Chapter 19 Management

A hospital is downsizing, but the RNs have been assured that everyone on the unit will keep their jobs and that downsizing will occur through normal attrition. Today, the evening charge nurse reported to the manager that the staff was discussing rumors about mass layoffs. What is the best approach to take? a. Tell an informal leader the truth and let the leader spread the news informally. b. Hold a meeting for all staff members and tell them that the rumor is not true. c. Ignore the rumor because it will soon pass. d. Find out who started the rumor and correct the information.

B

A member of a work group that the nurse-manager leads is aloof and dismissive of the group's role. The member has occasionally made jokes during serious discussions and seems skeptical that the group will meet its goals. What role is this member playing? a. Blocker b. Playboy c. Dominator d. Recognition seeker

B

The nurse is caring for a client with a diagnosis of chronic obstructive pulmonary disease and who is experiencing a new onset of dyspnea. When contacting the client's care provider, the nurse should state the client's admitting diagnosis in what stage of the SBAR tool? a. S b. B c. A d. R

B

The nurse is caring for a postoperative client whose pain is not being relieved by the current analgesia regimen. When using the SBAR model for communicating with the client's health-care provider, how should the nurse best address the "A" component of the model? a. "The client is postoperative day 2 following total hip arthroplasty." b. "The client's pain control might be inadequate because she's been rating it at 9 out of 10 for the past hour." c. "The client also has type 2 diabetes and atrial fibrillation." d. "An increase in her hydromorphone dose is probably a good idea."

B

The nurse-manager has consulted the hospital information system to address a clinical issue. What characteristic is the hospital information system most likely to have? a. It is likely based on a social media platform. b. It is probably not freely available from the Internet. c. There is a high likelihood that it is out of date. d. It is probably accessible only from desktop computers, not wireless devices.

B

Which nursing action demonstrates compliance with the American Nurses Association (ANA) principles for social networking by nurses? a. Strictly avoiding the use of social networking in a professional setting b. Participating in the development of institutional policies governing online conduct c. Ignoring any information that appears to have the potential to harm a patient's welfare d. Realizing that social networking is not related to a nurse's professional boundaries

B

Which principle should guide the nurse-manager's use of nonverbal communication? a. It is generally consistent across cultures, unlike verbal communication. b. It supersedes verbal communication when the two are incongruent. c. Nonverbal communication should be minimized because it confuses the receiver regarding the true intent of the message. d. Nonverbal communication is a significant part of the communication exchange only when it is not congruent with the verbal exchange.

B

A large health-care organization has struggled to meet mandated electronic health record (EHR) standards. What actions address the likely challenge that this organization is facing? Select all that apply. a. Improving communication between managers at the organization's various sites b. Increasing the organization's budget for technology c. Investing more in employee training d. Engaging clients and families with the process e. Increasing the use of evidence-based practice

BC

The nurse-manager has been approached by an angry employee whose vacation request was denied. What should the manager do when communicating with this employee? Select all that apply. a. Tell the employee that anger will not be tolerated and then leave the situation. b. State, "I understand that you are angry that your vacation request wasn't approved." c. Allow the employee sufficient opportunity to express what she wants from the manager. d. Tell the employee how her mode of communication is hindering the message. e. Ask the employee, "Are you accusing me of bullying you by turning down your request?"

BC

A nurse sits at the foot of a patient's bed during an admission interview. This positioning supports the proxemics concept of which psychological comfort zone? a. Intimate relationships b. Personal interactions c. Social exchange d. Public distance

C

A nurse-manager has a reputation as being an assertive communicator. How does this manager most likely communicate? a. Through confrontation and intimidation b. In an unfeminine way that is clear and direct c. Directly and honestly, while respecting the rights of others d. In a clear, but occasionally offensive, manner

C

A nurse-manager is communicating with a subordinate. What component of this communication would be considered as part of the external climate? a. The clarity of the message b. The subordinate's personality c. The culture of the organization d. The manager's stress level

C

A nurse-manager is having a difficult conversation with a subordinate whose performance has long been inadequate. The emotional component of the manager's message will be most clearly conveyed by: a. the formality or informality of the words the manager chooses. b. the pace and pitch of the manager's speech. c. facial expressions, body movements, and gestures. d. the amount of time that the manager lets the employee speaks before interrupting.

C

An RN is a team leader for a small module of clients. While listening to a recorded report on a client, one of the team members remarks, "My mother lives near him, and she says his home life is in chaos." How should the RN best respond? a. Politely ask the team member to be quiet. b. Include the information in report for the next shift. c. Ask the team member how this information relates to the client's care. d. Ignore the team member's comment.

C

Electronic health records (EHRs) have recently been introduced in a health-care organization, and the steering committee is ensuring that the system meets the criteria for meaningful use. This characteristic of the EHR ensures that the system: a. is readily accessible in any care setting, nationwide. b. uses language that is accessible to and understandable by clients. c. contains data that has the potential to improve client outcomes. d. means the same thing to every user.

