Leadership Exam

The manager senses that a nurse is very anxious at the beginning of the performance interview. How should the manager proceed?

"I have looked back over all of my notes and interactions with you to prepare for our interview." The manager should calmly start the interview, ignoring the nurse's tension, which will likely pass as the interview continues.

The nurse has attended a "how to" refresher course on successful delegation. Which statement indicates successful learning has taken place?

"I knew that effective delegation made my job easier, but I never thought about how it could benefit the hospital."

Which statement by the nurse manager is the best example of day-to-day coaching?

"Let me show you a method I have found to be effective in making patient assignments." Coaching is a mentoring relationship. It is a brief interaction.

The nurse manager is coaching an employee who has been late for work three mornings this week. What statements and questions should the manager include in this coaching session?

1. "What is causing you to be late?" 2. "When you are late it throws the pace of the entire unit off and client care suffers." 3. "You have been late three times this week and that is not acceptable." 4. "What are you going to do to avoid being tardy again?"

The nurse executive of a for-profit hospital continually works to provide an environment that is better for the nursing staff. Why is this effort so important?

1. An environment that is better for nurses is associated with lower mortality rates. 2. Nurses are more satisfied working in an environment that is better for nursing.

A nurse who works in a hospital with a collective bargaining unit requires disciplining. Which actions by the nurse manager are critical?

1. Coaching the nurse as appropriate 2. Reviewing policy and procedures with the nurse 3. Discussing expectations that were not met

A hospital on the Gulf Coast of the United States would list which situations among its top vulnerabilities?

1. Flooding 2. Hurricane 3. Tornado 4. Industrial accident

Which strategy could be used by nurses to promote nursing's power image?

1. Maintaining expertise by attending continuing education events. 2. Encouraging all disciplines to work toward organizational goals 3. Attend local events with influential people 4. Asking questions about reasons behind processes and policies.

A nurse is interested in the possibility of collective bargaining in the workplace. What will the nurse find when researching this possibility?

1. Most nurses do not work under collective bargaining agreements. 2. The National Labor Relations Board (NLRB) has addressed collective bargaining in nursing.

A nurse manager is orienting newly hired staff nurses to the organization's total quality management program. As part of orientation, the manager has assigned the nurses to interview the organization's internal customers. Which group would the nurses interview?

1. Newly hired radiology technicians 2. Nurses who have worked at the facility over 5 years

A health care organization has just achieved Magnet status. During the award ceremony the organization's chief executive officer should give primary praise for this achievement to which employees? Select all that apply.

1. Nurse executive 2. Staff nurses While much of the work will have been delegated to others, the nurse executive is a primary force in achieving Magnet status. Magnet status focuses on nursing excellence. Staff nurses are the primary drivers of this excellence.

Which nurse has legitimate leadership authority in the organization?

1. Nurse managers 2.Case managers Rationale: The have legitimate authority conferred by the organization and described in job descriptions.

Which topic would likely appear on the agenda for a staff meeting chaired by a nurse manager who follows transactional leadership?

1. Progress on request to increase personal day benefits. 2. Review of policy and procedures for unit evacuation 3. Standardized first of shift assessments.

The nurse manager is completing employee evaluations. Which practices should the manager use when doing these appraisals?

1. Sharing the appraisal with staff nurses verbally and in writing. 2. Requiring the staff nurse to sign the appraisal. 3. Allowing the nurse to make written comments on the appraisal. 4. Advising the nurse of the right to appeal the appraisal.

The nurse manager has completed a series of team-building exercises with a command group. Which statement by a group member indicates that cohesiveness is occurring?

A "we" statement indicates that the group member feels like a part of a cohesive group.

The nursing committee is planning a change in the unit's organization. Which statement reflects the priority expected outcome of these change agents' work?

All nursing responsibilities and changes have the expected outcome of improving client care.

The nurse manager feels that changing the unit's method of assigning break times would benefit the flow of client care. What should be the manager's first action associated with this idea?

Assessment is the first step of the change process, just as it is the first step of the nursing process.

