Quiz 2 (Chapters: 5,6,7,8,9,10)

Sarah, one of your RNs, tells you that she can't understand why Jim, an Aboriginal patient, wants to do a smudge. In coaching Sara, you suggest which of the following?

"Ask him what he means by a smudge and what meaning it has for him."

Which of the following would be the most appropriate mission statement for a nursing center?

"At Coeur, we strive to achieve optimal pain management with patients who are experiencing chronic pain."

At Orangetown Hospital, the nursing department is developing a mission statement for nursing. Which would be a suitable mission statement?

"At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership, education, and interprofessional collaboration."

Susan, an RN in the ED, would like to pursue leadership roles in her career. She is frustrated that others in her working environment seem to pay little attention to her creative ideas or place her in informal leadership positions. As her colleague, you want to provide her with helpful feedback. Which of the following statements will provide feedback as to how she might communicate power and demonstrate that she is capable of handling other leadership responsibilities?

"At times, you tend to slump and avoid eye contact when you are talking with colleagues and families."

A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the nurse manager about seeing his "acupuncture doctor" for treatment of his migraine headache. The best response to this patient would be:

"How long have you been using acupuncture treatment?"

During managers' meetings, Lindsay is surprised by the forthrightness of male managers. She finds that, during discussions, she would be more likely to say:

"I wonder if we should consider changing our policy on performance appraisals? What do you think?"

One of the staff nurses on your unit makes the comment, "All this time I thought Mary was black. She says she is Jamaican." The best response would be to say:

"What did you think when you learned she was Jamaican?"

One of your staff nurses asks for your advice because a patient refuses to sign a consent for surgery. The patient says that he won't sign because he doesn't understand the nature of the surgery. You advise that (select all that apply):

-Consent must not be coerced. -The patient has a right to choose not to consent.. -Witnessing a consent is related only to the voluntary nature of the signature.

In a busy rehabilitation unit, the team manager decided that the best way to reward the staff was to give them a monetary bonus rather than time off. The staff was very concerned about the decision and went to the administration with a number of complaints. Critical thinking is a process that entails a number of steps. What steps did the manager omit? She should have (select all that apply):

-Identified what assumptions were underpinning the issues. -Considered why it was important to make this change or the context for the change. -Considered how this change might affect staff relationships.

As a nurse manager in a for-profit hospital, you are interested in promoting teaching programs for physicians, because evidence suggests that hospitals with teaching programs tend to promote better care for patients. Your administration indicates that it cannot support your ideas or proposal because of (select all that apply):

-Increased salary costs. -Duplication of tests and procedures. -Graduate medical education.

Organizational culture includes (select all that apply):

-Norms. -Traditions. -Behaviors. -Values.

With regard to nursing practice, nurse managers are held responsible for (select all that apply):

-Practicing within legal guidelines established under state law and nurse practice acts. -Ensuring that nursing staff under their supervision are currently licensed to practice.-

As a nurse manager, you have to be effective in managing a culturally diverse staff. Which of the following nurse manager attributes would assist you in addressing the cultural needs of your staff (select all that apply)?

-Respecting others -Understanding the importance of language -Encouragement of potential in all staff

As a new manager in the ED, you meet with each of the staff to ask about their priorities and what they think is going well in the department or what is of concern to them. Almost all of the staff express frustration and distress at being treated rudely or disrespectfully by patients, staff from other departments, and physicians and complain that they feel that nurses in the ED are not valued. With the staff, you brainstorm to raise the profile of nurses. Which of the following strategies would be most effective? (Select all that apply.)

-Speaking positively about one's work -Dressing and grooming in a clean and neat manner -Using titles (e.g., Mr., Mrs., Ms.) and last names. -Developing a code of conduct for the ED staff.

The institution where you are a nurse manager has resisted the adoption of a new document management software, citing cost as a concern. You meet with other nurse managers who are in favor of the software and prepare a proposal to take to the senior executive with the goal of persuading the executive to adopt the software. This is an example of:

A coalition.

