staff nurses. Which factor is most critical as the nurse manager prepares to submit the request to administration? 1. Timing of the request 2. Negative inquiry 3. Compromise 4. Persistence

Correct Answer: 1 Rationale 1: The nurse manager should plan to meet with administration when there is sufficient time and the supervisor seems receptive. Rationale 2: Negative inquiry is used after a request has been denied. Rationale 3: Compromise occurs after a request has been denied. Persistence and repetition are used after a request has been denied. Rationale 4: Persistence and repetition are used after a request has been denied.

The nurse executive is reviewing client satisfaction surveys. Which trend would the nurse evaluate as indicating the nursing care delivery system in use is not effective? 1. Sixty percent of respondents replied with the name of an unlicensed assistant when asked the name of the RN who cared for them. 2. Seventy percent of respondents accurately listed their discharge medication. 3. Eighty-eight percent of respondents reported that invasive interventions were performed by an RN. 4. Thirty percent of respondents reported that their nurse sometimes seemed rushed.

Correct Answer: 1 Rationale 1: This response may indicate that the RN is not able to provide the skilled care needed. There may be a lack of RN presence in patient care. Rationale 2: This statistic indicates the RN is providing discharge instructions, which is correct use of RN knowledge. Rationale 3: Most invasive procedures are done by RNs, so this indicates correct use of skill sets. Rationale 4: The nurse will sometimes be rushed. This low percentage is likely not an indicator of problems.

A long-term-care facility is considering implementing total patient care. Prior to implementing this system, what must be available? 1. Enough RN staff to provide all the care to the residents 2. A group of licensed assistants who are good at taking direction 3. A strong nurse manager 4. RNs willing to assume 24-hour accountability for the care provided to residents

Correct Answer: 1 Rationale 1: Total patient care means that all the care for the clients or residents is provided by the RN. Rationale 2: Unlicensed assistants are not used in total patient care. Rationale 3: While a strong nurse manager is always desirable, it is not strictly necessary to implement total patient care. Rationale 4: 24-hour accountability is a part of primary nursing, not total patient care.

Question 12 Type: MCSA Which is the most important consideration in choosing a structure for nursing care? 1. Client need 2. Efficiency 3. Cost 4. Timeliness

Correct Answer: 1 Rationale 1: While all four options are important, client need takes precedence over the others because nursing provides a service to the client. Rationale 2: Efficiency can be improved by choosing the correct nursing care delivery system, but this is not the most important consideration. Rationale 3: Costs can be contained by choosing the correct nursing care delivery system, but this is not the most important consideration. Rationale 4: Timeliness of care can be improved by choosing the correct nursing care delivery system, but this is not the most important consideration.

A nurse manager is aware that there is a strong grapevine communication system on the unit. The manager elects to use this grapevine to distribute information about an upcoming change in unit policy. In making this decision, the manager should consider which possibilities? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The information may be rapidly disseminated. 2. The information may be altered as it moves across the grapevine. 3. Most people try to spread information accurately. 4. Most people do not pay any attention to the grapevine. 5. Professional nurses do not participate in grapevine communication.

Correct Answer: 1,2 Rationale 1: Grapevine communication is often rapid and complete. Rationale 2: Grapevine communication is often altered as is goes from person to person. Rationale 3: The grapevine is very prone to distortionsometimes significant distortion. Rationale 4: Most people do believe or at least attend to the grapevine. Rationale 5: Grapevine communication crosses all levels of professionalism.

Which directions given by the nurse to the assistant are most likely to be understood and completed correctly? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Here are your directions for this morning. Please give the clients in rooms 2156, 2158, and 2159 total bed baths. 2. Go to the diet kitchen and get a cup of apple juice for the client in room 2112. 3. Ambulate the clients on the south wing. 4. Do you think youll have time to do shampoos today? 5. It might be a good idea to get the client in room 2110 up in the chair this morning. Or maybe it would be better to wait until this afternoon.

Correct Answer: 1,2 Rationale 1: Saying Here are your directions alerts the assistant that an important statement is going to be made. The instructions are clear and concise. Rationale 2: This is a clear and concise set of instructions. Rationale 3: This direction is not clear. Does the nurse want the clients whose rooms are on the south wing ambulated? Or does the nurse want all ambulation to occur on the south wing today? Rationale 4: This instruction is ambiguous. If the nurse would like for certain clients to have their hair shampooed today, the nurse should indicate that more clearly. Rationale 5: The nurse should be clear regarding what should be done before instruction is provided. Global Rationale:

A nurse manager approaches the nursing supervisor with a request for approval to incorporate 12-hour shifts into scheduling. The supervisor denies the request, stating this staffing pattern was used previously with poor outcomes. Which responses by the nurse manager may positively influence the supervisor? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. I agree it was not effective years ago, but other units have now had success with it. 2. What were your specific concerns about the 12-hour shifts? 3. I think it is unfair to refuse my unit this opportunity based on the past. 4. Why are you always so opposed to change on my unit? 5. If we dont offer alternative staffing patterns, we arent going to be able to attract new hires.