The director of quality improvement reports that the hospital will soon be using "dashboards" as part of the quality management process. How should the staff interpret this information?

Dashboards are electronic tools that provide ease of access to real-time or retrospective data.

The nurse cared for Senator Bill Smith while he was hospitalized last year. The nurse now wishes to send him a letter supporting a bill that will be voted on in the current legislative session. Which salutation should the nurse use in the letter?

Dear Senator: Rationale 1: The nurse should use a professional manner in the letter.

The nurse prepares the medication ordered for the client. The nurse asks the nurse assistant to give the medication when the client receives breakfast and to report on the task at its completion. The nurse assistant agrees. Which component of the steps of delegation was violated by this request?

Deciding on the delegate Rationale: The violation occurred at the step of deciding on a delegate. Nurse assistants cannot administer medications.

Nurses in a hospital are working to establish a union. Which finding will these nurses be interested in seeing?

Before an election can be held, the union must demonstrate interest by 30 percent of eligible hospital nurses signing an authorization card.

The nurse manager has instituted a policy of sending information to the staff via email. Many misunderstandings have occurred since this policy was implemented. What technique should the manager use to reduce this miscommunication?

Being certain that emails go only to the intended recipients

According to the behavioral view of leadership, how are leaders formed?

By being educated With training Through life experiences. Behaviorists believe leaders are made, not born.

A nurse is discussing the intent of the nurse's collective bargaining representation to strike. The nurse's spouse is concerned about the length of time the nurse may lose as a result of a strike. Which statement by the nurse is correct?

By law, a 10-day notice must be given to allow hospitals the opportunity to prepare for striking nurses' absences.

A nurse asks an unlicensed assistant to help with discharging clients since so many are going home at one time. The nurse states, "Can you help get these clients ready to go home by helping them pack?" Which option best describes the statement with regard to effective delegation?

Delegation would have been more effective had the nurse been more specific about which clients and when it should be completed.

A newly promoted nurse manager would like staff to solve problems without relying on preconceived ideas. How should the manager role-model this ability?

Demonstrate a genuine desire to find our why there is dissention. Rationale 3: Good managers start out with a commitment to find out why others disagree.

During a discussion of how to proceed on a project, a team member says, "I don't care how we do it. Just tell me what to do and I will get it done." What kind of followership is this nurse exhibiting?

Dependent Rationale: This dependent "you make the decision and I'll do it," statement is characteristics of an ineffective follower.

Which strategy is best for the newly licensed nurse who wishes to develop power in the organization?

Develop a "can do" attitude and reputation. Rationale 1: To become powerful in the organization, the newly licensed nurse should develop an image of power. This includes building a "can do" reputation.

Hospital administration is aware that staff may be reluctant to be called back to work in a disaster. How can the hospital be proactive in encouraging staff to make the decision to serve?

Develop a caring relationship with staff during normal times. If staff members have a caring relationship and feel ownership of the hospital, they are more likely to respond in an emergency.

A nurse manager has been appointed leader of a large task force charged with a complex assignment. What strategies should the manager use?

Develop a work plan with interim deadlines. This work plan will be necessary to keep all subgroups on task.

A serious disagreement has arisen between two staff nurses. The unit manager elects not to make a decision regarding the disagreement until more evidence is collected. Which part of the nursing process does this manager's critical thinking reflect?

Diagnosis Rationale 2: Suspending judgment is equivalent to the diagnosis step.

The hospital chief operating officer holds monthly focus groups with the purpose of gaining ideas and insights from nursing administration and staff nurses. Which type of communication does this indicate?

Diagonal communication Rationale 3: Diagonal communication involves dialogue among individuals at different hierarchical levels (e.g., staff nurses to chief executive officer of nursing).

A conflict has arisen between two staff nurses who work on the same unit. Which strategy is most important for the nurse manager to consider?

Conflict management begins with a decision regarding if and when to intervene. Failure to intervene can allow the conflict to escalate.

The nurses in an organization are in the process of selecting a bargaining agent. Which action by the nurse executive is considered a fair labor practice?