A facility that provides care for patients whose average length of stay is less than 30 days and to patients whose average length of stay is longer than 30 days, and who require inpatient and ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered:

A healthcare network.

As a nurse manager, you have been offered a position at a Veterans Administration hospital. In accepting the position, it is important for you to understand that veterans hospitals provide:

A range of services and are responsible to government and taxpayers.

Mary joins 5W nursing unit. Mary is a new graduate who is anxious to fit in. She soon learns that some of her "book learning" is being criticized by her colleagues, so she adapts her practice to what others on the unit are doing. She is demonstrating:

Acculturation.

To solve a problem, the nurse manager understands that the most important problem-solving step is:

Accurate identification of the problem.

Healthcare organization XYZ provides women's health services on an inpatient basis (average stay of less than 30 days). This facility would likely be considered:

Acute care, specialized.

You are the nurse manager for a not-for-profit health service for the homeless and for drug users in an impoverished neighborhood. As the manager, your concern about sustainability is related to:

An increase in uncompensated care events.

Sarah is a clinical nurse educator in the dialysis unit at Pines Health Center and provides education, consultation, and training support. Sarah has:

An influence over patient outcomes.

As a nurse manager, you have hired two new staff members who have recently come to the United States from other countries. Which of the following strategies might indicate your efforts to assist these staff members with acculturation to your unit?

Analyze a recent situation with them in which an order with a physician was not clarified and explore their beliefs about nurse-physician relationships.

A clinic nurse has observed another nurse deviating from agency policy in performing wound care. The best approach for the clinic nurse to take is to:

Assess the risk to the client and the agency before proceeding.

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

Assessment/Data collection

On your nursing unit, you employ LPNs, RNs, and advanced practice nurses. You will need to be familiar with at least:

At least one nursing practice act.

Which ethical principle is primarily involved in informed consent?

Autonomy

A patient refuses a simple procedure that you believe is in the patient's best interest. The two ethical principles that are directly in conflict in such a situation are:

Autonomy and beneficence.

In keeping with standards of The Joint Commission (TJC), the nurse manager organizes an orientation for new staff members. As part of the orientation, the nurse manager reviews the employee handbook. Employers may be bound to statements in the employee handbook:

Based on the employee's or the employer's expectations.

A hospital is working toward becoming a Magnet™ hospital. The chief nursing officer is aware that professional nursing departments of the future will:

Be designed to maintain nursing standards of practice.

Because an increasing number of Hispanic patients are being admitted, a nurse manager designs a staff-development program to help her staff understand the Hispanic culture. A nurse should understand that culture is determined by which of the following?

Behavior

Three gravely ill patients are candidates for the only available bed in the ICU. As the supervisor, you assign the bed to the patient with the best chance of recovery. This decision reflects which of the following ethical principles?

Beneficence

Taylor Hospital has well-defined organizational units that provide maintenance, financial services, care for cardiac patients, care for surgical patients, and so on. The organizational chart indicates that surgical units report to a surgical manager and all nursing units report to a vice president of nursing; financial services to an accountant and then to a business executive; and so on. The primary disadvantage of this organizational structure is:

Breakdown in function and communication across specialties.

As a nurse manager, you have been asked to be part of a design team for health services that have vertical integration. In planning for these services, your team will design a proposal that will:

Bring together acute care, ambulatory, home care, and palliative care services for the management of patients diagnosed with cancer.

In the Unity Healthcare organization, decisions, including those at the unit level, are made by a group of senior executives. Rules for employees are clear, and nursing care is delineated by procedures and protocols. This exemplifies:

Bureaucratic organization.

You volunteer at a free community clinic. A 13-year-old girl claims to have been diagnosed with SLE and presents with chlamydia. The team leader at the clinic advises that:

Care can be provided as long as consent is voluntary and information about treatment and options is provided.

Cultural diversity is the term used to describe a vast range of cultural differences. Events have symbolic meanings for the nurse manager and the staff. The event that would be most likely to provide symbolic meaning to a nurse manager and staff is a:

Celebration of National Nurses Week with the focus on cultural care.

