Chapter 22 :Nurse Leader, Manager, and Care 8th edition

A client is received into the emergency department after getting shot in the chest. The client is hemorrhaging profusely and is in hypovolemic shock. The nurse calls a code blue. What type of leadership style will be most effective during the management of the code?

Autocratic leadership Explanation: Autocratic leadership will be most effective in this scenario. Autocratic leadership involves the leader assuming control over the decision and activities of the group. During code blue, a leader is needed to direct the actions needed and make quick decisions to positively affect the client

The nurse manager has recently promoted a staff nurse to the charge nurse position. Which type of power does the charge nurse now have?

Explicit power Explanation: Explicit power is determined by virtue of the nurse's position. A charge nurse is responsible for making decisions and carrying out tasks not performed by staff nurses. Implied power involves a person without a leadership position being in a position of authority with peers. Reward power involves rewarding staff with something that they deem important. Coercive power involves using threats as punishments to force staff to do something they do not want to do. (less)

The nurses who provide care on a medical unit are skeptical about the planned change from a traditional narcotic cupboard to a computerized medical supply and management system. Which of the following statements demonstrates mistrust about the benefits of this proposed change?

"I've heard those machines don't even cut down on med errors like they say they do."

Which of the following nurse leaders most clearly exemplifies transformational leadership?

A leader who is dynamic, inspiring, and promotes change by the power of her convictions Explanation: Transformational leaders can create revolutionary change. They are often described as charismatic, and they are unique in their ability to inspire and motivate others.

Two nurses are having a disagreement over who will take the next admission to the unit. The nurse manager asks one of the nurses to take the admission and explains that this will be considered a personal favor. Which style of conflict resolution did the nurse manager display?

Accommodating

The new graduate nurse is evaluating the effectiveness of her assigned nurse mentor. Which characteristic should the new graduate recognize as being inappropriate for the nurse mentor to role model?

Advising the new graduate to consult her before making decisions regarding client care

A nurse manager of a hospital unit is working within a decentralized management structure. Which nursing action best exemplifies this type of system?

Decisions are made by those who are most knowledgeable about the issue.

A staff nurse works on a medical unit where staff retention is very high. There is a a sense of equality between the leader and the staff nurses. The unit decisions and activities are shared between the leader and the group. The designated nurse leader practices which of the following leadership styles?

Democratic

The nurse manager who asks staff members to give suggestions on how to improve collaboration between nurses and physicians is exhibiting what style of leadership

Democratic

A nurse can improve his or her skill with time management by doing which of the following?

Evaluating success with accomplishment of goals in client care

Maggie Brown, RN, is the designated charge nurse on the telemetry unit. She organizes and facilitates the unit meetings, in addition to making assignments and performing staff evaluations. Maggie's power to lead is defined by which of the following terms?

Explicit Explanation: Maggie's official assigned role gives her explicit power by virtue of that assignment.

The new graduate nurse is having difficulty managing time required to care for a group of complex clients. Medications are several hours behind schedule and several nursing procedures have not be performed. What is the first step that the nurse needs to take to resolve the time management issue?

Identify which nursing interventions are priority.

The chief nursing officer (CNO) wants to encourage nurses in the hospital to become clinical nurse leaders (CNL) and is reviewing a roster of nurses working on the medical-surgical unit. Which nurse should the CNO recognize as being qualified to take the CNL examination?

Jane Doe, MSN, RN; nurse manager; 7 years of nursing experience; supportive; engaged in community service activities Explanation: Jane Doe is the only nurse qualified to become a CNL. The American Association of Colleges of Nursing (AACN) requires that the registered nurse must have received a minimum of a master's degree

The nurse manager calls a staff into a unit meeting to discuss patient satisfaction. During the meeting, several staff members assume control. The nurse manager does not intervene to regain control of the group. Which type of leadership style is the nurse embodying?

Laissez-faire

Which style of leadership is rarely used in a hospital setting because of the difficulty of task achievement by independent nurses?

Laissez-faire In laissez-faire leadership, also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group

The nurse manager notices a trend in nurses routinely arriving to work late. How can the nurse use the transactional leadership style to get nurses to arrive to work on time?

Monitor time clock reports on a monthly basis and enter all nurses who have not been tardy into a raffle for a paid day vacation.

The nurse and unlicensed assistive personnel (UAP) are working together to admit a client newly diagnosed with diabetes to a nursing unit. Which task would be inappropriate to delegate to the UAP?

Monitoring insulin requirements

The proficient nurse wants to become a more effective leader. Which step will be appropriate for the nurse to take?