Correct Answer: 1,2 Rationale 1: This is an example of using fogging, or agreeing with part of what is said. This technique may make the supervisor rethink the decision by offering some new information. Rationale 2: Asking about previous concerns is a type of negative inquiry. It helps the nurse manager understand the supervisors position, but also requires the supervisor to rethink the issue. Rationale 3: Telling the supervisor it is unfair is the same as calling the supervisor unfair and is confrontational. Rationale 4: This approach is confrontational. Rationale 5: Threats, even veiled threats, are confrontational and should not be used.

A nursing team consists of an RN, two LPNs, and two UAPs. Which work would be completed by the RN? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Reviewing the clients plan of care with the UAPs 2. Discussing the clients increasing shortness of breath with the LPN 3. Updating the care plan of a client who will undergo surgery tomorrow 4. Administering oral medications to clients 5. Calling the physician to discuss the clients response to a new treatment

Correct Answer: 1,2,3,5 Rationale 1: The RN team leader is responsible for conducting the nursing care conference and reviewing the clients plan of care with the team. Rationale 2: The RN team leader guides the client care and helps to resolve any problems that may occur. Rationale 3: Developing and updating nursing care plans is the work of the RN team leader. Rationale 4: Typically the team leader is involved in indirect client care activities. Rationale 5: Communicating and collaborating with physicians is generally the responsibility of the team leader.

As the RN team leader, identify potential disadvantages of using team nursing to deliver care to assigned clients. Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Continuity of care may suffer. 2. Client/staff communication may be an issue. 3. There is little cost savings to the institution. 4. Delegation is necessary. 5. Not as many professional staff are required.

Correct Answer: 1,2,4 Rationale 1: Continuity of care may suffer when care is given by more than one person. Rationale 2: Team nursing requires excellent communication skills in all team members, who must communicate with clients, families, and each other. Rationale 3: Team nursing does save on personnel costs. Rationale 4: The RN must be careful to delegate only tasks that are appropriate for the skill level and licensure of the designated personnel. The RN is ultimately responsible for all client care. Rationale 5: Team nursing does reduce the numbers of professional staff required.

Which statement by a newly licensed nurse indicates an understanding of why it is necessary to structure nursing care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. It helps to coordinate care to a group of clients. 2. It organizes care responsibilities. 3. It ensures that the staff doesnt get overtime. 4. It improves physician efficiency. 5. It provides skilled care by skilled staff.

Correct Answer: 1,2,5 Rationale 1: Structure is necessary to ensure that care is coordinated. Rationale 2: Structure is necessary to ensure that all care responsibilities are covered. Rationale 3: While structure may make nursing care more efficient, it does not ensure that no overtime will be necessary. Rationale 4: The objective of structuring nursing care is not to ensure physician efficiency. Rationale 5: Structuring nursing care helps to assign nurses with certain skills to clients whose care requires those skills.

The nurse manager has asked that another staff nurse position be funded for the unit. The supervisor denies the request. Which statements by the manager are examples of negative assertion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. I know I havent been too careful in keeping personnel costs low, but we are really going to need another position. 2. I dont see why another position cannot be funded. We have met our budget each year for the last 3 years. 3. I realize that my staff is not always positive about organizational changes, but having this extra staff member might reduce some of their stress. 4. I can understand what you said about budget being tight, but we still need the position. 5. Do you not understand how hard my nurses are working?

Correct Answer: 1,3 Rationale 1: Negative assertion occurs when the speaker accepts some of the blame for the situation. Rationale 2: This is an example of negative inquiry. Rationale 3: Negative assertion is accepting some of the blame. Rationale 4: This is an example of fogging. Rationale 5: This is a confrontational statement and should be avoided.

A hospital is considering implementing the use of critical pathways and case management. Which statements by a nurse would indicate to the nurse manager that more education should be provided? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. If we use critical pathways, we wont have physical therapy to help us ambulate clients. 2. If a client is not able to follow the critical pathway, a variance will be written. 3. The critical pathway lists discharge outcomes but wont help us with day-to-day guidance of care. 4. Once the client is on a critical pathway, we must follow it until discharge. 5. Using critical pathways will help us reduce length of stay and costs to the client.

Correct Answer: 1,3,4 Rationale 1: Critical pathways are designed to direct the care of many disciplines. There is no reason to believe that physical therapy will no longer be available to help with client ambulation. Rationale 2: Variances are written when the client is not making progress according to the critical pathway. Rationale 3: The critical pathway orients staff to the outcomes that should be achieved by the client each day. Rationale 4: If the client has variance from the critical pathway, it may be revised. Rationale 5: Critical paths use resources appropriate to the care needed, and thereby reduce cost and length of stay.

What should the nurse executive consider when planning the nursing care delivery system of a new hospital? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. How to optimize use of nursing knowledge 2. The system used by competing hospitals 3. How to ensure that clients receive optimal care 4. Skill sets likely to be present in the nurses who will be employed at the hospital 5. What groups of nurses are available for employment

Correct Answer: 1,3,4,5 Rationale 1: Optimizing the knowledge of the available nurses is an important component of deciding on a nursing care delivery system. Rationale 2: The system used by competing hospitals is not of great importance in choosing the system for a new hospital. Rationale 3: The provision of safe and effective nursing care is the most important of all considerations. Rationale 4: Optimizing nursing skills is an important consideration when choosing a nursing care delivery system. Rationale 5: The nurse executive must consider who is available to fill the nursing positions in the organization. Creating a system that requires employing numbers of nurses or nurses with particular specialties or education levels will not be effective if those nurses are not available to employ.