Decision making is described by the nursing educator as the process one uses to:

Choose between alternatives.

Sarah, one of your RNs, tells you that she can't understand why Jim, an Aboriginal patient, wants to do a smudge. Sarah's response is based on her:

Circle of familiarity.

A unit manager watches a new RN graduate interacting with a patient. When the RN comes out of the room, the unit manager says, "I don't know what they taught you in your nursing program, but if I see you do that again, I will write you up." This example demonstrates:

Coercive use of power.

During a unit meeting, you notice that Vivian listens attentively when Mary is speaking and offers support and advice when Mary presents ideas to the group. You are surprised because Vivian has often confided that she does not like Mary. Vivian's behavior is best described as:

Collegial.

Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high turnover rate among rehab-assistants because of the heavy work assignments. Despite his need for staff, Justin decides to review each application thoroughly and interview candidates carefully because he recognizes that it is important to hire staff who can best provide high-quality care and who will fit well with the team. Which of the following decision-making solutions should Justin consider to have a more efficient department

Consider all the options listed.

A merger has occurred between a hospital and a local home health agency, creating new roles for the nursing staff in both agencies. The nurse managers of both systems begin to evaluate and revise patient care processes and systems. With the merger, the healthcare organization's changes are:

Creating more jobs in the community for registered nurses.

During a fire drill, several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This autocratic decision style is most appropriate for:

Crisis situations.

One means of ensuring that nurses floated to other patient care areas in healthcare organizations are qualified to work in those areas is:

Cross-educating staff members to other areas of the institution.

During performance appraisal, you praise Xia for her attention and care to nursing details. You suggest that her care would be further enhanced by greater acknowledgment of patients' feelings. Xia bursts into tears and leaves the office. Later, you learn that criticism is perceived as akin to failure in Xia's culture. You reflect on how you could modify your approach in the future to acknowledge different cultural interpretations of feedback. Your response is indicative of:

Cultural awareness.

The nurse manager of a unit is asked by a family member of a dying Native American patient if it is possible to have the patient's eight-member family recite the rosary by the bedside. The manager responds affirmatively. The nurse manager is most likely exhibiting behavior related to:

Cultural sensitivity.

When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidate's lack of eye contact reflects the candidate's cultural sensitivity. You are exhibiting:

Cultural sensitivity.

Which of the following patients would be most likely covered under Medicare?

Dan, who is 68 years of age and in good health

Select the statement that best defines the difference between problem solving and decision making:

Decision making is a goal-directed effort; problem solving is focused on solving an immediate problem.

With revenue reductions and cost-saving measures, the number of managers has been reduced, which has increased the number of team leaders supervised by managers by as many as three. This change may result in:

Decreased patient satisfaction.

A new director of nursing in a small rural hospital wants to make changes from the traditional model of governance to a shared-governance model. Select the characteristic below that best describes the traditional organizational structure in which a staff nurse is assigned to carry out nursing tasks for clients but is not given the chance to provide input into forming the policies and procedures by which care is delivered or the standards by which care is evaluated:

Delegated responsibility but no authority

The nurse manager for a unit's culturally diverse staff creates a staff-development program so the professional nursing staff members can enhance their understanding of cultures on the basis of published literature. The literature reveals that the following characteristic is inherent in a culture. It:

Develops over time.

In designing programs through your institution to address the health needs of Hispanics in your community, you most likely would develop programs related to:

Diabetes.

While walking past a patient's room, you overhear one of the RN staff telling a patient that the patient has no right to refuse chemotherapy treatment because the family and the doctor think the treatment is the best option for the patient. This patient is 40 years of age and alert. When you meet later to discuss what you heard with the RN, it is important to:

Discuss that statute law provides for patient autonomy and refusal of treatment.

A nurse manager must implement a 2% budget cut on the nursing unit. Which approach should the manager use to most effectively empower the staff of the unit?

