Chapters 1, 3, 4, 26, 27
A nurse manager is discussing with unit staff the repeated lack of staff compliance in documenting exercise activity for post-cardiac surgery clients. The unit's licensed practical/vocational nurses are responsible for ensuring that clients carry out the prescribed exercise regimen and that the activity is documented. Using Drucker's five basic functions of a manager, identify appropriate functions for the nurse manager to use when addressing this situation (select all that apply): a. Divide the necessary activities into manageable tasks, so clients adhere to the exercise regimen. b. Establish objectives and goals for each area and decide who is accountable for them. c. Allow clients to organize the activities. d. Engage in activities that motivate the team, and communicate effectively with the responsible staff members. e. Analyze, appraise, and interpret the performance of responsible staff, and communicate these findings to staff management.
A, B, D, E
An example of a care activity that would likely not be delegated by an RN to a UNP is (select all that apply): a. Teaching self-catheterization to a patient with paraplegia who has limited English. b. Basic care for a patient with a head injury who is rapidly deteriorating. c. One-to-one observation with a suicidal patient. d. Assessment of patients being admitted through the Emergency Department. e. Basic hygienic care for a patient who is post MI and stable.
A,B,D
A group of managers is meeting to discuss ideas related to the successful implementation of evidence-based practice on their units. Susan has been asked by the director of care to assume leadership of these discussion groups. After two such sessions, Susan expresses disappointment to her mentor that the group seems disinterested in her ideas and that they are listening to Ken, who has much less experience with leadership. In discussing this with Susan, the mentor understands that leadership: a. Is a designated role. b. Must be earned. c. Is more likely to be taken by someone who is more talkative. d. Rarely is taken over by someone with less experience.
B
A manager who is concerned with ensuring that patients on her surgical unit have the necessary information to make informed choices is: a. Practicing legal nursing care. b. Demonstrating respect for patient rights. c. Avoiding risks. d. Likely experiencing staff issues with informed consent.
B
A nurse executive who considers herself a Baby Boomer will have the challenge of convincing the emerging workforce of the necessity of committee meetings. One of the primary reasons that the Baby Boom generation appears to have so many meetings in the work environment is that: a. They feel more comfortable in a group. b. They find that the journey to the solution is as important as the solution itself. c. They were deprived of collective action opportunities in the past and now feel that solutions are better when many people have input. d. Baby Boomers are aging and need the respite from work that meetings offer, so they can recuperate from the physical demands of the work environment.
B
A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of the older adult patient. Using complexity principles, what would be the best approach to take in making this change? a. Leverage the hierarchical management position to get unit staff involved in assessment and planning. b. Engage involved staff at all levels in the decision-making process. c. Focus the assessment on the unit, and omit the hospital and community environment. d. Hire a geriatric specialist to oversee and control the project.
B
As a leader on a rehab unit, you encourage all staff members to see themselves as having a role in decision making and quality care. You see your role as involving particular responsibilities in decision making but not as a hierarchal role. This view of decision making and leadership is consistent with: a. Trait theories. b. Complexity theory. c. Situated theory. d. Emotional intelligence.
B
As the RN charge nurse on the night shift in a small long-term care facility, you've found that there is little turnover among your LPN and nursing assistant (NA) staff members, but they are not very motivated to go beyond their job descriptions in their work. Which of the following strategies might motivate the staff and lead to greater job satisfaction? a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night LPNs and NAs. b. Allow the LPNs and NAs greater decision-making power within the scope of their positions in the institution. c. Hire additional staff so that there are more staff available for enhanced care and individual workloads are lessened. d. Ask the director of nursing to increase job security for night staff by having them sign contracts that guarantee work.
B
At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. It would now be best to: a. Arrange another meeting in a week's time so as to allow a cooling-off period. b. Turn the dispute over to the director of nursing. c. Insist that participants continue to talk until a resolution has been reached. d. Back the unit manager's actions and end the dispute.
B
Budgeting and protection of revenues is a function of: a. Leadership. b. Management. c. Team leadership. d. Followers.
B
Chart audits have revealed significant omissions of data that could have legal and funding guidelines ramifications. As the unit manager, you meet with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. This is an example of: a. Leadership. b. Management. c. Decision making. d. Vision.
B
During a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on: a. Supportive behavior by the leader and immature followers. b. The development level of the followers and the type of behavior of the leader. c. Well-developed followers combined with a strong leader who acts quickly. d. The leader's ability to evaluate personnel and communicate that evaluation.
B
During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is: a. Empowering. b. A leadership tag. c. A symbol. d. A management task.