Disallowing collective bargaining organizational meetings at the hospital. Nursing administrators are not required to allow union activities on hospital property or during working hours.

The nurse manager is concerned about a family member's complaint regarding the professional behavior of a nurse on the unit. Which is the most effective method to address this issue?

Discuss the complaint with the individual nurse face-to-face.

The day shift nurses and night shift nurses are in clear opposition regarding the responsibilities that each shift should be assigned. This opposition has created a "we-they" distinction on the unit. This is an example of which phenomenon?

Distancing mechanisms or differentiation serve to divide group members into small, distinct groups, which increases the risk for conflict.

A newly licensed nurse is concerned about the legal aspects of delegation. What is the most important question for the nurse to consider prior to delegating a task?

Does this task involve nursing judgment? Rationale: The nurse should not delegate tasks that involve nursing assessment or judgment.

When the nurse manager orders supplies for the unit, which communication mode is best?

E-mail Rationale: To avoid misunderstanding of supplies needed, a written request is the most appropriate choice. It avoids misunderstanding, as the needs can be checked off a list.

The census was higher than anticipated and the client acuity level was also high; however, there were fewer nursing hours paid. This variance is an example of which budgetary variance?

Efficiency variance is a reflection of the difference between budgeted and actual nursing care hours provided.

A nurse manager overhears a conversation in which staff nurses complain about the evaluation process. One nurse says, "It really is just a waste of time. I get the same raise no matter what I'm rated." Which is the best way for the manager to address this concern?

Emphasize the practice development aspects of evaluation.

Which strategy is most likely to increase participation in the use of evidence-based practice in nursing?

Ensure adequate training, recognition, and easy access to the Internet. There must be training, easy access, and recognition for using evidence-based practice in nursing.

The nurse has been concentrating on improving personal communication skills. Which option represents the final step in this nurse's work to improve communication?

Ensure the communication is understood. Rationale: Ensuring all parties understand the communication is the last step as it involves evaluation.

A nursing executive is comparing the entire hospital financials for the month and notes that the medical laboratory's revenue is higher than environmental services. What is a possible explanation?

Environmental services is a non-revenue-producing cost center.

A nurse manager wishes to use a model of job performance to help match employees and tasks to achieve the greatest effectiveness. What should the manager do first?

Establish, in writing, the expectations of each task.

This is the first meeting of a task force. What should be the leader's primary objective of this meeting?

Establishing a standard of total participation During the first meeting a standard of total participation should be established.

In an attempt to decrease tardiness, a hospital gives employees an extra hour's pay for each wage period that the employee has not been late for work. This incentive program is an example of which theory?

Expectancy theory emphasizes the role of rewards to the employee in order to increase a desired behavior.

Regardless of which delivery system or combination of delivery systems is appropriate, which skill is required for effective use?

Flexibility is a skill imperative when choosing a delivery system(s) for nursing care. The system must meet client and staff needs and organizational and unit-specific goals, as well as remain within cost constraints

The standard method of appraisal used by the facility rates a nurse's performance as satisfactory, but the nurse manager feels the nurse has room for improvement in many areas. What action should be taken by the manager?

Focus on developing a plan to improve the areas concerned.

A hospital administrator initiated the emergency operations plan (EOP) after being notified that a tornado struck a nearby community. Thirty minutes later law enforcement calls to report that while significant damage was done, there were only minor injuries. What should the administrator do now?

Follow the EOP to deactivate the plan. There should be specific information in the EOP to deactivate the plan.

How can a nurse best influence policies in an organization?

Follow the nursing process. Rationale 1: Close examination of the political process shows that it closely follows the nursing process. The nurse will assess the situation, create a plan of action, implement that plan, and evaluate and revise the plan.

During the first meeting of a newly created task force, the nurse manager notices that individuals tend to cluster with members of their specific nursing units. The nurse manager begins the meeting with an explanation of the focus of this group. These behaviors are characteristic of which stage of Homans's group process?

Forming occurs in the initial stage of the group process; the members are cautious in approaching each other as they come together as a group.