Discuss the guidelines for the budget cuts with the staff, making the decisions with those who participate.

Nurses who engage in in-fighting, seek physician support against nursing colleagues, and avoid political advocacy through membership in nursing organizations:

Do not understand how their failure to exercise power can limit the power of the whole profession.

Sue, a nurse manager, has a staff nurse that has been absent a great deal for the past three months. A whistleblower gives some information to Sue indicating that the staff nurse will be resigning and returning to school.

Do nothing.

To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk manager. Risk management is a process that attempts to identify potential hazards and:

Eliminate these risks before anyone else is harmed.

Maintaining a culturally diverse staff and working with a culturally diverse patient population is an important function of a nurse manager who works in the hospital of a large medical center. On your palliative care unit, you have recently received complaints from families about ineffective pain management for their family members and you determine this occurs primarily when certain nurses are working. What approach might you take to resolve the concerns of the families, patients, and potentially, the staff?

Encourage conversation with patients and among staff that facilitates learning about cultural beliefs and priorities in dying.

After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of teenagers who are unmanageable. To maximize group effectiveness in decision making and problem solving, the nurse manager has:

Encouraged equal participation among members.

When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidate's lack of eye contact reflects the candidate's:

Ethnicity.

A new graduate RN joins your unit. After a few weeks, she complains about some of her peers on the unit and compares their practices negatively to what she learned in her nursing program. She also is vocal about how she has learned so much here that she did not learn in her program. She is best described as:

Experiencing cultural marginality.

Amy has worked in the dialysis unit on staff for about 12 years. She is frequently consulted by other nursing staff regarding protocols and policies on the unit. What type of power is Amy using?

Expert power

The principle that requires nurses to uphold a professional code of ethics, to practice within the code of ethics, and to remain competent is which of the following?

Fidelity

You are a nurse manager in a facility that is part of a national system of specialized hospitals that provide services to children and that is funded and managed through a religious charity organization. This system emphasizes compassionate, faith-based care. What level of consolidated system is represented in this example?

Fifth level

A nurse manager at a home healthcare service has resigned to take a position at a local ambulatory care center. She has been hired because of her expertise in TJC accreditation. To initiate the changes, the nurse manager has to be knowledgeable about the differences between a home healthcare institution and an ambulatory care center, which is a primary care institution. Primary care institutions are facilities that provide:

First access to care.

The local health department nurse manager has developed and implemented a disaster readiness plan as part of a community service. Community services:

Focus on the treatment of community-wide problems rather than on individual health problems.

Politics is usually:

Found in all social organizations.

The hospital administration gives approval to the chief nursing officer to hire clinical nurse specialists in staff positions rather than in administrative positions. A clinical specialist who has staff authority but no line authority typically is able to:

Function through influence.

Several nurses on an adolescent psychiatric unit complain that the teens are becoming unmanageable on the 0700-1900 shift. To resolve this problem, the nurse manager decides that the staff should have a brainstorming session. The goal of brainstorming is to:

Generate as many solutions as possible.

During orientation of new nurse managers, the chief nursing officer stresses strategies that help nurse managers to achieve a powerful image. Which groups of behaviors best contribute to a powerful image for the nurse manager?

Greeting patients, families, and colleagues with a handshake and a smile; listening carefully when problems arise

High-quality decisions are most likely to be made in nursing situations when:

Group size is neither too small nor too large.

A staff nurse who was fired for reporting patient abuse to the appropriate state agency files a whistleblower lawsuit against the former employer. Reasons that the court would use in upholding a valid whistleblower suit claiming retaliation include that the nurse:

Had previously reported the complaint, in writing, to hospital administration.

A local hospital has formed a corporate partnership with a reputable HMO (health maintenance organization). The nurse manager has had to educate staff and personnel about the financial implications of this partnership. An HMO:

Has a centralized administration that directs and compensates physician services.

Collaborative partnerships between hospitals and schools of nursing are examples of hybrid organizational structures. A hybrid organizational structure:

Has a mixture of the characteristics of various organizational types.