Promote a healthy work environment and become a nurse mentor.

The registered nurse (RN) has received orders to perform an unsafe practice on a client. The RN voices concern with the physician who gave the order, but the physician refuses to change the order. Whom should the nurse consult next regarding the order?

The Charge Nurse

A charge nurse on a medical-surgical unit is asked by the nurse manager to serve as a mentor to another staff nurse who is less experienced. Which of these would best describe this role?

The charge nurse is providing support for the staff nurse in new responsibilities.

The nurse is advising a client about health problems related to being overweight. The client acknowledges the need to lose weight. The nurse provides education on how to count calories in food and the importance of daily exercise. The client states she will begin to count caloric intake beginning with the next meal. The client also states intentions to begin an exercise program with friends. Which statement illustrates Lewin's stage of unfreezing?

The client acknowledges the need to lose weight.

The case manager works in a facility that supports a participative leadership style. Which of the following should the nurse recognize as an example of democratic leadership style?

The interdisciplinary health care team collectively developing plans of care for clients

The registered nurse (RN) wants to delegate a task to an unlicensed assistive personnel (UAP) but is unsure if the task can be delegated. What is the best resource for the RN to use in determining if the task is appropriate?

The nurse practice act or facility's policy and procedures

The primary responsibility of the nurse manager is to ...

create plans and budgets Explanation: Information about trends is necessary to project human and financial resource needs and to create plans and budgets. Nurse managers must be able to develop budgets that provide sufficient resources to accomplish unit goals.

A nurse working in a physician's office uses the managerial function known as "organizing." What is involved in this function?

resources Ex: The organizing function of the nurse manager involves acquiring, managing, and mobilizing resources to meet both clinical and financial objectives

A female client has been having yearly Pap smears and yearly mammograms for more than 10 years. According to Lewin, this is an example of what type of change?

Refreezing Explanation: Refreezing is the long-term solidification of the new pattern of behavior.

A registered nurse (RN) serves as the chair of the Nursing Practice Committee for the hospital. The meetings do not have a planned agenda; members of the committee who are interested in a particular topic feel free to suggest it and then to lead the subsequent discussion. This chairman's leadership style could be termed what?

Laissez-faire Explanation: Little or no direction is provided in laissez-faire management: coworkers develop their own goals, make their own decisions, and take responsibility for their own management.

Which of the following attributes would be characteristic of a nurse mentor? Select all that apply.

• Demonstrates leadership abilities • Supportive • Resourceful • Experienced licensed professional

The nurse is conducting an in-serve on change theories. Which example should the nurse include in the presentation illustrating Lewin's three stages of change?

A need for a safer intravenous therapy pump is identified. New intravenous therapy pumps are purchased and training for staff nurses is provided. Intravenous therapy pumps are placed on the nursing unit for client care.

In a hospital setting, one nurse is responsible for overseeing the quality and financial outcomes of patient care while working collegially with physicians and other caregivers, as well as with payers to manage patients along an agreed-on clinical pathway. This is an example of what type of health care delivery systems?

Case management Explanation: The case management model is when one nurse is responsible for overseeing the quality and financial outcomes of client; care; the nurse works collegially with physicians and other caregivers as well as with payers to manage clients along an agreed-on clinical pathway. Functional nursing is when nurses and other staff are assigned to specific tasks for a group of clients. This model is based on the assembly-line concept. Specializing tasks increases efficiency but results in impersonal care. Primary nursing is when a nurse is accountable for planning, evaluating, and directing the care of a client 24 hours a day throughout the client's stay. Collaborative practice model is when nurses and physicians work together in collaborative practice models

A nurse manager is trying to resolve a conflict between the day and night shifts. She wants to convince the involved persons to set aside their differences, determine a priority common goal having to do with improved client care, and accept mutual responsibility for achieving this goal. The nurse manager is using which of the following types of conflict resolution?

Collaborating Explanation: Collaborating has all parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. This requires mutual respect, honest communication, and shared decision making. Avoidance, as a conflict resolution, involves looking the other way and doing nothing to resolve the conflict. Competing has one side winning at the expense of the other. Compromising means that each side gives up something of value

The nurse and unlicensed assistive personnel (UAP) are working together to admit a pediatric client to a nursing unit. Which task would be inappropriate to delegate to the UAP?

Initiating intravenous therapy Explanation: When delegating the RN must determine the skill level, education of the UAP, client's condition, complexity of the client, and potential for harm. Initiating intravenous therapy is reserved for the nurse due to the potential for harm and scope of the UAP. The UAP can assist the nurse by obtaining equipment, securing the client, and soothing the client.