After the second week of orientation the new nurse witnesses the death of a child in the ED. Which role should this nurse's preceptor focus on at this time?

Counseling the new nurse.

The nurse manager's expected outcome is to increase evidence-based practice on the nursing unit. To meet this outcome, the manager encourages nurses to base their practice on which technique?

Current research Current research is a good source of evidence-based practice strategies.

Using the classical organizational theory model, what would be the most appropriate method for the nurse to voice concern over unfair client workload assignments?

Discuss the problem with the nurse's team leader and then the charge nurse if the problem remains unsolved.

At the beginning of a brainstorming session, the manager lists the rules to be followed. Which rule should be included and enforced?

Do not critique any ideas presented. Rationale 3: Brainstorming is for idea generation only. Idea critique will follow in another session.

A staff nurse tells a manager, I don't want to be promoted. I am a much better follower than I am a leader." How should the manager interpret this remark?

Followership is a valuable skill in nurses. Rationale: In any situation where people must work together, followership is a valuable skill.

The nursing group has been charged with the task of solving a patient care problem on the units. Which step should this group take first in this process?

Gather information to define the problem. Rationale 3: Problem solving begins with collecting the facts, which provides clues to the scope and solution of the problem.

The nurse manager needs to delegate specific tasks to the charge nurse of the unit. Which action is an appropriate use of delegation?

Having the charge nurse lead a nursing quality assurance task force

The nurse manager has decided that the only way to deal with an issue is to use coercive power. What strategy is important for this nurse manager to employ?

Investigate to get the facts of potential infractions before responding to them. Rationale: The manager should always investigate to get facts to avoid jumping to conclusions.

One of the nurse competencies of the synergy care delivery model is "moral agency." Which action is an example of that trait?

Moral agency is "doing the right thing." Reporting a medication error is the right thing to do.

There is substantial unrest among the staff of an intensive care unit that has resulted in negative client outcomes. Which employee factors should the manager assess first?

Motivation and ability to be effective in the job.

Nurse asks nurse manager if he can go home early.The request is denied, says, "I don't understand why I can't leave early.This statement is an example of which technique of influencing the supervisor?

Negative inquiry Rationale: Negative inquiry is a statement of "I don't understand." Negative inquiry is an effective technique, provided the person to whom it is directed does not become defensive or distraught.

A home health agency has a policy requiring nurses to make routine visits at night. How might politics be used to change this policy?

Obtain research material to provide reasons why routine nursing visits at night are not as effective as during the day.

What is the best example of a pediatric unit's organizational culture?

Organizational culture is based on norms and traditions such as nurses wearing colorful attire.

The nurse manager gave the unit secretary complete responsibility for the unit's staffing, including finding replacements for call-ins and disciplining nurses with excessive call-ins. This is an example of which type of delegation?

Overdelegation Rationale: Overdelegation delegator loses control by providing the delegate with too much authority or responsibility. Discipline of an employee is a responsibility of the manager and cannot be delegated due to confidentiality and controversy associated with it.

An ICU nurse manager states, "The hospital has a union but I wouldn't advise joining," to a newly hired nurse. The human resources (HR) director is informed of this comment. How should the HR director respond?

Remind the manager that there is to be no interference with an employee's decision to join the union.

The nurse has set a goal becoming a clinical leader (CNL). What actions should this nurse plan to reach this goal?

Return to school to obtain a master's degree. Rationale: CNLs are educated at the master's level.

The nurse manager is calculating the cost of offering two bonus incentives to nursing staff for covering call-ins for sickness. Which option best describes the basis of this decision?

Subjective probability Rationale 4: Even though option A is more cost-effective, the manager believes option B to be in the best interest of the unit. Subjective probability is the likelihood that an event will or will not occur based on personal judgment and beliefs.

In which situation should the nurse be most concerned that communication was distorted?

The emergency nurse receives a client who was transferred via ambulance for confusion.

In which situation would a "meeting before the meeting" be advisable?

The nurse expects the disagreement that started in the last meeting to carry over into this meeting.