The Wellington Mental Health Institute is fully accredited by the AOA and not directly by the CMS. This means that the Wellington facility:

Has been reviewed and accredited by the AOA, which is a deeming authority for CMS.

In matrix organizational structures, a nurse manager understands that this type of structure:

Has both a functional manager and a service or product-line manager.

From the information supplied in this chapter, which statement best defines critical thinking? Critical thinking is a:

High-level cognitive process that includes creativity, problem solving, and decision making.

Sondra, a new graduate, recently began a position as a registered nurse in a rural hospital, where she is the youngest and newest staff member. Although she has limited experience, she has a strong knowledge base, is confident, and was considered to have strong entry-level skills on graduation. Sondra meets with her former instructor and confides that she is very frustrated that others do not seem to accept her leadership. What might you suggest that would help Sondra to understand what is happening in terms of power and influence?

Identify the informal leaders on her unit and how they affect care decisions.

The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports about patients falling during the 11-7 shift. The nurse manager knows that the best way to resolve the problem is to:

Identify the problem.

The risk manager wants to evaluate the reasons for an increased number of falls on the rehab unit. The risk manager devises a fishbone diagram. A fishbone diagram is a useful tool to:

Identify the root causes of problems.

When confronted with the controversy and the apparent poor morale of the evening staff, the unit manager decided the staff needed to take some time off. He scheduled holidays for the staff without consulting them. A couple of the staff nurses approached the manager and indicated that the problem was not scheduling, but rather the team leader and her patient assignments. What was the unit manager's first missed step in problem solving?

Incorrect problem identification

With the help of a federal grant, the local school nurse has established a spreadsheet that contains relevant nursing data so that she can analyze children's health. School health programs are:

Increasingly seen as primary care sites for children.

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

Informative.

A nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks toward a patient with a previous history of sexual abuse. The patient sues, claiming malpractice. Which of the following conditions may not apply in this situation?

Injury

The nurse manager of a rehab unit wants to purchase a new anti-embolic stocking. To make a high-quality decision, the nurse manager would:

Involve the rehab staff in the decision.

As a nurse manager, you notice that Maria, a Hispanic nurse aide, is visibly upset. When you ask her if something is wrong, she becomes tearful and says, "Why is it that when John and I work together in giving patients care, he jokes about my being "a little fat Mexican"? The nurse manager's best response is, "Do you think he:

Is stereotyping you without thinking?"

Which of the following is the best example of skilled negotiation?

Jerry speaks with his supervisor about his supervisor's concerns related to bedside reporting before presenting a proposal to change this process.

Which of the following interactions is MOST consistent with the idea of networking?

Join a nurse executive interest group to meet other executives for support and for sharing ideas of expertise.

The facilities department is experiencing some challenges and is undergoing reorganization. Because of your familiarity with systems theory, you:

Know that the nature of challenges and reorganization in facilities will have an impact on other areas.

Two nurses approach their manager about a conflict regarding the next month's schedule. The nurses are talking loudly and at the same time. The manager most effectively uses communication skills to resolve the conflict by:

Listening to each nurse speak to the other without interruption and asking clarifying questions to help them resolve the issue themselves.

A nurse manager in a for-profit environment finds it difficult to recruit staff. This difficulty may be most related to aggressive profit goals and:

Lower salary compensation for staff.

An individual in a wheelchair is applying for the position of receptionist in an outpatient clinic. The nurse manager understands that the Americans with Disabilities Act of 1990 requires that employers:

Make reasonable accommodations for persons who are disabled.

A nurse manager recognizes the need to expand her professional network as she begins a job search for a middle-management position. Which of the following actions is least likely to expand her job-searching network?

Making a long overdue return call to a former colleague who is now a chief nurse executive

A nursing informatics specialist hired by Blue Cross/Blue Shield (a form of third-party payers benefit package for a prepaid fee that uses specific standards to approve a period of time for the use of inpatient and community health services) is participating in:

Managed care.

