Nursing: A Concept-Based Approach to Learning, 2e (Pearson) Module 40 Professional Behaviors
1) A toddler who has just been admitted to the pediatric unit is crying and scared. No treatment has been initiated at this point. The nurse needs to start an IV, and the parent asks, "Can I stay with my child and help through the procedure?" In providing care for the family, how does the nurse respond? A) "I can teach you ways to help your child throughout the procedure if you would like to be involved." B) "We do this all the time, so don't worry. I will come get you when we are done" C) "Be ready to hold the child down when I tell you to." D) "I will be very quick so there is no need for you to stay for the procedure."
Answer: A Explanation: A) A part of nurse competency is knowing the procedures to follow when performing skills. The nurse who is going to initiate an IV on a pediatric client should always seek assistance from the parent if the parent is willing and capable of offering assistance. Telling the parents that they need to hold the child without giving them a Choice is not appropriate; many parents do not want to participate in activities that cause pain to their child. The nurse does not know how long the procedure will be, and telling the parent not to worry is pointless.
5) The nurse on third shift missed the last chance for the unit competency, stating, "Oh well, it's not like I don't know what I'm doing." The nursing student knows that this is which type of attitude? A) Arrogance, which keeps the nurse from developing and from accurate assessment of her strengths and weaknesses B) Pessimism, which endangers the nurse's professionalism C) Optimism, which helps the nurse realize that things will turn out for the best D) Sarcasm, which threatens the nurse's job performance
Answer: A Explanation: A) Arrogance, or excessive pride and a feeling of superiority, can be an extremely dangerous characteristic in the nurse, as it can lead to a false belief that the nurse is always right and does not need input from others. For example, when the unit begins using a new IV infusion pump, the arrogant nurse does not bother attending the in-service and believes that it is possible to "figure things out" independently. Accurate self-assessment of strengths and weaknesses, as well as acceptance of feedback from others, promote both safety and growth and are therefore abilities essential for the nurse.
4) The nurse taking care of clients on the medical-surgical unit is habitually late and often leaves work for nurses on the other shift to complete. The nurse knows that in order to keep his job, which action must occur? A) The nurse must take responsibility and accept any corrective action. B) The nurse must continue the same behaviors. C) The nurse must have a positive attitude. D) The nurse must trade shifts in order to be on time.
Answer: A Explanation: A) Being reliable and being accountable are key factors in professionalism. From a systems perspective, each nurse is responsible for completing the duties of the job appropriately so that others can complete their work, too. Almost everyone must miss work or arrive late on occasion. But when poor attendance or lack of punctuality becomes a habit, it also becomes a performance issue and possible grounds for corrective action (steps taken to overcome a job performance problem) or dismissal (termination of employment).
6) The nurse observes the student nurse's behavior on the unit, and notes the student is always on time, neat in appearance, and caring toward clients. Which factor best indicates to the nurse the student level of professional commitment? A) A pattern of behaviors congruent with the nurses' professional code of ethics B) A strong belief in and acceptance of the company's goals, values, and mores C) A willingness to be able to exert control over personal behaviors D) A strong desire to be a part of a group
Answer: A Explanation: A) Factors associated with professional commitment include a strong belief in and acceptance of the profession's code, role, goals, values, and morals; a willingness to exert considerable personal effort on behalf of the profession; a strong desire to maintain membership in the profession; and a pattern of behaviors congruent with the nurses' professional code of ethics.
7) The nurses in a nursing home have a unique nursing team consisting of all four generational cohorts. The nursing management knows that the best nursing teams utilize which generation's contributions? A) The contributions from each generation's strengths B) Those of the hardworking, loyal veterans C) Those of the adaptable, techno-savvy Generation Xers D) Those of the young, optimistic Millennials
Answer: A Explanation: A) Learning from the unique strengths of each generation can decrease interpersonal tension and facilitate personal growth. Nurses who learn to acknowledge and appreciate their colleagues from different backgrounds, including generational backgrounds, have a distinct advantage. The best teams utilize the contributions of each generation's skill set and strengths. The hardworking, loyal veterans; the idealist, passionate baby boomers; the technoliterate, adaptable Generation Xers; and the young, optimistic Millennials can come together in a powerful network of nurses with a remarkable ability to support each other and maximize each nurse's contribution to client care.