B
During staff development programs, staff nurses verbalize their frustration about their workloads and having to delegate so many tasks to others. One of the main reasons that delegation has emerged as an issue is because of: a. The amount of paperwork required to complete care. b. The complexity of client care. c. Earlier discharge practices. d. The numbers of other disciplines present on a given unit.
B
Functions such as "delegates tasks to assistive personnel" that are outlined in a position description for an RN Team Leader would be considered: a. Active delegation. b. Passive delegation. c. Passive accountability. d. Active responsibility.
B
Joan, the nursing unit manager, finds it difficult to work with Thomas, a new graduate. Thomas has many ideas, and his manner of presenting them irks Joan. After reflection and discussion with others, Joan recognizes that she also feels threatened by his behavior. She comes to understand that Thomas is trying to establish his own role on the unit, is not trying to challenge her, and needs guidance, coaching, and affirmation. Joan is demonstrating: a. A positive self-concept. b. Deepening self-awareness. c. Leadership. d. Acquiescence.
B
Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style? a. Transformational b. Transactional c. Trusting d. Truthful
B
Nurses in the CCU are unhappy and frustrated with their nurse manager. They complain that "nothing is ever good enough for him." These statements suggest that the nurse manager's goals may be: a. Measurable. b. Unrealistic. c. Attainable. d. Too low.
B
Recruiting among the emerging workforce (18- to 35-year-olds) is a challenge for healthcare agencies. Marketing brochures should address the leadership and vision of the healthcare agency. Which of the following workplace environments will attract applicants in the emerging workforce? a. A highly professional environment b. A nurturing and receptive environment c. An environment highlighted by lots of meetings, so staff members can have lots of input d. A totally online environment, so staff members will not have to interface with uncaring colleagues
B
The Sunny Long-Term Care Facility has experienced numerous difficulties with staff relationships, despite its success in maintaining financial viability and judicious use of resources. Staff members complain that the primary concerns of the facility include applying policy, saving money, and ensuring that lawsuits are avoided. There is little trust in, and involvement of, staff members. This facility may be: a. Well managed and well led. b. Overly managed and not well led. c. Poorly managed and well led. d. Overly led and overly managed.
B
The day shift nurse asks an LPN/LVN to complete a component of care for a client. The day shift nurse is engaging in what function? a. Delegating b. Assigning c. Sharing d. Authorizing
B
The hospital administrator approves a case management position for a new rehabilitation unit to help reduce costs. In developing the job description, the nurse manager understands that a key element of case management is: a. Managing of care by nurse managers. b. Coordination of resources for effective outcomes. c. Rapid discharge of clients to decrease costs. d. Managing of care for outpatient clients only.
B
The new head nurse on G Unit has been the subject of a great deal of discussion and complaining during breaks. She is a competent nurse of tremendous integrity with approximately 30 years' experience. Her predominant method of problem solving and communication is through meetings, which can go over the allotted time. The staff may: a. Be represented by a high number of Baby Boomers. b. Be presenting different generational values and attitudes than the head nurse. c. Be unresponsive to her transactional leadership style. d. Want a leader rather than a manager.
B
The nurse manager in the Emergency Department needs to implement new staffing patterns. As a transformational leader, the nurse manager should: a. Explain in detail how well the new idea will work. b. Reinforce how this change will respond to the ideas and solutions generated by staff members. c. Reason with staff members that the new idea will save money and allow more free time. d. Imply that raises will be smaller than anticipated if the new idea is not accepted.
B
The nurse manager plays a unique role in institutional management in that the nurse manager: a. Encourages shared decision making. b. Models professional nursing behavior. c. Interprets healthcare trends and their impact on revenues. d. Coordinates care and allocates resources.
B
The nurse manager, as the leader of the unit's "customer (client) first" initiative, has asked the staff nurses to develop and administer a survey to every client before discharge. In asking the staff nurses to accomplish this task, the nurse manager is demonstrating: a. Accountability. b. Shared leadership. c. A common purpose. d. Independence in the nursing manager's role.
B
The style of leadership that Kari is exhibiting is likely to: a. Ensure that the organization is financially stable. b. Stifle innovative thinking about ways to move out of financial jeopardy. c. Lead to apathy and disinterest in the organizational goals. d. Lead to decreased attrition of staff on her unit
B
Which of the following indicates safe delegation? a. The nurse supervisor for a large urban acute care department asks the unit manager to accept two new acutely ill patients, which the manager does. The unit is short two staff, and the replacement is inexperienced. b. A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit manager's unit is fully staffed and patients are stable. c. The nurse supervisor asks the head nurse for Unit A to make do without a replacement for an ill staff member because Unit A was originally overstaffed anyway. Patient acuity levels are very high on Unit A and two staff are orientating. d. The nurse supervisor asks the charge nurse on Unit B to cover Unit F, which is two floors up, because the charge nurse for Unit F is ill. The charge nurse for Unit B is an experienced manager but has no experience with the nursing care required on Unit F.