During a staff shortage, you hire an RN from a temporary agency. The RN administers a wrong IV medication that results in cardiac arrest and a difficult recovery for the patient. Liability in this situation:

May depend on the patient's belief regarding the employment relationship.

"At Thoroughcare, we provide health care for women and children in transition" is an example of a:

Mission statement.

Tracy is an RN case manager who interfaces between the Centers for Medicare & Medicaid. Tracy's responsibilities most likely would include:

Monitoring physician documentation of the need for medical care.

A member of a patient's family calls the nurse manager of the palliative care unit to express concern that a member of the family, who died on the weekend, had requested analgesics from the RNs on duty. An RN came with the analgesic nearly 45 minutes later, just after the patient had died. The manager is aware that the unit was especially busy that weekend because many patients were seriously ill, staff had called in ill, and the staffing manager was unable to completely replace staff who were absent. The manager is deeply troubled that the family member had to die in pain because it violates what she knows should have been done. This manager is experiencing:

Moral distress.

As a manager, you are responsible for two separate units: a CCU and a cardiac step-down unit. The organization and relationships on these units are distinct and very different from one another. Your decision has been to support the uniqueness of these units because each is effective in different ways in providing patient care. This approach is consistent with which principle?

Multiculturalism

The chief nursing officer and the dean of the School of Nursing believe that by establishing rules and regulations and controlling the environment, this partnership will:

Need a degree of flexibility to engender success.

One day, at coffee, your co-worker suggests that you and she sit with unit members of the hospital research committee. She suggests that this would be an excellent way to get to know people who share her interest in research. Her actions are an example of:

Networking.

The manager in the coronary care unit believes that the most important ethical considerations in performance evaluations are that they include the employee's good qualities and that they give positive direction for professional growth. This belief is an example of:

Nonmaleficence.

Your colleague Mary, a recent graduate, announces one day that she intends to leave nursing in 3 to 4 months to pursue a position in marketing. While at your agency, she plans to give patients excellent care and to learn as much as she can, because "Who knows? Nursing is a great job with a great pay and I may return someday." Mary's statements most accurately exemplify which orientation to the concept of nursing? Nursing as a(n):

Occupation.

Lucy, head nurse on the surgical unit, works with her staff to find ways in which they can work together with other disciplines to provide more effective care for patients on the unit. Lucy likely knows her power is:

Of unlimited capacity when shared with others.

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

Optimizing model

A new CEO has been hired at Valley Hospital who proposes to change the centralized organizational structure that was put in place ten years ago, based on widespread consultation with staff. The proposed structure involves substantial flattening of the organizational structure, with significant decision making being made at the point-of-care and an emphasis on interprofessional collaboration. There is a great deal of discussion about the balance between hospital-wide budget decision making and unit-based decision making. This discussion represents:

Organizational reengineering.

Which of the following would be the most appropriate focus in developing a business plan for a nurse-owned home healthcare service?

Pain management for patients with low back pain

A staff nurse in the area that you manage has excelled in the delivery of patient education. You are considering implementing a new job description that would broaden her opportunity to teach patients and orient new staff members to the value of patient education. The ethical principle that you are most directly reinforcing is:

Paternalism.

Which of the following is an example of an HMO?

Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.

A nurse manager working for a not-for-profit organization should be familiar with the regulations that impact the organization. Not-for-profit organizations:

Pay no taxes.

In a telehealth organization, a nurse who is licensed in New York and Pennsylvania provides teaching to a patient who resides in Pennsylvania. The patient charges that the teaching failed to provide significant information about a potential side effect, which led to delay in seeking treatment and untoward harm. Under which state nurse practice act and standards would this situation be considered?

Pennsylvania

Sarah, RN, complains to you that a male nurse from a different culture sits very close during charting and leans toward her when speaking. In responding to Sarah, you consider that differences across cultures that are relevant to this situation include:

Personal space.

A statement such as "We believe in the right of patients to make choices and to have care that is sensitive to their preferences and needs" is a _____ statement.