Question 6 Type: MCMA The hospital administration is considering adopting primary nursing as its model of nursing care delivery. Disadvantages of this method are that Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The client may have multiple primary nurses if transfers within the facility are necessary. 2. Physician satisfaction is decreased. 3. Staff nurses cannot be held legally liable for care provided outside their work hours. 4. It requires a knowledge-based nursing practice model. 5. All persons caring for the client must have excellent communication skills.

Correct Answer: 1,3,5 Rationale 1: If a client requires transfer between units, a new primary nurse will be assigned in each unit. In some cases, this could result in multiple primary care nurses during one hospitalization. Rationale 2: Physician, nurse, and client satisfaction is generally increased with primary care. Rationale 3: The premise of primary nursing is that the nurse holds 24-hour-a-day accountability for client care. Legally, nurses cannot be accountable for care provided outside their work hours. Rationale 4: Requiring a knowledge-based nursing practice model is seen as an advantage of primary nursing. Rationale 5: Excellent communication must exist between the primary nurse and associate nurse. This is often difficult.

A nursing unit has just completed a 6-month trial of using team nursing to provide care. The overwhelming opinion of the staff is that the experiment was a disaster. What are the most common reasons team nursing is not successful? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. There are problems with delegation. 2. There are problems with the skill set of the UAPs on the teams. 3. The LPNs on the team do not accept their position of being in the middle. 4. Communication on the team or with the nurse manager is flawed. 5. RNs and LPNs struggle with who is in control and has the power on the team.

Correct Answer: 1,4 Rationale 1: If the team leader does not delegate effectively or team members do not accept delegation well, team nursing will not be effective. Rationale 2: Problems with UAP skill sets can be overcome by education. This is not a common reason team nursing does not work. Rationale 3: While LPNs can be in the middle between the UAP and the RN, there is no indication that this is a common problem. Rationale 4: Poor communication is a common problem and can make the team approach ineffective. Rationale 5: There is no indication that this is a common issue.

he hospitals management team wishes to institute case management to improve the quality of nursing care. As a beginning step, the team is choosing specific medical diagnoses on which to focus. What criteria should the team use when choosing these diagnoses? 1. Diagnoses given to only a few clients 2. Diagnoses that carry high risk for the client and the provider 3. Diagnoses that have low reimbursement rates 4. Diagnoses that involve as few providers as possible

Correct Answer: 2 Rationale 1: Case management is used for high-volume diagnoses. Rationale 2: Case management is used with high-risk diagnoses. Rationale 3: Case management is used with high-cost diagnoses. Rationale 4: The number of providers associated with a diagnosis is not a criterion for case management.

The nurse manager is counseling a male nurse about several recent incidents in which female nurses complained that he was abrupt and condescending. What advice should the manager give this nurse? 1. Make sure that anything you say is clear and concise. 2. Dont feel as if you are responsible for fixing every problem. 3. Avoid using phrases such as sort of when talking to females. 4. Dont personalize everything.

Correct Answer: 2 Rationale 1: Males tend to communicate clearly and concisely, especially in professional relationships. Rationale 2: There are many gender differences in communication. Male tend to take responsibility and feel the need to fix things. Rationale 3: Using phrases such as sort of is a more common trait of female conversation than of male conversation. Rationale 4: Women tend to personalize, while men are more focused on the issues.

A change in nursing care delivery system is being considered by hospital administrators. Which information should the nurse executive add to this discussion? 1. There has been little change in nursing care delivery over the last few years. 2. We must look to the nursing process for guidance in nursing care. 3. Too much time is spent deciding on a system of care. 4. Any system is okay, as long as the nurses follow it.

Correct Answer: 2 Rationale 1: Nursing care delivery systems are in continual revision as nurses strive to find the perfect system for providing care to clients with varying degrees of need. Rationale 2: The nursing process reflects nursing care and consists of assessment, planning, implementation, and evaluation. Rationale 3: A comfortable and efficient system for delivery of care is important to client outcomes. Rationale 4: The system must be safe, efficient, and effective.

The RN leader of a team overhears one of the UAPs on the team say, Ill sure be glad when I get my RN license. All they do is sit around doing paperwork. How does the RN interpret this comment? 1. As a need to be more involved in direct client care when this UAP is on the team 2. As a common disadvantage of the team approach to nursing 3. As an indication that this UAP should be reported for unprofessional behavior 4. As confirmation that UAPs are poorly educated and do not work well on teams

Correct Answer: 2 Rationale 1: The RN must focus on the work that requires RN skills. In some cases, this work consumes much of the shift. The RN should not ignore that work to placate the UAP. Rationale 2: Resentment against the team leader for not doing real nursing is a common drawback of team nursing. Rationale 3: Reporting the UAP for unprofessional behavior will not make the resentment go away and may make the situation worse. Rationale 4: There is no indication that this UAP is not educated or does not work well on a team. The UAP may not understand the roles on the team.