B
Which of the following nurses is MOST likely to inspire others to do their best? a. Nancy, RN, is an individual who enjoys details and organization. She regularly leaves notes for the next shift about what has been done incorrectly or omitted. b. Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious. c. Clara has been the head nurse on Unit 3Y for years. She is quiet but enjoys patients and their families. She has not been to a conference in years because the unit is her entire life. d. Karen is a team leader. She is extraordinarily vigilant about ensuring that everyone is treated fairly in assignments. She is also very conscientious about care and regularly checks up on what everyone is doing to ensure that it is done correctly.
B
With delegation, responsibility and accountability remain with the: a. Physician. b. Professional who delegates. c. Individual who receives the delegation. d. Individual who previously performed the task.
B
You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Before assigning Evelyn to Mrs. N.'s care, the most appropriate action of the care coordinator would have been to: a. Determine Evelyn's educational background and preparation for this role. b. Ask Evelyn if she has worked with inhalers before and to describe what she knows about them. c. Advise that if Evelyn has any questions about what to do with the inhaler, she should come to the coordinator. d. Advise Evelyn that working the inhaler is not really complicated and that she should ask the patient how to check medication levels in the inhaler.
B
You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Determination of Evelyn's educational preparation and certification is related to the concept of: a. Accountability. b. Authority. c. Role performance. d. Assignment.
B
You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. This incident is an example of: a. Incompetence of the UNP. b. Failure to follow through. c. Skills but no motivation. d. Lack of accountability.
B
You overhear a newly graduated RN telling one of your colleagues that leadership and management belong to the unit manager and not to her. As a nursing colleague, you respond by demonstrating understanding that the perception of the new graduate: a. Is correct. Leadership is not the role of the staff nurse. b. Would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals. c. Has been influenced by nurse leaders and managers who leave for other positions. d. Is related to the general perception that nurse leaders and managers are not satisfied in their jobs.
B
As a senior executive, you are keen to develop your hospital as a learning organization. Part of your purpose in translating this vision into practice is to (select all that apply): a. Retain funding from third-party payers. b. Develop leaders. c. Maintain and/or improve quality of care. d. Stay abreast of new knowledge and evidence.
B, C, D
A family is keeping vigil at a critically ill patient's bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with people in such situations. In response to this situation, you approach the unit manager to apprise her of your concerns that the family dynamics of the patient involved may lead to staff-family and patient-family conflicts. You suggest that the physician may need to discuss the treatment plan with the family. The unit manager advises that he will arrange this discussion. If, after the meeting with family members, this is identified as a desired approach, you support the manager's decision. Your actions indicate that you are acting in what role? a. Leadership b. Management c. Follower d. Evidence-based
C
A grievance brought by a staff nurse against the unit manager requires mediation. At the first mediation session, the staff nurse repeatedly calls the unit manager's actions unfair, and the unit manager continues to reiterate the reasons for her actions. What would be the best course of action at this time? a. Send the two disputants away to reach their own resolution. b. Involve another staff nurse in the discussion so as to clarify issues. c. Ask each party to examine her own motives and issues in the conflict. d. Continue to listen as the parties repeat their thoughts and feelings about the conflict.
C
A nurse manager has worked rapidly to bring the staff to accept changes in the unit's mission, so that downsizing can be avoided. This nurse manager is using quantum leadership by: a. Focusing on past concerns related to the mission. b. Teaching staff members how to self-manage themselves. c. Determining accurately the direction of change in the institution. d. Requiring all staff members to review and reinforce their technological skills.
C
A nurse manager is experiencing considerable conflict among staff members because of weekend staffing coverage. During a called staff meeting, the nurse manager asks the disgruntled staff to meet as a group and determine the best staffing practices. In doing this, the nurse manager is using the concept of collaboration to: a. Demonstrate interdependence. b. Depict flexibility and broadmindedness. c. Focus all energies of staff members on a best possible strategy. d. Defuse the possibility that staff members will escalate their discontent when staffing the unit on weekends.