6) A nurse has just received a shift report for a 12-hour shift. As the nurse is preparing to enter a client's room, the nurse overhears a coworker telling an offensive joke with a sexual undertone to the client. What is the best action for the nurse at this time? A) Tell the nurse, in private, that such conduct is offensive and not professional. B) Ignore the coworker and walk away. C) Report the incident to the nurse manager. D) Ask to be scheduled opposite this coworker.
Answer: A Explanation: A) Nurses must develop skills of assertiveness to deter sexual harassment in the workplace. Telling the coworker to stop, and why, is the first step in putting an end to the situation. Ignoring the situation or asking to be scheduled opposite this individual is not addressing the situation in an assertive manner. Reporting the incident to the nurse manager would be a second step if the behavior doesn't stop after the nurse's approach.
3) A charge nurse is making assignments for the shift. The charge nurse notes that a client from a different culture was recently admitted and will require a thorough admission assessment during the upcoming shift. Which generation of nurse is likely to be the most culturally sensitive and to be the best choice for this client assignment? A) The Millennial nurse B) The Generation X nurse C) The veteran nurse D) The baby boomer nurse
Answer: A Explanation: A) The Millennial generation nurse would most likely provide the most culturally sensitive viewpoints and would be the best choice for this assignment. The Millennial generation nurse received the most education regarding culturally sensitive care and can be a unit resource for the other generations of nurses on the unit.
6) The nurses on the cardiology unit are unhappy with their nurse manager. The nurses complain that he is "inflexible and impersonal." The nurses realize that he is which type of leader? A) Bureaucratic B) Autocratic C) Laissez-faire D) Situational
Answer: A Explanation: A) The bureaucratic leader does not trust anyone to make decisions and instead relies on the organization's rules, policies, and procedures to direct the group's work efforts. Group members are usually dissatisfied with the leader's inflexibility and impersonal relations with them.
7) When speaking with a nursing student about the nursing profession, the student states, "I'm so nervous about taking the NCLEX, but I'm excited also; your nurse manager asked if I wanted to work here!" The nurse knows that the student is in which stage of commitment development? A) The integrated stage B) The testing stage C) The passionate stage D) The exploratory stage
Answer: A Explanation: A) The commitment to a profession develops in five stages; exploratory, testing, passionate, quiet and bored, and integrated. The integrated stage is the final stage of commitment. Individuals who reach this stage have integrated both positive and negative elements of the profession into a more flexible, complex, and enduring form of commitment. They act out their commitment as a matter of habit. These students are in the final stages of their nursing program and are beginning to see themselves as nurses, eager to take the NCLEX-RN ® and begin employment.
3) The nurse working in a neonatal intensive care unit (ICU) is caring for a critically ill 28-week-old preemie. The parent calls the nurse and asks if it would be possible to bring the client's 2-year-old sibling to visit because the sibling is having nightmares about the client's death. Small children are not permitted to visit because of the risk of infection to the infants on the unit. What should the nurse do? A) Seek permission from unit management and the physician to allow the sibling to visit. B) Offer to make counseling available to the sibling. C) Tell the parent that visiting is not permitted and offer to take pictures of the client. D) Tell the parent to bring the sibling in to visit in the middle of the night.
Answer: A Explanation: A) The nurse realizes that certain rules are in place for the protection of clients. The nurse would be compassionate enough to seek permission to allow the sibling to visit and see that the infant is alive and being cared for. Telling the parent what the rules of the unit are will only increase the family's frustration when they are looking to the nurse for assistance. Offering counseling may or may not be an effective means of assisting the family. The sibling needs to be reassured that the infant is alive. The nurse would not make the decision without the permission of the management team.
4) The nurse manager on the neurology unit helps the other nurses on the unit become more involved with the local neurological association and providing healthcare in-services to the community. The nurses on the unit know that the nurse manager shows which type of commitment to the nursing profession? A) Affective commitment B) Normative commitment C) Obsessive commitment D) Continuance commitment
Answer: A Explanation: A) There are three types of commitment: affective, normative, and continuance. Affective commitment is an attachment to a profession and includes identification with and involvement in the profession. Affective commitment develops when involvement in a profession produces a satisfying experience.