Philosophy

A nurse belongs to several professional organizations, serving on a state-level committee of one group and on two task forces at work. The nurse is committed to a range of health issues and knows the state senator from the nurse's district, as well as the name of the representative in Washington, DC. This nurse exemplifies which level of political activism in nursing?

Political astuteness

Jane, an experienced head nurse, is given the task of completing the summer vacation schedule for the pediatric unit. She is fully aware of the hospital's restrictions on time off and the number of staff on vacation at any given time, as well as its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative?

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

The workgroup on NU 23 is marked by apathy toward the ward's patients, high absenteeism, open conflict among team members, and high turnover of personnel, including managers. The underlying behavior in this situation may be characterized as:

Powerlessness.

A colleague asks you to give her your password access so that she can view her partner's healthcare record. This request violates the patient's right to:

Privacy.

Mr. M. complains to you that one of your staff asked him details about his sexual relationships and financial affairs. He says that these questions were probing and unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry with him and would not provide him with good care. Mr. M.'s statements reflect concern with:

Privacy.

As a charge nurse, you counsel your RN staff member that he has satisfied his duty of care by notifying a child's physician of his concerns about deterioration in the child's status at 0330 hours. The physician does not come in. The child dies at 0630 hours. As the charge nurse, you could be held liable for:

Professional negligence.

In which of the following situations would you expect low morale and frustration?

Recruitment ads promise opportunities for advancement for everyone. Promotions are given only to individuals with long-standing service and entrenched relationships.

A manager relies on his director (immediate supervisor) for advice about enrolling in graduate school to prepare for a career as a nurse executive. The director may exercise what kinds of power in the relationship with the manager in this advisory situation?

Referent, expert, and information

In opening a new dialysis unit, the nurse manager has to develop a philosophy for the unit. This philosophy needs to:

Reflect the culture of the unit and its values.

Despite repeated invitations by his colleagues to become involved in regional and state nursing practice committees, Tom refuses. His reason is that "nursing committees rarely get anything worthwhile done because of politics and conflicts." According to the text, Tom's view of involvement:

Reflects the essential process of power.

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

Satisficing.

A primary care clinic is established in Pleasantville to provide comprehensive services to infants, children, and families within the community. The executive director of the clinic oversees physician and nursing services for infants, children, and families; a neurodevelopmental clinic; psychology, family counseling, and social work services; nutritional counseling; speech and hearing services; and physiotherapy. This type of organizational structure is known as:

Service-line.

Which of the following is an outcome of managed care?

Shift of patients to outpatient and home health services

Because of rapid turnover and the ongoing hiring of new graduates, the skill levels of staff in a busy CCU are varied. Senior staff are becoming burned out with the need to provide mentorship and guidance to new staff. As the manager, you propose the addition of a nurse in advanced practice to provide consultation and education for staff. This position is termed a(n):

Staff position.

To satisfy duty of care to a patient, a nurse manager is legally responsible for all of the following except:

Supervising the practice of the physician.

As a nurse manager, you have been asked to assist in designing a subacute facility for open heart patients who require further complex care after hospitalization. In setting up the facility, which of the following would require reassessment?

The facility is an older house that is more than 30 minutes away from the acute care center.

As a nurse manager in a hospital, you would expect which of the following to be the major contributor to funding and revenues in your organization?

The federal government

In reviewing the current delivery model, the nurse manager is aware that a demographic change that will have a significant effect on the healthcare delivery systems of the future is:

The increasing percentage of the population that will be over age 65.

Within the deaf culture, there is considerable disagreement about the use of SEE (Signed Exact English) and ASL (American Sign Language). This is indicative of:

The need to recognize diversity within groups.

The chief nursing officer is given the task of reviewing and revising the organization's mission, philosophy, and technology. In reviewing them, the chief nursing officer understands that they should be reflected in:

The organizational structure.

John Smith, one of three managers at BSG Labs, drafted a policy that would allow his department to do more testing in his lab. This policy included the times for regular collection as well as a new process for emergency laboratory testing. The policy and procedures were never followed. The reason was that:

The policy made decisions for other departments in the company.