C
Ali, an RN on your unit, is consistently late to work and makes remarks such as "Do you really want me to do that?" when patients and care are assigned to her. You have spoken with her frequently about her: a. Ability. b. Skills. c. Attitude. d. Personal issues.
C
An RN colleague, who is a long-standing and collaborative member of your team, is performing a complex and novel dressing for the first time for the patient to whom she has been assigned. Which of the following would be the most appropriate communication with her? a. "How do you usually do this kind of dressing?" b. "The dressing needs to be done today and tomorrow with the supplies on this cart." c. "Here is what you need for the dressing, and I will show you what needs to be done." d. "I know you know what you are doing. Let me know if you have any problems."
C
As the clinical director of 24 employees, you have been asked to explain to staff members why they are not getting a raise this year, even though they have been working short-handed for many months and patient satisfaction scores have never been higher. Because you believe yourself to be a transformational leader, you will approach this problem by: a. Telling the assistant clinical director and asking her to share the bad news with the other staff members. b. Posting a note on the bulletin board that includes the phone number of the chief nursing officer, so anyone who has complaints may express them. c. Showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future. d. Meeting with a small group of seasoned staff members and asking them how to break the news.
C
As the nurse manager who wants to increase motivation by providing motivating factors, which action would you select? a. Collaborate with the human resource/personnel department to develop on-site daycare services. b. Provide a hierarchical organizational structure. c. Implement a model of shared governance. d. Promote the development of a flexible benefits package.
C
County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah provides Colleen, her RN colleague with details regarding the patients to whom Colleen has been assigned on the day shift. This is an example of: a. Accountability. b. Responsibility. c. Assignment. d. Delegation.
C
County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah's activity in the example described is termed: a. Passive delegation. b. Passive accountability. c. Active delegation. d. Active responsibility.
C
In planning a new wing, the nurse manager complies with the workplace safety requirements of the Occupational Safety & Health Administration (OSHA). Which of the following groups is considered to be at high risk for violence in the workplace? a. Pediatric staff b. Postsurgical unit staff c. Emergency Department staff d. Medical oncology unit staff
C
In working with Cheryl, her mentor suggests that it is really important for Cheryl to engage in self-appraisal and to know her strengths. This observation is based on an understanding that: a. Self-confidence comes automatically out of leading. b. Self-confidence requires constant self-affirmation of strengths. c. There is little external motivation and affirmation in leadership. d. Supervisors of leaders rarely provide feedback.
C
The hospital administration is discussing the possibility of closing hospital beds in your unit because of a nursing shortage and the increased amount of overtime required to care for patients. As the leader on the unit, which of the following examples best demonstrates your transformational leadership style? a. Your entire staff walks out on strike. b. Your staff sends an ultimatum to the clinic director demanding higher pay. c. A group of your staff members goes to the administration to propose closing of a different unit. d. A group of your staff members goes to the administration to request that they be allowed to work the overtime hours.
C
The nurse manager is setting up the room assignments for the unit. She has one critical patient on the unit, who is going to require more care than the others. Before delegating a task, a nurse manager should: a. Delegate the admission assessment to the LPN. b. Review the employee's performance assessment for the most recent period. c. Assess the amount of guidance and support needed in a particular situation. d. Create a task analysis of critical behaviors for the individual.
C
The unit manager is working in a large metropolitan facility and is told that two UNPs are to be assigned to work with her. Delegation begins with: a. Acknowledging the arrival of the second UNP on the unit. b. Providing clear directions to both UNPs. c. Matching tasks with qualified persons. d. Receiving reports from the prior shift.
C
To retain supervisory staff members, the director of nursing develops a mentoring program. The best person to be a mentor for a new supervisor in a leadership position is someone who has: a. Been in exactly the same position and can relate to the new supervisor's problems. b. Had vast leadership opportunities and likes to talk about his or her past experiences. c. Leadership experience and time to spend communicating with the new supervisor about his or her experiences. d. People who can help the new supervisor get what he or she needs to make the organization grow quickly and prosper in the process.
C
Which of the following exemplifies accountability? Karen, the nurse manager on 5E: a. Consistently submits her budgets on time. b. Gets along well with her staff and with other managers. c. Outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury. d. Actively solicits ideas regarding scheduling from her staff.