The nurse manager should be most careful not to hold preconceived beliefs when listening to which person? 1. The hospital administrator discussing next years budget 2. A staff nurse the manager has worked with for 25 years 3. A newly licensed nurse who is hesitant to address the manager 4. A physician discussing prognosis with the client and family

Correct Answer: 2 Rationale 1: The manager will probably pay close attention to the hospital administrator because of the position. Rationale 2: When there is a long-term relationship, the listener sometimes thinks they know what the other person is going to say. Careful listening is necessary in these situations. Rationale 3: The manager would be attuned to someone who is new to the organization and who might be hesitant to speak. This is not a common situation in which the manager would have preconceived beliefs. Rationale 4: The nurse manager will likely listen very closely to this conversation without preconceived beliefs.

The nurse has a concern regarding the quality of care being provided in the hospital. What should the nurse consider first before communicating this concern? 1. The medium of the message 2. The relationship between the nurse and the receiver of the message 3. The timing of the message 4. What to include in the message

Correct Answer: 2 Rationale 1: The medium of the message is not the first consideration. Rationale 2: The first consideration is the relationship with the receiver of the message. This will guide the remainder of the choices the nurse will make. Rationale 3: Timing is essential, but it is not the first consideration. Rationale 4: In this situation, the nurse likely has numerous points to express. It might not be the best plan to include them all in the initial conversation.

The nurse plans to seek employment in an acute-care setting after graduation. Which form of communication would be most effective in applying for a position? 1. Send an e-mail to the nurse manager, requesting a job interview. 2. Send a written letter and rsum in the mail. 3. Call the nurse manager to ask if any jobs are open. 4. Drop into the nurse managers office to discuss employment options.

Correct Answer: 2 Rationale 1: This approach is too informal. Rationale 2: Applying for a job requires a high level of formality. A written cover letter and rsum are expected by most organizations offering employment opportunities. This submission would be done by e-mail only if that is the organizations specific request. Rationale 3: This approach is too informal. Rationale 4: Dropping in to the managers office is not professional. Any meetings generally occur at the request of the potential employer and would occur after the rsum and cover letter are sent.

What is the most important reason that excellent communication skills are essential for nurses? 1. Nurses must communicate with all disciplines. 2. All nursing activities occur in relationships. 3. Interpersonal skills get the work done. 4. Good communication ensures no problems occur.

Correct Answer: 2 Rationale 1: While nurses do communicate with all disciplines, the correct reason is broader. Rationale 2: Nursing activities occurring in relationships make communication skills essential. Rationale 3: Excellent communication skills can get the work done more quickly and effectively, but the correct reason is broader. Rationale 4: Excellent communication skills do not keep problems from occurring.

A problem has arisen on a unit whose nursing staff is composed primarily of members of Generation X. Which strategies should the nurse manager employ to get staff input into solving this problem? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Schedule a staff meeting for discussion of the problem and its possible solutions. 2. Post a notice on the bulletin board explaining the issue. 3. Ask nurses individually for input. 4. Develop a possible solution and share it with nurses in a formal meeting. 5. Ask for input via text message and promise to respond to texts immediately.

Correct Answer: 2,3 Rationale 1: Generation X members do not like group problem solving and decision making. This is more the style of baby boomers. Rationale 2: Generation X members would be more likely to read the information, formulate an opinion, and share it with the manager. They like decisions to be made without unnecessary discussion. Rationale 3: Generation X members do not like unnecessary discussion, so asking for input individually would be a good strategy. Rationale 4: Traditionalists are more likely to respond to a suggestion from someone higher in the chain of command. They also tend to be more formal. Rationale 5: Generation Y is more likely to want immediate feedback from e-mails or text messages.

The nurse executive of a for-profit hospital continually works to provide an environment that is better for the nursing staff. Why is this effort so important? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. It is the most cost-effective way to manage a hospital. 2. An environment that is better for nurses is associated with lower mortality rates. 3. Nurses are more satisfied working in an environment that is better for nursing. 4. When the environment is better for nursing, it is also better for other disciplines. 5. Most of the strategies that improve the environment for nursing do not cost anything.

Correct Answer: 2,3 Rationale 1: Making the environment better for nurses may not be the most cost-effective strategy. Rationale 2: Research indicates that a better nursing environment is associated with lower mortality rates. Rationale 3: An environment that is better for nurses is associated with greater nurse satisfaction. Rationale 4: There is no evidence that improving the environment for nursing improves the environment for other disciplines. Rationale 5: There is little that can be done in a hospital environment that does not entail at least some cost.

A large metropolitan hospital uses differentiated practice as part of the structure of nursing services. Following this plan, nursing responsibilities are assigned based on which criteria? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Seniority 2. Educational level 3. Experience 4. Nurse preference 5. Affordability

Correct Answer: 2,3,4 Rationale 1: Seniority does not mean competence. Rationale 2: Differentiated practice takes education (primarily associates degree and bachelors degree) into consideration when determining nursing responsibilities. Rationale 3: Experience is considered in differentiated practice. Rationale 4: Nurse preference is taken into consideration in differentiated practice. Rationale 5: While cost containment is always an issue, in true differentiated practice it is not a primary determinant of responsibilities.