With the current health care industry focus on managed care, nurses must be more cost-conscious. Which option is an example of a nurse being cost-conscious?

The nurse's decision to use fewer supplies when changing a dressing

Which situation indicates the nurse needs additional training on effective delegation?

The office nurse calls in orders for admission on a client following a surgical complication.

The chairperson of the nursing faculty leads the monthly meetings of the curriculum committee. This permanent group, which is designed to meet organizational goals, is which type of group?

The purpose of a command group is to accomplish tasks in an organization, and these groups are recognized as legitimate organizational entities.

The nurse manager has determined the need to hire two staff nurses. Which factor is most critical as the nurse manager prepares to submit the request to administration?

Timing of the request Rationale: The nurse manager should plan to meet with administration when there is sufficient time and the supervisor seems receptive.

A group of nurses has been convened to solve a problem. As the first step in this process, the group leader asks for a definition of the problem to be solved. Which statement reflects the best problem statement?

Unit clerks have made 10 transcription errors in the last 6 months. Rationale 4: A good problem statement reflects the facts without judgment as to cause.

A union representative tells the nurses of a hospital that they should review the Kentucky River trilogy as part of their education regarding unionization. What will the nurses learn from this review?

Which nurses are considered to have supervisory status. These three landmark decisions outline which nurses have supervisory status.

A nurse says, "I am always worried that I will be liable if someone I delegate a task to does something that hurts the client." What is the manager's best response to this concern?

"As long as you follow the five rights of delegation, your liability is minimal."

The nurse manager is counseling a male nurse about several recent incidents in which female nurses complained that he was abrupt and condescending. What advice should the manager give this nurse?

"Don't feel as if you are responsible for fixing every problem." Rationale: There are many gender differences in communication. Male tend to take responsibility and feel the need to "fix" things.

A nurse has a longstanding conflict with another nurse working the same shift. Over the last few days the first nurse has made an effort to smooth over the conflict. Which statement would the nurse manager evaluate as an example of a "smoothing" comment?

"Even though we don't agree on much, I do think you are correct about enforcing the length of lunch breaks."

A certified nurse's aide (CNA) has been reported to the nurse manager for refusing to perform hand hygiene between clients when providing morning care. Which statement by the nurse manager would be the most effective?

"Forgetting to perform hand hygiene between clients can spread infection."

Which statement made by the nurse manager is an example of the first step of delegation?

"I am going to delegate the responsibility of creating the vacation schedule."

Which manager statement reflects concern about the most important requirement for today's nurse manager?

"I am taking a day off tomorrow for my annual physical." The most important work of the manager is to stay physically and mentally healthy.

Which example represents a qualifier that may interfere with the message to be communicated?

"I hate to bother you with this, but we have a problem." Rationale: Qualifiers are often used as "entry statements" into important discussions, but they can interfere with the message being communicated.

An employee is sabotaging the work of a newly oriented charge nurse, and the charge nurse has not been successful in addressing the problem. When the nurse manager addresses the issue, which is the most appropriate statement?

"I know it must be frustrating working with a new charge nurse, but how can we make this situation better?"

Which statement indicates understanding of how a nurse could improve personal decision-making skills?

"I should practice making decisions by developing potential solutions and then choosing one." Rationale 2: Practicing making decisions will increase the nurse's experience, comfort, and overall skill.

The nurse manager meets with the staff nurses to discuss ways to improve communication among the shifts. Which statement by the nurse manager best exemplifies the final stage of conflict management?

"I will evaluate the outcomes of our strategies on a monthly basis." In any situation, the nurse manager should use the nursing process to intervene

A level III disaster has occurred and the hospital is receiving clients by ambulance and those who have walked in to the emergency department. The wife of a man who is critically injured screams, "Why doesn't someone do something for my husband? He is dying!" How should the nurse manager respond?

"I'm so sorry, but your husband's injuries are very severe. We have to take care of the others first." This is a kind statement of fact and is a good way to address this wife.

The nurses of a hospital have given notice of their desire to unionize. The nurse executive is meeting with all nurse managers to discuss their role. Which information should the executive provide for these managers?