C
You recently acquired a position as a unit manager. During your time on the unit, you have formed a strong social network among your staff, have promoted the development of relationships between your staff and workers in other areas of the organization, and have formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, you are engaging which principle? a. Empowerment b. Systematic thinking c. Development of networks d. Bottom-up interactions
C
You walk into Mr. Smith's room and find him yelling at the LPN, Miss Jones. He is obviously very upset and after you speak with him regarding his behavior, you determine that he has not slept for three nights because of unrelieved pain levels. The LPN is very upset with Mr. Smith and calls him an "ugly, old man." You acknowledge her feelings and concerns and then suggest that Mr. Smith's behavior was aggressive but is related to lack of sleep and to pain. You say to Miss Jones, "Can you both, together with Mr. Smith, determine triggers for the pain and effective approaches to controlling his pain?" This approach demonstrates: a. Lack of empathy and understanding for Miss Jones. b. Concern with placating Mr. Smith. c. Leadership behavior. d. Management behavior.
C
. Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She is assigned David, a patient who has been admitted with a severe head injury. In communicating with Sally, you would: a. Provide a detailed explanation of what she needs to do with ICP monitoring. b. Tell her when she needs to provide an update about David's status. c. Ask her to tell you what she knows about ICP monitoring and share expectations about reporting. d. Advise her that you are available if she needs you.
D
A key advantage that a nurse manager has in terms of delegating is that: a. Clients receive less attention because too many staff make it difficult to coordinate care. b. Nurses report less pressure to perform necessary tasks themselves. c. Administration can predict overtime more accurately. d. Team skills can be used more effectively.
D
A nurse manager in a hospital is deeply concerned that senior administration makes decisions about budgetary directions that affect staffing and other resources without sharing the rationale for changes or demonstrating concern as to how these changes may affect patients or staff. She says she does not feel respected and is emotionally tired as a result. This situation represents: a. Bureaucratic organization. b. Realities of current health care. c. Negative organizational culture. d. Quantum leadership.
D
A nurse manager's responsibility for financial management involves making budgetary decisions. Budgets that allow the nurse manager to allocate resources at the unit level allow: a. Minimal nurse manager input. b. Limited rationale for budgetary requests. c. Budgetary allocations at the executive nurse level. d. Budgetary decision making at the point-of-service (POS).
D
A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled but must often care for his wife, who is undergoing treatment for breast cancer. According to Maslow's need hierarchy theory, what would be the best approach to satisfying the needs of this nurse, other staff, and patients? a. Line up agency nurses who can be called in to work on short notice. b. Place the nurse on unpaid leave for the remainder of his wife's treatment. c. Sympathize with the nurse's dilemma and let the charge nurse know that this nurse may be calling in frequently in the future. d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife's treatments.
D
According to the complexity theory, which of the following should be the focus of measurement? a. Cost per hospital day b. Bed utilization c. Infection rates d. Staff morale and budgets
D
After a newly hired director of nursing has reviewed the hospital's strategic plans, she develops a timeline for achieving those plans. The new leader is: a. Not expecting that novice leaders will have a vision. b. Demonstrating mistrust of the abilities of her staff to implement the plans. c. Instituting deadlines against which the performance of staff will be evaluated. d. Translating a global document into realistic plans for nursing.
D
After assessing an older adult patient in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. The nurse manager's decision and actions are based on: a. An established clinical pathway. b. Confirmatory scientific evidence. c. Unit protocol. d. Experience.
D
As a nurse manager on a urology unit, you note that there has been a marked increase in medication errors on the unit. Which of the following actions would be consistent with the National Database of Nursing Quality Indicators (NDNQI) measures? a. Staff are consulted regarding improvements in interprofessional approaches to patient care. b. Nursing staff are asked for input regarding the purchase of new medication carts. c. A recognition program is developed to acknowledge nurses who have provided safe and exemplary care utilizing skills in the staffing mix to optimize the delivery of patient care. d. Recent changes in staffing mixes are examined to determine if the timing of changes coincides with the increase in errors.
D
As a nurse manager, you embrace the usefulness of resources such as Smart Bed. This behavior is important to: a. Budget development. b. A manager's role. c. Succession planning. d. Encouragement of staff utilization of technology.
D
As a nurse manager, you identify that a shift in nursing care models might increase patient and staff satisfaction and avoid downsizing. Administration is reluctant to adopt this approach because downsizing is seen as critical to reduction of costs. To leverage your ideas, you: a. Ask staff to send e-mails to administration encouraging consideration of your option. b. Invite a senior member of administration to your staff meeting, so you can tell him what you are planning. c. Write a letter of complaint to a member of the institutional board about the lack of openness of the administration. d. Identify influential members of your nurse manager group with similar ideas and request an opportunity to meet with administration to discuss options.