A registered nurse will be the case manager of a group of ten clients. What will the nurse expect as part of this assignment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse will determine interventions for all the disciplines needed as part of the clients care. 2. The nurse will meet with other disciplines to agree on the choice of critical pathways for each client. 3. The nurse will work to build consensus with the physicians caring for the clients on the team. 4. The nurse will define the expected nursing outcomes for the clients on the team. 5. The nurse will collect and analyze data regarding the clients on the team.

Correct Answer: 2,3,4,5 Rationale 1: Each discipline determines its own interventions. The disciplines collaborate to design care. Rationale 2: Collaboration with other disciplines is a critical component of case management. Rationale 3: A main emphasis of case management is building consensus with physicians caring for the clients. Rationale 4: The nurse is responsible for defining expected nursing outcomes. The other disciplines involved will set expected outcomes for their work. Rationale 5: Essential baseline data, such as length of stay, cost of care, and complication information, are collected and analyzed by the nurse and other members of the team.

Which nursing interventions would be in line with the chronic care model? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Blood sugar is measured frequently in an attempt to achieve tight glycemic control. 2. The nurse provides the client with the URL for a new website dedicated to self-management of a chronic respiratory disease. 3. The nurse advocates for the client who has decided to forego further dialysis. 4. Client information is entered into an electronic medical record. 5. Information about the operating hours of a community recreation center is provided to the client with coronary artery disease.

Correct Answer: 2,3,4,5 Rationale 1: The chronic care model manages how care is delivered, not a specific disease. Rationale 2: Self-management is one of the six components of the chronic care model. Rationale 3: Decision support is one of the six components of the chronic care model. Rationale 4: Use of clinical information systems is essential to the chronic care model. Rationale 5: Use of community resources is one of the six components of the chronic care model.

The nursing supervisor is planning an education session on collaborative communication between nurses and physicians. Which topics should be on this agenda? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Interdisciplinary respect 2. Understanding the role of the physician 3. Understanding the role of the nurse 4. Communication across disciplines 5. Active listening skills

Correct Answer: 2,3,4,5 Rationale 1: This topic is diffuse and hard to understand. More precise topics should be used. Rationale 2: Role understanding is essential to collaboration. It must include both roles. Rationale 3: Role understanding is essential to collaboration. It must include both roles. Rationale 4: Communication is the key to collaboration. Rationale 5: Listening is an essential part of communication.

The RN receives reports on eight clients in the morning. Client assignments are then delegated to an LPN and two nursing assistants. The morning is busy, with physician visits and new client orders, and the RN communicates these new orders to the LPN and nursing assistants. The RN also meets with the case manager to discuss nursing home placement for a client. What type of nursing care delivery system is in place in this hospital? 1. Critical pathways 2. Total patient care 3. Team nursing 4. Functional nursing

Correct Answer: 3 Rationale 1: Critical pathways are a set of strategies used by health care providers to attain expected outcomes. Critical pathways are not a nursing care delivery system, and there are insufficient data to determine if they are used in this scenario. Rationale 2: Total patient care is given by one nurse. Rationale 3: The RN in this case is leading a team. A variety of skilled caregivers cares for a group of clients. Rationale 4: Functional nursing breaks down the assignments into tasks.

The nurse asks the nurse manager if he can go home early because the census is low. When the request is denied, the nurse states, I dont understand why I cant leave early. I will use vacation time and this will help minimize personnel costs for the shift. This statement is an example of which technique of influencing the supervisor? 1. Fogging 2. Negative assertion 3. Negative inquiry 4. Compromise

Correct Answer: 3 Rationale 1: Fogging is a technique used when the person is in partial agreement with what was said. Rationale 2: Negative assertion involves some acceptance of blame for what was said. Rationale 3: Negative inquiry is a statement of I dont understand. Negative inquiry is an effective technique, provided the person to whom it is directed does not become defensive or distraught. Rationale 4: Compromise implies that an agreement has occurred between the nurse manager and the nurse.

The hospital is opening its first intensive care unit. The nurse executive should plan to staff this unit according to which model of care? 1. Functional nursing 2. Team nursing 3. Total patient care 4. Modular nursing

Correct Answer: 3 Rationale 1: Functional nursing has the disadvantages of less continuity of care and potentially less skilled personnel caring for the client. Rationale 2: Team nursing has the disadvantage of not having a professional nurse attending to all client care needs. Rationale 3: In total patient care, one nurse cares for a client and, being totally accountable for the client, can give continuous, holistic, and expert care. Rationale 4: Modular nursing is somewhat synonymous with team nursing and has the disadvantage of not having a professional nurse to attend to all client care needs.