5) The charge nurse on first shift was never officially hired for that position, but the nurses on the unit recognize her as the charge nurse because she has been on the unit for 20 years. The nurses know the charge nurse has which type of position? Select all that apply. A) Informal leader B) Nursing leader C) Mentor D) Formal leader E) Official
Answer: A, B Explanation: A) A leader does not require an official position to lead. Leaders are people with the ability to rule, guide, or inspire others to think or act as they recommend. A leader influences others to work together to accomplish a specific goal. Leadership may be formal or informal. The formal leader, or appointed leader, is selected by an organization and given official authority to make decisions and to act. An informal leader is not officially appointed to direct the activities of others but, because of seniority, age, or special abilities, is recognized by the group as a leader and plays an important role in influencing, facilitating, and mentoring colleagues, coworkers, and other group members to achieve the group's goals.
6) The charge nurse, who is a member of Generation X, is training a new nurse, who happens to belong to the Millennial generation. The student nurse knows that which aspect(s) of the two nurses' work ethics are in conflict? Select all that apply. A) Self-directed versus need for feedback B) Loyal to profession versus rush of new challenges and opportunities C) Workaholic versus need for work-life balance D) Respect authority versus questioning authority E) Prefer personal form of communication versus personal cell phones
Answer: A, B Explanation: A) Workplace ethics for Generation X include: seek challenges; are self-directed; are comfortable with technology; expect instant access to information; desire employment where they can create balance in work and personal life; prefer managers to be mentors and coaches; have limited motivation to stay with the same employer but are loyal to their profession; desire more control over their own schedule; pragmatic focus on outcomes rather than process. The Millennial generation's work ethics include: being social, confident, optimistic, talented, well-educated, collaborative, open-minded, and achievement-oriented; having expectations of daily feedback; high maintenance; having the potential to become the highest-producing workforce in history; thriving on the adrenaline rush of new challenges and new opportunities; having personal cell phones a necessity for daily life and interpersonal communication.
5) The nurse working on the adult psychiatric unit complains of feeling "burnt out." Which suggestion(s) will help the nurse reduce stress? Select all that apply. A) Meditate or take a long soak in a tub. B) Join a local Zumba class. C) Participate in a professional organization. D) Accept an extra shift. E) Don't accept failure; try, try, and try again.
Answer: A, B, C Explanation: A) Nurses can prevent burnout by using healthy techniques to manage stress. To do so, they must first recognize their stress and become attuned to responses such as feelings of being overwhelmed, fatigue, angry outbursts, physical illness, and increases in coffee drinking, smoking, or use of alcohol or other mood-enhancing substances. Once attuned to stress and their own personal reactions, nurses must identify which situations produce the most pronounced reactions. Suggestions that help reduce stress include planning daily relaxation activities, establishing a regular exercise program, learn to say no, accepting errors and failures as learning experiences, accepting change and limitations, developing collegial support groups, participating in professional organizations, and seeking counseling if needed.
7) You are a newly hired nurse manager who believes in the theory of shared governance and you direct your unit using that style. As the nurse manager, you know that which skills ensure that you are an effective nurse leader? Select all that apply. A) Modeling the way B) Empowering others C) Giving feedback D) Receiving feedback E) Being political
Answer: A, B, C, D Explanation: A) Nurses are encouraged to design new models of care to improve quality, efficiency, and safety. Effective nurse leaders mentor and direct client care; actively advocate at the point of care; are expert clinicians and apply evidence-based care; model the way; are risk takers and inspire others to create a shared vision; are assertive and challenge the status quo; enable others to act and encourage the heart; empower others to embrace their passions and talents; value point-of-care nurses as equal partners; are trustworthy and model honest communication; are transparent and share information; give and receive feedback; are energetic and committed; collaborate and educate; are responsible and ethical; are creative and flexible; network and build teams; and are politically astute.
Answer: A, B, D Explanation: A) Good communication skills are essential to successful leaders and include assertiveness, clear expression of ideas, accuracy, and honesty. Critical thinking is a creative process that includes problem solving and decision making. Networking is a process whereby professional links are established through which people can share ideas, knowledge, and information; offer support and direction to each other; and facilitate accomplishment of professional goals.