D
As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas. You are employing _____ leadership. a. Situational b. Trait-based c. Contingency-based d. Transformational
D
As the manager, you have been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperatively that is being operationalized throughout your organization. Which of the following illustrates effective leadership? a. The training modules are left in the staff room for times when staff are available. b. The current approach is continued because it is also evidence-based and is more familiar to staff. c. You decide to implement the approach at a later date because of feedback from the RNs that the new approach takes too much time. d. A RN who is already familiar with the new approach volunteers to take the lead in mentoring and teaching others how to implement it.
D
Electronic health records (EHRs) are being instituted at Pleasant Valley Hospital. Some of the staff on Unit 4 complain to the manager that acquiring the technologic skills required is too time consuming. They question its value in patient care. The manager responds that: a. The use of technology is inevitable in our technologically oriented society. b. The hospital is no longer able to find the space to accommodate paper record keeping. c. The initiative is being driven by decision makers higher up in the hierarchy and there is no choice. d. EHRs will increase effectiveness of care by enhancing coordination and improving patient outcomes.
D
In delegating to a UNP in a home health setting, which of the following represents the most appropriate delegation communication? a. "You will be taking care of Mrs. S., who needs assistance with her bath." b. "You will need to help Mrs. S. get into and out of her shower. Ensure that you check the condition of her feet, and let me know if you have any concerns when you check in." c. "I am not sure that you know how to do this, but I am giving you Mrs. S. She is quite obese and needs skin care." d. "Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness."
D
In developing an orientation program, the hospital educator breaks essential organizational information down into chunks, which she develops as online modules. This is an application of which of Drucker's functions of management? a. Establishment of goals and objectives b. Motivation and communication c. Analysis and interpretation of performance d. Organization of activities into manageable tasks
D
John is interested in leadership positions within his nursing organization. Al-though he has been on the same unit for 10 years, he has attended two workshops during that time and has steadfastly refused opportunities to engage in leadership development opportunities or other learning offered as part of the hospital's succession planning strategy. He says that he is interested in a leadership role primarily because it will give him a more stable work schedule and will enable him to spend more time with his family. In coaching John, it would be important to: a. Affirm that his years of service and stability on the unit are the most important attributes for assumption of a leadership role. b. Reinforce that his concern with maintaining balance outside work would be a key factor in selecting him for a leadership position. c. Encourage him to consider the financial rewards of the position, as well as the positive effect on his work schedule. d. Encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in life-work balance.
D
Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and as a result, a suit is launched in which both Sarah (the delegator) and Leslie (the delegatee) are named. Sarah is named in the suit because she: a. Retains accountability for the care of the patient. b. Worked the same shift as Leslie. c. Has passive accountability for delegation. d. Retains accountability for the outcomes of care for the patient.
D
Nancy is a staff nurse who works on a rehabilitation unit. Nancy tells you that the assistants are experiencing difficulty with the new lift and wonders what your thoughts are on organizing an in-service training. Nancy is exhibiting which trait of a follower? a. Provides a vision for safety that is communicated b. Thrives on taking risks in identifying the problem with safety c. Coordinates the development of knowledge and skills necessary to use the lift d. Assumes responsibility for identifying a safety concern and concedes authority for solution to you
D
Role theory has its underpinnings in management theory. Management theories influence managers' leadership styles. Which of the following theories would a nurse manager be most likely to follow when redesigning the staffing schedule? a. Humanistic b. Productivity c. Psychological d. Quantum
D
Susan, a new graduate on the dialysis unit, appears to take Kari's remarks very seriously and works even harder, often volunteering for extra assignments. She also is often in Kari's office, advising of successes with her patients and of the extra effort that she is committing. This behavior suggests that Susan: a. Is fearful of losing her job. b. Lacks understanding of Kari's leadership style. c. Is not intimidated by Kari's leadership style. d. Knows how to "play the game."
D
The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility. While making rounds on the units, the staff development coordinator overhears RN staff complaining that they feel it is insulting to be required to participate in a competency program. Which behavior by the staff development coordinator is most appropriate in this situation? a. Disregard staff concerns and continue with development of the program. b. Inform the nurses that this program is a requirement for JCAHO accreditation. c. Schedule a meeting with the chief nurse executive to apprise her of the situation. d. Facilitate a meeting so nurses can articulate their values and concerns about a competency program.