The hospital chief operating officer holds monthly focus groups with the purpose of gaining ideas and insights from nursing administration and staff nurses. Which type of communication does this indicate? 1. Lateral communication 2. Downward communication 3. Diagonal communication 4. Grapevine communication

Correct Answer: 3 Rationale 1: Lateral communication involves discussion among individuals at the same hierarchical level (e.g., all nurse supervisors). Rationale 2: Downward communication involves direction given by management to the staff. Rationale 3: Diagonal communication involves dialogue among individuals at different hierarchical levels (e.g., staff nurses to chief executive officer of nursing). Rationale 4: Grapevine communication is an informal channel among individuals at all hierarchical levels and has the potential to generate misinformation.

The RN working on an orthopedic unit is caring for a postoperative client with a hip replacement who is not transferring well from bed to chair. The client is behind on the mobility training program. What action is the nurses priority? 1. Instruct physical therapy to increase treatments to four times daily. 2. Contact the family to discuss preoperative mobility problems. 3. Inform the case manager of variance in the critical pathway. 4. Discuss the problem with the clients surgeon.

Correct Answer: 3 Rationale 1: Ordering an increase in physical therapy is not within the scope of nursing and would not be the priority action. Rationale 2: The family may have important information about the clients mobility, but this is not the priority action. Rationale 3: The case manager tracks all variances, reports to the collaborative team, and may revise the critical pathway. Rationale 4: Discussing the problem with the surgeon is not the priority action.

At a strategic planning meeting the nurse executive recommends instituting patient-centered care as a model of care delivery in the hospital. Which statement by the hospital CEO indicates understanding of this concept? 1. We have always had the patient at the center of everything we do. 2. We cant afford to hire more RNs. 3. Im concerned about the increased time and leadership our nurse managers will have to provide. 4. I like the idea of centralizing all our care.

Correct Answer: 3 Rationale 1: Patient-centered care as a practice model is not the same as centering care around the patient. Rationale 2: There would be fewer RNs in the patient-centered care model. Rationale 3: The nurse managers role in patient-centered care requires considerable time. The nurse manager must be a strong leader. Rationale 4: Patient-centered care is actually decentralized. Many of the tasks traditionally done by a central office, such as admission, are unit based.

A group of nurses is developing a poster presentation titled Nursing Care Delivery Through the Ages for the hospitals annual Nurses Day celebration. What form of nursing care delivery should they depict as occurring prior to 1930? 1. Team nursing 2. Functional nursing 3. Total patient care 4. Primary care

Correct Answer: 3 Rationale 1: Team nursing evolved in the middle to late 1940s. Rationale 2: Functional nursing grew out of the nursing shortage caused by World War II. Rationale 3: The original model of nursing care delivery was total patient care or the case method. During the 1920s, total patient care was the typical delivery system, with much RN care being provided in the home. Rationale 4: Primary nursing was conceptualized and implemented during the late 1960s.

The nurse manager has instituted a policy of sending information to the staff via e-mail. Many misunderstandings have occurred since this policy was implemented. What technique should the manager use to reduce this miscommunication? 1. Using text messaging instead of e-mailing 2. Requiring a return e-mail from everyone reading the information 3. Being certain that e-mails go only to the intended recipients 4. Sending all e-mails with a message line that says Important

Correct Answer: 3 Rationale 1: Text messaging can make the problem worse as it implies the need to respond quickly. Rationale 2: Having everyone send a return e-mail will set the nurse manager up for an onslaught of messages that are really not important. Rationale 3: E-mail communication is fraught with difficulties. The best of these options is to be certain that e-mails go only to the intended recipients. The use of reply to all or distribution lists is convenient, but can result in sending the e-mail to persons whom it does not affect. When this happens, people begin to ignore e-mail. Rationale 4: Sending the message line Important with each e-mail is much like crying wolf, and recipients will soon realize that the term Important is meaningless.

Which nursing care delivery situation best reflects the concept of a clinical microsystem? 1. A rural free clinic housed in a church gymnasium that is staffed by volunteer nurses and physicians 2. A walk-in clinic in a local discount store that is staffed by a nurse practitioner 3. An inpatient burn unit 4. A general medical-surgical unit in a midsized hospital

Correct Answer: 3 Rationale 1: The free clinic likely does not have the support staff, equipment, and facilitative environment necessary for a clinical microsystem. Rationale 2: A walk-in clinic in a retail outlet does not have a tightly defined population to receive care and is not likely to function as a clinical microsystem. Rationale 3: The burn unit likely has a core team of caregivers, a defined population to receive care, informational systems in place, support staff, equipment, and an environment that facilitates provision of care. Rationale 4: A general medical-surgical unit is less likely to have the components necessary to support a clinical microsystem.

Which example represents a qualifier that may interfere with the message to be communicated? 1. Please notify me when this task is complete. 2. Are you satisfied with the care you are receiving? 3. I hate to bother you with this, but we have a problem. 4. How can I help you solve your issues with this physician?

Correct Answer: 3 Rationale 1: This is a direct command or request and does not contain a qualifier. Rationale 2: This is a valid inquiry that does not include a qualifier. Rationale 3: Qualifiers are often used as entry statements into important discussions, but they can interfere with the message being communicated. This qualifier (I hate to bother you) sets up the receiver of the message to feel bothered. Qualifiers also reveal a lack of confidence in the sender. Rationale 4: This is a valid inquiry and does not include a qualifier.