"If the nurses on your unit want to organize, do not interfere."

A community-owned hospital has been purchased by a health care conglomerate. The staff is aware that the organizational theory governing the hospital is likely to change. Which statement indicates a lack of understanding of organizational theory on the part of a staff nurse?

"If this new company is based on systems theory, there will be a lot of focus on how much work we can produce."

The manager tells a potential nurse hire that the organization is a "closed shop" organization. The nurse asks for clarification. Which response by the manager is most accurate?

"It means you are required to join the union if you accept this position." A "closed shop" is a business in which union membership is a precondition of employment.

After several near-incidents during procedures, the nurse manager is increasingly concerned about how nursing staff communicates with physician staff. Which advice from the manager would be most beneficial to the nursing staff?

"Let's review the steps of the procedures that we know are the biggest problems."

The National Labor Relations Board (NLRB) has certified a union to be the bargaining agent for a hospital. A nurse working in the hospital has a grievance and says to the nurse manager, "Wait until the union gets involved." Which response by the manager is appropriate?

"NLRB certification does not mean a union will develop." Certification by the NLRB of a union to be the bargaining agent does not automatically mean employees have a contract.

A nursing curriculum includes integrated content on critical thinking. Which statement reflects movement toward designing the curriculum to meet Carnegie Foundation recommendations?

"Our emphasis must change to improving students' clinical reasoning skills." This is a Carnegie recommendation.

A nurse manager is discussing the hospital's changes to peer evaluation with nursing staff. Which comment by a staff nurse would the manager interpret as evidence of understanding this process?

"Our evaluations will be more objective."

A nurse constantly complains about employee policies and procedures and frequently mentions how "they" are "out to get us." The nurse is surprised when referred to by the manager as "disgruntled" during a discussion of this behavior. What information should the manager provide this nurse?

"People who are constantly complaining decrease the morale of the rest of the unit." Disgruntled, complaining employees adversely affect everyone else's morale.

The nurse manager has identified physical assessment skills lacking in a new registered nurse. Using goal-setting theory, which statement by the manager would be the most effective in enhancing the nurse's assessment skills?

"Plan to study one body system a week and demonstrate your assessment skills to me every week."

A 70-year-old client develops a catheter-induced urinary tract infection. Which statement by the nurse would indicate to the nurse manager a need for additional understanding of this situation?

"Thankfully we can treat this with an antibiotic." The nurse who focuses on taking care of the results of a potential medical mistake is not accepting the seriousness of the situation.

The nursing staff at a hospital is upset regarding nurse-client ratios. One of the nurses says, "Our contract is not being honored. I think we need to tear it up and strike, starting tomorrow." Which response by the union representative is most appropriate?

"The FMCS (Federal Mediation and Conciliation Service) has to have 30 days' notice of our intent to strike."

The nurse manager overhears staff discussing the shortage of nurses. Which statement by a staff member would the manager evaluate as misinformation?

"The demand for nurses is declining because of fewer hospital admissions." Job numbers for nurses are expected to continue to grow.

The nurse is acting as team leader for a client care conference. Which opening statement is best for this meeting?

"The issue with this client is the time limit for Medicare to pay has almost expired, and we aren't ready for discharge." The team leader is the meeting facilitator, teacher, and client advocate for the patient care conference.

During an interview with a potential employee, the nurse manager tells the individual that an additional 10 percent of the hourly rate will be paid for working the 7:00 pm-7:00 am shift. What is another way the manager could have described this difference in pay?

"The night shift differential is 10 percent."

Which statement would be inappropriate for a manager to write on an employee's performance appraisal?

"The nurse is shy and quiet." A performance appraisal must focus on an individual's job performance and not personal characteristics.

A nurse assistant states, "I don't understand why they would select a nurse to be the union representative." Which response by a coworker is appropriate?

"The representative must be an employee of the union or a member of the nursing staff." The union representative may be an employee of the union or a member of the nursing staff.

An inexperienced speaker is practicing the delivery of a speech. Which statement indicates a lack of understanding about how easily communication is distorted?