D
The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader? a. The unit secretary who knows everyone's business b. The chief nursing officer who is in charge and is responsible for nursing services c. The chief cardiologist who admits the largest number of patients and brings in more revenue than any other physician d. The staff nurse who persuades other staff members to practice by making evidence-based decisions
D
The night nurse understands that certain factors need to be considered before delegating tasks to others. These factors include the: a. Complexity of the task and the age of the delegatee. b. Potential for benefit and the complexity of the task. c. Potential for benefit and the number of staff. d. complexity of the task and the potential for harm
D
The senior executive praises John for the positive patient evaluations that his unit has received. As an effective leader, John: a. Thanks the senior executive for having confidence in him and celebrates by going out to a special restaurant. b. Points out the impact that the changes he has initiated have had on the unit. c. Advises the senior executive that the mission statement and goals are important to him. d. Points out the contributions of his staff to the outcomes and shares the praise with his staff.
D
Which of the following is not important in a positive work environment, as defined by the AONE? a. Clear, open, trustful communication b. Accountability and clarity of roles and responsibilities c. Participatory decision making d. Challenge and striving for excellence
D
While explaining the importance of developing leadership skills among nurses to a group of first-year nursing students, Natalie, a nursing unit manager, emphasizes that: a. Most nurses are not expected to assume leadership roles. b. The role of nurse leadership is only at the bedside, ensuring that patient care is performed according to established standards. c. Only individuals in formal leadership roles are expected to be leaders. d. The public depends on nurses to assume leadership in moving consumer advocacy concerns forward.
D
You are a member of a team assigned to care for 15 general medical/surgical clients. You have all worked well together in the past in this same type of care. If you are assigned to coordinate this team's work, your best strategy, based on the Hersey and Blanchard model, would be to: a. Have a list of tasks to be accomplished and tell each member of the team what he or she must do. b. Encourage people to discuss their frustrations in providing this care. c. Ignore them—they've done it before. d. Provide minimal direction and let them come to you with questions
D
You are working in a home health service and have three unlicensed nursing personnel (UNPs) assigned to your team. You have worked with two of them for 2 years; the third is new. The two experienced UNPs have patients with complex illnesses for whom they provide basic care. The third member of the team has been assigned to patients with less complex illnesses. Your best approach to supervising their care is to: a. Remain in the office and ask each UNP to check in with you upon arrival at their first patient care site. b. Ask another RN to supervise the two experienced assistants so you can be with the new person full time. c. Meet the new staff member at the first patient care site and ask the others to call if anything is unusual. d. Meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual.
D
. The adage "leaders are born and not made" reflects which of the following ideas around leadership? a. Management can be taught; leadership depends on abilities. b. Mentorship is important in developing innate skills of leaders. c. Leadership is a natural skill that cannot be refined or developed. d. Succession planning and formal education related to leadership are ineffective.
A
A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who begins to complain loudly about the quality of care his mother is receiving. His behavior is so disruptive that it is overheard by staff, physicians, and other visitors. The family member rejects any attempt to intervene therapeutically to resolve the issue. He leaves the unit abruptly, and the nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner? a. Reflect to gain insight into how the situation could be handled differently in the future. b. Try to catch up with the angry family member to resolve the concern. c. Discuss the concern with the patient after the family member has left. d. Notify nursing administration of the situation.
A
A dispute arises between an RN staff member and an LPN over a patient issue. The tension between the two begins to affect other staff members, who are drawn into the conflict; eventually, the team becomes polarized toward either the RN or the LPN. This situation might have been prevented through: a. Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves. b. Asking other staff members what the real issues were in the dispute between the RN and the LPN. c. Reassigning one of the parties to another unit when it became apparent that the two individuals could not resolve the dispute themselves. d. Calling a staff meeting at the onset of the dispute to allow the team and the RN and LPN to discuss the initial dispute.
A
A family is keeping vigil at a critically ill patient's bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with people in such situations. What role are you assuming through this action? a. Manager b. Leader c. Follower d. Laissez-faire
A
A nurse executive is hired to restore a unit's productivity, which has decreased as the result of low staff morale. The nurse executive utilizes which of the following leadership principles? a. The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment. b. If staff members increase productivity, then they are given opportunity to engage in learning events such as workshops and conferences. If the staff members are not satisfied, they will insist on a different leader, who will get them what they want. c. Leaders at the national level who are seeking relief for nurses in the workplace are seen as the solution to the nursing shortage. d. Workplace satisfaction depends on staffing ratios, adequate pay, and tuition reimbursement, and these are things the leader can control.
A
After being interviewed for the unit manager position, the staff nurse reflects on the interview process. The staff nurse is aware that leadership begins: a. Within. b. Through a relationship with a mentor. c. With the job description. d. With the chief nursing officer of the organization.