C

The RN overhears the nurses' aide speaking in a harsh tone to a client with early Alzheimer's memory loss. Which statement should the RN make to begin addressing this issue? a. "You must remember to watch your tone of voice with clients. Someone might overhear." b. "Do you think it would be a good idea to have an in-service on dealing with Alzheimer's patients?" c. "I am concerned about your conversation with the client. It sounded short and impatient." d. "I have decided to reassign that client to another aide."

C

The nurse-manager is sitting on a practice committee and has adopted the role of gatekeeper. What action should the manager perform in this role? a. Acknowledge and praise each member's contributions. b. Mediate, harmonize, and resolve conflict when it arises. c. Facilitate and promote participation by all group members. d. Record the group's process and provide feedback to the group.

C

The nurse-manager is using the GRRRR model of listening when interacting with a colleague who exhibits challenging behaviors. What is the final action that the manager should implement when using this model? a. Confirm an action plan. b. Request any necessary information from the colleague. c. Thank the colleague for the collaborative conversation. d. Reflect privately on the quality of the interaction.

C

What principle should guide the nurse-manager's understanding of gender differences in communication? a. Research has disproven any gender-based differences in communication that were thought to exist. b. Gender is the variable that has the greatest effect on an individual's communication style. c. Men and women communicate and use language differently. d. In contrast with stereotypes, women have been shown to be more competitive communicators.

C

Which vocal delivery suggests to a listener that a person is asking a question rather than making a statement? a. Loudness b. Frequent pauses c. Tentativeness d. Rapid delivery

C

A manager is careful to address nonverbal aspects of communication when communicating with employees. What practices should the manager adopt? Select all that apply. a. Have communications in public places as much as possible to reduce intimidation. b. Stand between 12 and 18 inches from an employee when having an important conversation. c. Be thoughtful about aspects of appearance that can be controlled by the manager. d. Avoid crossing arms across the chest. e. Limit eye contact with employees to avoid being perceived as aggressive.

CD

A nurse-manager is drafting a memo that will be distributed within the organization. When using this form of communication, the manager should: a. send it to everyone in the organization to ensure equal access to information. b. begin with at least one page of background information to ensure clarity. c. avoid using headings so the reader is not confused. d. include only essential information.

D

What is the best example of downward communication by a nurse-manager? a. The manager reports a nurse's serious error to the chief nursing officer. b. The manager seeks advice from a colleague about how to deal with an employee who is chronically late. c. The manager contacts a client's physician to confirm the client's scheduled transfer. d. The manager reviews the results of a nurse's performance appraisal with the nurse.

D

What statement about the maintenance of confidentiality is true? a. It is the right of every client and must never be breached. b. It is made easier with electronic technology. c. It is primarily the duty of the medical records staff. d. It can be violated when there is a legitimate professional need.

D

A new nurse-manager has been warned by colleagues about the prevalence of "the grapevine in the organization's communication." What is the manager's best initial response to this phenomenon? a. Seek to understand the patterns and contributors of this pattern of communication. b. Inform subordinates about the harmful effects of grapevine communication and that it will not be tolerated. c. Instruct subordinates to use formal patterns of communication rather than informal patterns. d. Use grapevine communication to disseminate messages that are accurate and respectful.

A

A nurse-manager has recently established a "best practice committee" at the clinic. Which behavior by the committee members suggests that it is in the "storming" stage? a. Members attempt to impress each other with their credentials. b. The short- and long-term goals for the group are agreed upon. c. Group members achieve their stated goals. d. The members receive their instructions and mandate from the manager.

A

A nurse-manager is orienting a new graduate nurse to the unit and has found this individual's charting regarding assessment to be inadequate. What is the most appropriate statement to initiate a discussion with the new RN? a. "I'm concerned that your assessment charting seems to be unclear. Can I help you with this?" b. "Unfortunately, your charting is inadequate in every way." c. "Do you think a refresher course in charting would help you?" d. "Are you having difficulty assessing your client?"

A

Feedback from a nurse-manager's peers suggests that the manager's face-to-face communication is often ineffective. The manager should consider what potential cause of this problem? a. Incongruence between the manager's verbal and nonverbal messages b. Ineffective listening skills on the part of subordinates and colleagues c. Inadequate formal training on communication skills d. Career stagnation by the nurse-manager

A

How can the Internet be best used as a means of improving one's personal nursing practice? a. Accessing the latest research and best practice information b. Communicating with other health-care team members c. Minimizing the need for paper documentation d. Securing client information for confidentially

A

What strategy best increases the likelihood that a nurse-manager's communication will be accurately interpreted? a. Using more than one mode of communication b. Using face-to-face communication c. Producing clear, simple, written communication d. Repeating the message as often as possible

A