After several near-incidents during procedures, the nurse manager is increasingly concerned about how nursing staff communicates with physician staff. Which advice from the manager would be most beneficial to the nursing staff? 1. Dont forget, you are just as good as they are. 2. Physicians just dont listen as well as nurses. 3. Lets review the steps of the procedures that we know are the biggest problems. 4. Im going to listen to the physicians, but I think most of the problem lies with them, not the nurses.

Correct Answer: 3 Rationale 1: This statement sets up an us against them mentality. This mindset does not support respect for the physicians and could make communication more difficult. Rationale 2: This statement sets up an us against them mentality. This mindset does not support communication. Rationale 3: The nurse manager should ensure that the nursing staff is competent in the procedures that are causing problems by reviewing the steps of the procedures with them. Rationale 4: The preconceived notion that the problems are the fault of the physicians would make open and honest communication more difficult.

The nurse has made several near errors in client care in the last 2 months. The nurse manager says, These are simple errors. You just arent listening. How could the nurse improve listening skills in this situation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The nurse should try to think ahead about what the person talking is going to say. 2. The nurse should hold eye contact with the speaker at all times. 3. When listening to instructions, the nurse should ask anyone who interrupts to wait a moment. 4. The nurse should get sufficient time away from work to rest. 5. The nurse should be careful not to prejudge what the speaker is going to say.

Correct Answer: 3,4,5 Rationale 1: Thinking ahead in conversation interferes with the ability to listen and comprehend. Rationale 2: Eye contact does not mean the nurse is listening. Rationale 3: When many people are talking at one time, it is difficult to listen and comprehend. Rationale 4: Being tired and stressed from too much time at work can cause energy to flag, resulting in difficulty listening. Rationale 5: Preconceived beliefs about what the speaker is going to say makes it more likely that the nurse is not going to listen effectively.

The nurse is always intimidated when asking a physician to clarify orders. Which statements should the nurse use to help counteract this feeling? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Im sorry, Doctor, but I need for you to repeat the dosage on that medication order. 2. Doctor, what was the dosage on that medication you just ordered, and do you want the client to get up in the chair today? 3. How often did you want the furosemide given? 4. Uh, can you tell me if you need for this client to be NPO today? 5. Doctor, what rate did you want for the IV?

Correct Answer: 3,5 Rationale 1: Saying Im sorry discounts the message. Rationale 2: The nurse should focus on one point at a time. Rationale 3: This is a direct statement. Rationale 4: This statement is weak. Avoid uh and um. Rationale 5: This is a direct statement, and it starts with a name that gets the physicians attention.

An inexperienced speaker is practicing the delivery of a speech. Which statement indicates a lack of understanding about how easily communication is distorted? 1. I know I can better connect with my audience with good eye contact. 2. If I repeat a complicated section in another way, comprehension is improved. 3. If I know the background of the audience, it can help with tailoring the content. 4. The topic is not complicated, so I dont have to worry about misunderstanding.

Correct Answer: 4 Rationale 1: Eye contact can assist in keeping the message clear. Rationale 2: Repeating the message can assist in keeping the message clear. Rationale 3: Tailoring the message can assist in keeping it clear. Rationale 4: It does not matter how uncomplicated the topic is; misunderstandings and distortions can still occur.

In which situation should the nurse be most concerned that communication was distorted? 1. The nurse obtains an admission history from the parents of an adopted child. 2. The nurse gives discharge instructions to a couple in their early 80s. 3. The nurse manager hires a new nurse originally from the Philippines. 4. The emergency nurse receives a client who was transferred via ambulance for confusion.

Correct Answer: 4 Rationale 1: Just because this child is adopted does not mean that the admission history will not be correct or that communication with the child or parents will be impaired. Rationale 2: Just because a person is older does not mean that communication is impaired. Rationale 3: Just because the person is from another country does not mean that communication will be distorted. Rationale 4: Communication will be most affected by the confusion of the client because the nurse cannot be sure of anything the client said or that the client understood anything the nurse tried to communicate.

A newly licensed RN is beginning a job search. This nurse would be best served by working in an organization that provides which nursing care delivery system? 1. Primary nursing 2. Total nursing care 3. Functional nursing 4. Practice partnerships

Correct Answer: 4 Rationale 1: The nurse providing primary nursing must be very autonomous. This is not the best environment for a newly licensed RN. Rationale 2: The nurse providing total nursing care must be very autonomous. This is not the best environment for a newly licensed RN. Rationale 3: In functional nursing, the RN leads the team. The newly licensed RN does not have sufficient experience for this role. Rationale 4: Practice partnerships allow for two personnel to work together in giving client care. Ideally, a senior RN can be paired with a novice RN.

The nurse manager is concerned about a family members complaint regarding the professional behavior of a nurse on the unit. Which is the most effective method to address this issue? 1. Post a memo to the nursing staff about expected professional behavior. 2. Send an e-mail to the nursing staff about expected professional behavior. 3. Address the complaint with the individual nurse in a telephone conversation. 4. Discuss the complaint with the individual nurse face-to-face.