"The topic is not complicated, so I don't have to worry about misunderstanding."

Multiple casualties have arrived at the emergency department following a tornado. Which instruction from the manager to staff is incorrect?

"There is no time to worry about using personal protective equipment, just try to be safe." This is an essential time to use personal protective equipment.

The housekeeping employee asks the employees' agent what role the union representative plays. What answer should the agent provide?

"They are responsible for administering the contract." The role of administering the contract falls to an individual designated as the union representative.

A nurse who has been abusing narcotics is in the nurse executive's office discussing the charges. The nurse executive is trying to convince the nurse to seek treatment for the abuse. Which statement should the nurse executive make?

"Treatment is your best chance at returning to practice." The nurse who successfully completes treatment stands the best chance at successfully reentering practice.

The health care institution has organized a committee to review and revise the strategic plan. As part of this work, committee members have been asked to submit a philosophy statement for consideration. Which statement meets the requirements of a philosophy?

"We believe clients are most important." The philosophy is a written statement that reflects the organization's values, vision, and mission. It is broader than a value statement.

The nurse executive of a hospital is surveying hospitals in a four-state area in regard to their disaster preparedness. The nurse would expect to hear which response to the question "What have you done to prepare for a disaster?"

"We conduct practice disaster drills." Over half of U.S. hospitals report conducting practice disaster drills.

A nurse manager is working on a task force to develop policy for man-made disasters. There is some discussion in the committee about whether fire should be included in the policy. Which suggestion by a task force member would be most useful?

"We should only focus on arson fires." Since arson fires are man-made, they would be included in this plan."

A nurse manager has provided education to emergency department nurses regarding disaster management. Which statement would the manager interpret as indicating understanding of this education?

"We should treat as many clients as possible as quickly as possible." This is the goal of emergency treatment in a disaster

Which ground rule statements by the leader will help the group meeting stay on task and on time?

"We will always meet on the second Wednesday of the month at 1:00 p.m. as this is the time all members have indicated is most convenient." "You can expect to receive an agenda for the meeting at least 1 week in advance of the meeting."

A nursing leader wishes to maintain an image of power on a multidisciplinary committee. In a meeting, a committee member makes a statement that the nurse believes is in error. How should the nurse respond?

"What evidence supports that statement as accurate?" Rationale 3: The nurse should not take the statement at face value, but should ask for evidence that it is correct.

The nurse manager has decided to use evidence-based practice (EBP) to solve an issue and has called staff nurses together for input. Which question, as posed by the manager, reflects the first step of the EBP process?

"What is the exact clinical issue with which we are dealing?" Identifying the clinical question is the first step in the EBP process

Hospital administration has elected to use TeamSTEPPS as a method of team building. What should the nurse manager tell staff about this training?

"You can expect additional efforts to help us keep on track." Sustainability is a part of this framework.

A nurse has been asked to teach newly hired nurses how to operate some client care equipment that the unit has just received. The nurse says, "I'd love to do this, but someone else will need to take my clients today." How should the manager respond?

"You will need to work the education into your day as you take care of clients."

The chief nurse officer (CNO) has received numerous complaints by staff regarding their manager. Not granting days off, favoring staff members, allowing lateral violence in the department. Which statement by the CNO to the manager would specifically describe a lack of civility?

"Your behavior is rude and disrespectful towards your staff." Lack of civility is rude, disrespectful, and impolite behavior.

The nurse executive is addressing a conference on collective bargaining and nurses. Which statement should the executive include in this address?

"Your concerns that collective bargaining may separate staff nurses and managerial nurses are well founded."

A nurse manager is leading an education session regarding disaster triage for emergency department nurses. Which statement should the manager include in this instruction?

"Your triage system will be reversed during a disaster." Triage is reversed during a disaster. The least injured clients are seen first.

The unit employs 35 FTEs (full-time equivalents) based on an 8-hour shift. The average benefits for these FTEs are 12 vacation days, 10 holidays, 6 sick days, and 4 personal days. Based on these figures, the FTE required per employee to replace benefit time is _____ FTE. Round to the nearest hundredth FTE.