Answer: A, B, C, E Explanation: A) The transformational leader empowers the group, facilitating independence, individual growth, and change. The leader enlists others to participate in attaining the goal and share in the organization's vision but does not expect unreflective obedience.
3) A nurse manager has had to interact with a particularly difficult physician who is demanding of and demeaning to the nurses on the unit. Through this situation, the nurse manager has learned that which are characteristics of successful communication? Select all that apply. A) Accuracy B) Assertiveness C) Critical thinking D) Honesty E) Networking
Answer: A, B, D Explanation: A) Good communication skills are essential to successful leaders and include assertiveness, clear expression of ideas, accuracy, and honesty. Critical thinking is a creative process that includes problem solving and decision making. Networking is a process whereby professional links are established through which people can share ideas, knowledge, and information; offer support and direction to each other; and facilitate accomplishment of professional goals.
2) During a staff meeting, the new nurse manager informs the staff that they will be getting an e-mail account that will need to be checked every day for information from the manager. Which response(s) would be expected of a "Generation X" new graduate nurse? Select all that apply. A) "Can we access the e-mail from home?" B) "That sounds like a great idea." C) "I would rather get the information directly from you." D) "I would rather receive the information in a unit newsletter." E) "Can we e-mail one another?"
Answer: A, B, E Explanation: A) Generation X, Generation Y, and Millennial nurses would all support the new policy and would ask if the nurses could e-mail each other and if the e-mails could be accessed from home.
1) A 52-year-old veteran nurse working on the medical-surgical unit of an urban hospital is frequently consulted by other staff members on clinical issues that she has experience with and new procedures that she assimilates quickly. What characteristic(s) of the informal leader does this nurse demonstrate? Select all that apply. A) Seniority B) Insecurity C) Special abilities D) Age E) Supervisory position
Answer: A, C, D Explanation: A) Informal leaders are recognized by the group as leaders and play an important role in influencing colleagues, coworkers, and other group members to achieve the group's goals. They often become leaders because of seniority, age, or special abilities. Leaders tend to be informed and confident. An informal leader is not officially appointed.
2) A student nurse accidentally left an elderly client's bed up after giving a bed bath. Luckily, another nurse found that the bed was not left in the lowest position and was able to rectify the matter before something happened. The student responded, "I know better. I should've double-checked the bed before I left the room." Which characteristic is this student demonstrating? A) Compassion B) Integrity C) Fidelity D) Justice
Answer: B Explanation: A) Integrity means adhering to a strict moral or ethical code. By admitting to not double-checking the position of the bed, the student shows accountability and integrity. Justice has to do with being fair. Fidelity means to be faithful to agreements and promises. Compassion is an awareness of and concern for the suffering of others.
Answer: A Explanation: A) The nurse realizes that certain rules are in place for the protection of clients. The nurse would be compassionate enough to seek permission to allow the sibling to visit and see that the infant is alive and being cared for. Telling the parent what the rules of the unit are will only increase the family's frustration when they are looking to the nurse for assistance. Offering counseling may or may not be an effective means of assisting the family. The sibling needs to be reassured that the infant is alive. The nurse would not make the decision without the permission of the management team.
Answer: C Explanation: A) Nursing integrity ensures that patients' rights are respected in the healthcare setting. If the nurse were to confront the two colleagues on the elevator, it could be overheard by others. The nurse should wait to speak to the other nurses privately about the breach of confidentiality. The nurse could report the incident to the unit manager, but it would be best for the nurse to confront the two colleagues in a professional way. The nurse should confront the two colleagues in a private manner in a professional way. If that cannot be done, then notifying the nurse manager would be the next step. The risk manager is only involved in situations where there is an injury to the staff or a client.
1) A new graduate nurse has been hired to work in a busy cardiac intensive care unit at the local hospital. The nurse will spend 12 weeks in orientation to the unit. How does the new nurse demonstrate commitment? A) Joining the ANA B) Questioning the preceptor during all procedures C) Attending every shift on time D) Exhibiting clinical competence
Answer: C Explanation: A) The new nurse can demonstrate commitment by showing up for all shifts in a timely fashion. It should not be necessary for the new nurse to question every procedure, as the new nurse has some clinical experience. Joining the ANA is a commitment, but is not relevant to this question. Clinical competence develops over time, and the new nurse is not likely to exhibit competence yet; showing up on time is a better predictor of the nurse's commitment.