At Hospital XYZ, staff members on Y3 have dealt with the third head nurse in three years. Donna, the current head nurse, lacks confidence in patient-nurse relationships, and scheduling and other processes are routinely left to the last minute. Staff members approached Donna first and then administration with their concerns about Donna's effectiveness as a leader. The staff was told that the problem is likely staff related, that it is simply an unhappy group, and that there is nothing that will be done further about their concerns. The philosophy of the organization indicates that "open, transparent communication between staff and management is desired and supported," and that "innovation and creative thinking are the foundation of the organization's progress." In assessing this situation as a newly hired senior executive, you anticipate that:

The situation will lead to ongoing disgruntlement and attrition.

In caring for a patient from an East Indian culture, the staff expresses frustration that many people are in the room at any one time, which interferes with care. As the nurse manager, you provide leadership in understanding that this behavior of the family and friend network reflects:

The social organization of friendships and family networks in East Indian culture.

Knowing when to have the entire team participate in the decision-making process or when to have only the team leader make the decisions depends on the situation and the desired outcomes. The autocratic process is used in which of the following situations?

The task and the outcome are relatively simple and defined

A nurse is participating in a baccalaureate course. For the class, she has to attend the legislative session regarding the new role of medication assistants. Nurses should be involved in shaping public policy primarily because:

They are closest to the front line of health care and see how it affects clients and families.

A group of patients with early Alzheimer's disease and their spouses approach you regarding help with the establishment of a local Alzheimer's Society for the support and education of affected individuals and their families. As a manager in an ambulatory care clinic, what suggestion or advice would you offer this group?

Through partnership, you will provide supports, if possible, that the patients and spouses themselves identify as necessary in the establishment of the group.

In the Unity Healthcare organization, communication flows:

Top to bottom.

Individuals living with asthma, who also live in poverty, are much less likely to seek early care and are more likely to go to emergency rooms for assistance. This example reflects:

Transcultural care.

The parents of a toddler who dies after being brought to the ER launch a lawsuit, claiming that the failure of nurses to pursue concerns related to their son's deteriorating condition contributed to his death. The senior nurse executive is named in the suit:

Under the doctrine of respondeat superior.

To prepare for the orientation of newly hired nurses, the nurse manager plans a presentation outlining the concept of healthcare networks. Healthcare networks are:

Units that serve large populations.

An outpatient surgery manager is evaluating infusion pumps for the operating room. The manager should:

Use a decision-making tool to evaluate brands.

A good nursing decision maker is one who:

Uses various models to guide the process based on the circumstances of the situation.

A staff nurse asks the nurse manager for a few days off for personal reasons. The nurse manager turns in the request to the human resources office with a note indicating that the staff nurse has demonstrated excellent working skills and is a valued employee. The nurse manager has used the influence of her position to help this staff member. Influence is the process of:

Using power.

Literature on oppression in nursing has:

Verified the presence of behaviors associated with oppression within nursing.

"Georgia Hospital will provide care that is a national example of consumer service" is a:

Vision statement.

A nurse manager is experiencing poor staff morale on her unit. While participating in a baccalaureate course, the nurse manager had learned that one of the reasons nurses lack power today is probably because of the past. In the early decades of the profession, nurses lacked power because:

Women lacked legal, social, and political power because of legal and cultural barriers.

At Health Center XYZ, staff members on the rehab unit have a head nurse who is intolerant of error and publicly chides anyone who makes a mistake. Over time, the rules on the unit dictate that mistakes are hidden and that areas of concern related to the functioning of the unit are discussed in tub rooms and are never openly discussed during periodic meetings. New staff members are quickly made to realize that silence is expected. The situation described is an example of:

Work culture.

According to Leininger, "cultural imposition" is a major concern in nursing because nurses have a tendency to impose their values, beliefs, and practices on patients of other cultures. The discussion topic most likely to be without cultural imposition would be:

Wound management.