Correct Answer: 4 Rationale 1: The purpose of a memo is to convey general information to a group; it has a low level of personal intimacy. Rationale 2: The purpose of e-mail is to broadcast information to large groups; it has a low level of personal intimacy. Rationale 3: A telephone conversation is less intimate than face-to-face communication, and the individuals response cannot be seen. Rationale 4: More important or difficult issues should be communicated face-to-face to the nurse involved so that the individuals response can be seen and questions can be answered appropriately.

The nurse has been concentrating on improving personal communication skills. Which option represents the final step in this nurses work to improve communication? 1. Think about the goals of the communication. 2. Develop an appropriate and thoughtful response. 3. Decide how to say what you want conveyed. 4. Ensure the communication is understood.

Correct Answer: 4 Rationale 1: Thinking about the goals is assessment. Rationale 2: Developing an appropriate response is an implementation. Rationale 3: Deciding how to say what you want conveyed or how to deliver your response is an implementation or plan. Rationale 4: Ensuring all parties understand the communication is the last step as it involves evaluation.

A hospital is concerned about low customer satisfaction ratings and poor evaluation on quality indicators. The nurse managers are asked to implement a nursing delivery system that is cost-effective and improves both customer satisfaction and quality of care. Which nursing delivery system should the managers implement? 1. Total patient care 2. Functional nursing 3. Team nursing 4. Patient-centered nursing

Correct Answer: 4 Rationale 1: Total patient care is costly and less efficient for nursing staff. Rationale 2: Functional nursing is cost-effective but lacks continuity of care. Rationale 3: Team nursing is cost-effective but may lack continuity of care, which can cause client dissatisfaction. Rationale 4: The focus of patient-centered nursing is the promotion of efficiency, quality, and cost control.

The staff nurse would like to improve personal communication with peers, patients, and the medical staff. Which strategy would be most effective for this nurse? 1. Plan to be more assertive in all communication. 2. Work to manage fear of conflict. 3. First learn to delegate clearly to others. 4. Attend the hospital-based communication training.

Correct Answer: 4 Rationale 1: While being more assertive in communication could help this nurse, this is not the most complete option. Rationale 2: Working to manage fear of conflict is not the most complete option. Rationale 3: Learning to delegate clearly would help the nurse learn to communicate better, but this is not the most effective strategy. Rationale 4: Attending training on communication would be the best plan for this nurse. The strategies described in the other options would likely be included in this training.

The nurse manager holds a regular Wednesday meeting with the charge nurses on the unit. There is no new information to discuss this Wednesday. What should the manager do? A. Hold the meeting so that the charge nurses do not feel that the meetings are not important. B. Hold the meeting, but only meet for 10 minutes instead of the usual 60 minutes. C. Reschedule the meeting for Thursday. D. Cancel the meeting.

D. Cancel the meeting.

A nurse manager's week is filled with handling routine and repetitive issues. Which strategy should the manager employ to make handling these tasks most effective and efficient? A. Ask those involved to leave voice mail messages about any routine matter. B. Encourage those involved in routine matters to call between 10:00 a.m. and 12:00 p.m. each day. C. Keep the office door open to be accessible to those dealing with these routine tasks. D. Hold a meeting each week especially for dealing with routine and nonurgent matters.

D. Hold a meeting each week especially for dealing with routine and nonurgent matters.

For the last several weeks, the nurse manager has felt as if there is not enough time in the day to accomplish all the required tasks. The manager goes home exhausted and does not look forward to going to work in the morning. What strategy may help alleviate some of this stress? A. Do tasks as quickly as possible. B. Hurry through work, hoping someone else will catch any mistakes that are made. C. Do not start any new tasks after lunch. D. Pick a simple task and complete it just before going home each day.

D. Pick a simple task and complete it just before going home each day.

Which activities are similar enough that they could be grouped to better manage time? A. Restocking the medication cart B. Discussing a diet request with a new client C. Calling for extra linen from laundry D. Search the Internet for an unfamiliar client diagnosis E. E-mailing a colleague a question about the schedule

D. Search the Internet for an unfamiliar client diagnosis E. E-mailing a colleague a question about the schedule

The nurse manager is significantly behind in the required paperwork for the job. How can the manager rectify this situation? A. Make stacks of work on the corner of the desk so the work can be seen. B. Use paper for all communication so a record is kept. C. Discontinue subscriptions to all journals. D. Set a goal to work on paperwork for a portion of every day.

D. Set a goal to work on paperwork for a portion of every day.

A nurse manager has identified that a major time waster is the amount of time spent on the telephone each day. Which strategy would help reduce this time? A. Answer the phone, "Hello, how are you?" B. Send all calls to voice mail. C. Use e-mail for potentially troublesome issues. D. Set a specific block of time to return calls.

D. Set a specific block of time to return calls.

Which strategies would decrease the amount of time the nurse manager spends with "drop-in" visitors to the manager's office? A. Set office hours to eliminate those visits. B. Keep the office door closed. C. Arrange furniture so the desk faces the door. D. Stand up to greet the visitor and remain standing. E. Encourage appointments for routine matters.

D. Stand up to greet the visitor and remain standing. E. Encourage appointments for routine matters.