2) A student nurse is caring for an elderly client with dementia who is confused, agitated, and forgetful. The student leaves for a break and forgets to put the call light within reach of the client. When checking on the student's clients, the instructor discovers the student's negligence and determines which of the following? A) The student is appropriately taking care of self. B) The student's workload is too difficult. C) The student is demonstrating inappropriate safety measures for the client. D) The student is demonstrating appropriate comfort measures for the client.
Answer: C Explanation: A) The student is demonstrating inappropriate safety measures by not leaving the call light within reach of the client. There is no evidence that the student's load is too difficult. The student has ignored basic safety measures for this client. It is appropriate for nurses and students to take breaks; however, the safety of the client is the first commitment for the nurse.
1) A nurse mistakenly gave a client who was NPO for surgery a morning breakfast tray. After realizing the mistake, the nurse notified the physician as well as the client; explained the consequences of this mistake, which included a delay in the client's surgery; and documented the situation in the client's medical record. This nurse demonstrates which of the following? A) Social justice B) Human dignity C) Reliability D) Accountability
Answer: D Explanation: A) Accountability is accepting responsibility and the consequences of one's actions. By taking the responsibility for the mistake, the nurse is accountable with the physician as well as the client and provides accurate documentation of the action. Reliability implies that the nurse is dependable, such as arriving at work in a timely fashion. Social justice is upholding moral, legal, and humanistic principles. Human dignity is respect for the worth and uniqueness of individuals and populations.
2) The new graduate nurse is interviewing with managers in the hospital. The nurse has decided that working for a manager who demonstrates an autocratic style of leadership would be the best match for the nurse. To determine the manager's style, what should the nurse asks the manager? A) "What is your view of nurses working overtime?" B) "How do you implement orientation?" C) "What shift will I be working?" D) "Do you seek input from staff when implementing new policies?"
Answer: D Explanation: A) In order to determine the leadership style of the manager, the nurse would ask the manager how he or she handles new unit policies. If the manager states that policies are determined by leadership who will give orders and directions to the group, then the new graduate knows this manager is autocratic in nature. Asking about the shift will not tell the nurse about leadership style. How the manager implements orientation would not necessarily reveal the manager's leadership style. Working overtime is a unit or hospital rule, not a leadership style.
3) The student nurse is attending a lecture about commitment to the profession of nursing. The instructor is grading the student's commitment to nursing during this rotation. The instructor knows the student is committed to the nursing profession when the student does which of the following? A) Calls in sick for clinical to study for a class exam B) Declines to observe a new procedure to give a necessary bath C) Misses class to attend a political rally D) Calls in sick for clinical because of a respiratory infection
Answer: D Explanation: A) Whereas calling in sick for a frivolous reason demonstrates a lack of commitment, calling in sick with a bona fide illness demonstrates protection of the clients who are already compromised. Attending a political rally may be important, but for the student attending class demonstrates the greater commitment. Studying for a class exam is also important, but not more important than learning clinical skills. The student who demonstrates commitment seeks out as many new learning experiences as possible.
5) A nurse supervisor in a hospital that is about to vote on unionizing nurses has been told by the hospital CFO to schedule union organizers during times that have been arranged for union organizational meetings. How might this nurse respond professionally? Select all that apply. A) Schedule the organizers during union meeting times. B) Schedule the organizers according to clinical staffing needs. C) Reprimand nurses for attempts to unionize. D) Continue to implement the usual staffing procedures. E) Discuss the need for professional nursing integrity with the CFO. Answer: B, D, E
Explanation: A) Administrators may serve their careers and no longer the priorities of client-centered care. Nurses in authority who emphasize principles and who focus on client safety can extinguish negative behaviors and encourage nurses at the point of care. Some administrators can be identified by an attitude of arrogance, control, and acceptance of the hierarchical power structure. Nurses should maintain their integrity and that of their profession.