A nurse arranges all the resources available to teach a teenage girl how to manage her asthma. Which role is this nurse performing?

Organizing role Explanation: The role of management is to plan, organize, direct, and control available human, material, and financial resources to deliver quality care to clients and families organizing would include acquiring, managing, and mobilizing resources to meet both clinical and financial objectives.

The nurse manager is aware that nurses in the operating room are concerned about a proposed change in their working hours. Which of the following is the nurse manager's best approach in addressing this problem and the nurses?

Relate the proposed change to the group's existing beliefs and values. Ex: Approaches to overcoming resistance to change include relating the proposed change to the group's existing beliefs and values; explaining the rationale for change in clear, concise language and allowing for opportunities of open discussion; and listing the advantages of this change both for individuals and the group. (

Two new graduate nurses are requesting the same preceptor for unit orientation. Both new graduates have been very vocal about being unhappy if they do not receive their choice of preceptors. Which illustrates the nurses using a compromise approach to conflict resolution?

The nurses decide to share the preceptor. The preceptor will precept one nurse at the beginning of the orientation and precept the other nurse at the end of the orientation

Following a myocardial infarction (heart attack), a client begins to recognize the need to increase exercise, eat a low-fat diet, and implement relaxation techniques. According to Lewin, this is an example of what type of change?

Unfreezing Explanation: Unfreezing is the recognition of the need for change and the dissolution of previously held patterns of behavior.

A nurse is considering applying for a leadership role on her medical unit. She asks her colleagues what they consider to be good personal leadership skills. Which of the following would be appropriate? Choose all that apply

• Communication • Problem solving • Self-evaluation Explanation: Communication, problem solving, and self-evaluation are three of the four basic nursing leadership skills.

The nurse recognizes that a new mother is having difficulty breastfeeding her baby. The nurse provides assistance by demonstrating various positions to hold the baby while feeding. The nurse also educates the mother on ways to ensure proper latching. The new mother attempts to breastfeed the baby again using the new techniques and is successful. Which statement illustrates Lewin's stage of refreezing?

The new mother attempts to breastfeed the baby again using the techniques recently acquired and is successful Explanation: The new mother attempts to breastfeed the baby again using the techniques recently acquired and is successful

The nurse is getting accustomed to the role of nurse manager. What are requirements for this nursing role? Select all that apply.

• Creating schedules for the unit • Managing the unit's operational budget • Introducing methods to improve staff efficiency • Evaluating the success of the unit policies Explanation: The nurse manager is responsible for managing the unit's operational budget, improving staff efficiency, creating the schedule, and evaluating the effectiveness of unit policies.

A registered nurse is delegating activities to UAPs on a hospital unit. Which activities could this nurse normally delegate? (Select all that apply.)

• Giving a bed bath to a patient • Transferring a patient to another floor • Taking routine vital signs

A nurse is in charge of a large group of employees on a busy surgical floor. Today's care must be completed early due to a special event involving most of the employees. Which management style would work best in this situation?

Authoritarian Explanation: With authoritarian, or autocratic, leadership, the activities of the group are primarily directive, with activities determined by the leader and dictated to the followers, with no input from the followers on decisions. Coercive management forces actions upon staff. Democratic leadership is appropriate when the task, or decision at hand, is not one that requires urgent action, when subordinates can be expected to make meaningful contributions, and when their input can be taken into account. Laissez-faire management provides little or no direction; coworkers develop their own goals, make their own decisions, and take responsibility for their own management. (less)

Karen Wolf, RN, is the charge nurse on the orthopedic unit. She believes in giving the staff as much power as possible. The nurses are allowed, among other things, to create their own work schedules, provide dates and times for unit meetings, and create the agendas, to which Karen contributes. Karen's style of leadership can be described as which of the following?

Laissez-faire Explanation: With laissez-faire leadership, the leader relinquishes power to the group. Autocratic leadership involves the leader assuming complete control

A nurse leader is working with a client with hypertension who needs to learn about a low-sodium diet. The nurse recognizes the client is in the unfreezing stage of Lewin's Change theory with which client statement?

"I understand why I need to eat a low-sodium diet." Ex: Lewin's Change theory involves three phases which include unfreezing, moving, and freezing. With the unfreezing stage, the person recognizes the need for change. The client who understands why a low-sodium diet is needed with hypertension recognizes that this is a necessary change for their health status. If there is not a problem recognized, as with continuing a normal diet, the person is not ready for change. The person who is planning a meal is in the moving phase, which is the initiation of change after planning. The person who has already made the change with their daily menu is in the refreezing stage, where change has been effectively made