A
Becky graduated five years ago and is keenly interested in pursuing leadership opportunities. She has been active in learning about leadership through workshops and Internet research and recently began a graduate degree program with a focus on nursing administration. She has excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and sometimes aggressive behavior tends to alienate other staff members on the unit. In coaching Becky, you: a. Suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation. b. Suggest that she not consider leadership roles because her interaction skills are more suited to roles in which she has limited opportunities to work with others. c. Ask staff members on the unit with whom she works to provide her feedback about ways in which her behavior irritates or turns them away. d. Encourage her to continue her graduate courses, as information about strategies and technical aspects of the role will compensate for negative interactions.
A
During a discussion of concern about approaches used with aggressive patients in the Emergency Department, several staff members express concern for their safety. As a leader, the nurse manager should: a. Look directly at speakers and acknowledge their comments. b. Promise to implement each suggestion that is made. c. Implement the idea that receives the most discussion. d. Listen but implement the plan that she had in mind before the discussion began.
A
Nurses on Unit 17 complain that their manager frequently "checks up on them" and encourages little involvement in decision making and yet, during performance reviews, praises them for their outstanding performance. Nurses on Unit 18 indicate that their experience is different from that of nurses on Unit 17. The manager on Unit 18 encourages active involvement in decision making and provides authentic, growth-promoting feedback. The practices on Units 17 and 18 reflect. a. Differences in the managers' expectations of their role. b. Shaping of the workplace behavior of employees. c. Different approaches to cooperation and collaboration. d. Recognition of institutional priorities.
A
The manager of a surgical area has a vision for the future that requires the addition of RN assistants or unlicensed persons to feed, bathe, and walk patients. The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea. The best initial strategy in this situation would include: a. Exploring the values and feelings of the RN group in relationship to this change. b. Leaving the RNs alone for a time so they can think about the change before it is implemented. c. Dropping the idea and trying for the change in a year or so when some of the present RNs have retired. d. Hiring the assistants and allowing the RNs to see what good additions they are.
A
The nurse manager is anticipating changes on the unit because of managed care. It is up to the manager to "sell" the staff on this care concept. A goal of managed care that the staff must understand is that managed care is: a. Grounded in business theory. b. Useful for long-term patients only. c. Designed to reduce unit resources and staff. d. Not concerned with the best interests of clients.
A
The nurse on the 7-7 shift is assigning a component of care to an unlicensed nursing personnel (UNP) employee. The night nurse should remain: a. Accountable. b. Responsible. c. Authoritative and liable. d. Responsible and task-oriented.
A
The successful integration of informatics into healthcare settings is key to: a. Quality decision making related to management of resources and patient care. b. Accessing current information about business practices. c. Meeting the modern-day expectations of staff regarding technology use. d. Speeding up calculations and decisions in budget development.
A
The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are angry and ask for a meeting to discuss the change. After hearing their concerns related to reduction in professional autonomy and care quality, you: a. Acknowledge the loss. b. Explain the reasons for change, emphasizing the need to reduce costs. c. Repeat the information several times, giving detailed budget overviews. d. Adjourn the meeting and provide explanation through e-mail.
A
Which of the following would be most in line with Hersey and Blanchard's concepts? a. The team of caregivers on day shift are familiar with their roles and with the patients. The nurse manager decides to work on the unit budget in her office. b. After a year of working on the unit, Shari, an LPN, is still hesitant about many policies and procedures. The charge nurse decides to challenge Shari with more difficult patients. c. The nursing supervisor asks one of her charge nurses to lead a technology integration project. The supervisor continuously demands involvement in decisions that the charge nurse is making in the project. d. Team members complain that Alysha, an RN, is unmotivated, and that she refuses assignments that are complex or difficult. The charge nurse suggests that Alysha is relatively new and that she needs time to adjust.
A
While interviewing for a nurse manager position, Ann is asked to give an example of a situation in which she demonstrated leadership. Which of the following examples exemplifies leadership? a. Through research and investigation of best practice and practice-based evidence, she proposed a change in the management of incontinence in elderly patients. b. She ensures that new policies related to parenteral infusions are implemented consistently within her team. c. When asked by her students about institutional policies, she readily and patiently interprets policies to facilitate quality care. d. She organizes the team and delegates responsibilities effectively in providing nursing care.
A
You pull staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions. Staff members are becoming distanced from the family. After inviting the concerns of staff, you explain that the organization values patient-centered care and that evidence supports that acting as an advocate and a listener is helpful to families. You ask the staff for ideas as to strategies that are effectively patient-centered in these situations. In this situation, you are taking on which role? a. Leadership b. Management c. Follower d. Visionary
A