0.12 To arrive at this figure, add the number of days off, multiply by 8 hours per shift, and divide by 2080 0.12 of an FTE.

An organization has adopted the peer review process of evaluation. The manager shares which information with staff?

1. "Begin to work on a portfolio that shows how you have met your work goals for this year." 2. "If you are a member of a peer review committee, you will submit a written evaluation to me." 3. "This change has occurred as a result of our move to self-governance."

A nurse manager is struggling with two marginal nurses and goes to the supervisor for advice. How should the supervisor advise the manager?

1. "Continue to be persistent in your work with these nurses." 2. "Be fair and consistent with them." 3. "You must continuously assess the rest of your staff as you work with these two nurses." 4. "You must continue to address the issues with these nurses as they arise."

The nurse is working on a committee tasked with making a major organizational change. Which comments by the nurse would help to advance the work of this committee?

1. "Have we looked at all available data in order to make an informed decision?" 2. "What are the obstacles to implementing this change within the organization?" 3. "Are we including the opinions of all stakeholders in this decision?"

Which directions given by the nurse to the assistant are most likely to be understood and completed correctly?

1. "Here are your directions for this morning. Please give the clients in rooms 2156, 2158, and 2159 total bed baths." 2. "Go to the diet kitchen and get a cup of apple juice for the client in room 2112."

The nurse is always intimidated when asking a physician to clarify orders. Which statements should the nurse use to help counteract this feeling?

1. "How often did you want the furosemide given?" 2. "Doctor, what rate did you want for the I.V.?"

Manager approaches nursing supervisors requesting approval for 12-hour shifts into scheduling. Supervisor denies the request, due to previously with poor outcomes. Which responses by the nurse manager may positively influence the supervisor?

1. "I agree it was not effective years ago, but other units have now had success with it." 2. "What were your specific concerns about the 12-hour shifts?"

The manager's performance evaluation the supervisor says, "You are very good at adaptive decisions, but you need to be more precise in routine decisions. When the situation calls for really innovative decisions, you do not seem sure of yourself." How should the manager interpret this information?

1. "I am not following the policies and rules well." 2. "I should review the procedure manual." 3. "I'm good at using my previous experiences to guide my decisions."

A nurse manager is faced with the task of introducing an unpopular change to a staff that includes several nurses who have acted as rejecters to previous changes. The manager expects resistance but hopes to identify these rejecters early in the process. The manager should be particularly alert to which statements?

1. "I don't care what they say; I'm not giving care that way." 2. "I bet I can make it very difficult for this change to occur."

Efforts to increase nurses' use of evidence-based practice (EBP) to improve client care in the hospital have failed. Which answers are nurses likely to give when asked why this is occurring?

1. "I don't have time to finish everything I already have to do each shift." 2. "I don't want to practice nursing just like everyone else." 3. "The library at our hospital doesn't have many journals." 4. "If administration wanted us to use EBP, they would get us some more nurses to share the work."

The nurse manager is leading the monthly staff meeting for the professional nursing staff. Which statements by this leader reflect effective leadership?

1. "I have created an agenda that identifies the amount of time allotted for each step of the problem-solving process." 2. "The meeting will be called to order at noon and be adjourned in 1 hour." 3. "It is important that each of you is fully engaged in the decision-making process."

Which statements reveal that the nurse being described has real power?

1. "I have such respect for her and the work she does." 2. "It is an honor to work with her." 3. "She had an opportunity to go to another hospital, but she chose to stay here and help us through accreditation."

The nurse manager has asked that another staff nurse position be funded for the unit. The supervisor denies the request. Which statements by the manager are examples of negative assertion?

1. "I know I haven't been too careful in keeping personnel costs low, but we are really going to need another position." "I realize that my staff is not always positive about organizational changes, but having this extra staff member might reduce some of their stress."

A nursing administrator overhears nurses conversing during a break in a seminar on change. The administrator would interpret which statement as meaning that the nurse who made it is ready to become a change agent?

1. "I know that suggesting this change may backfire on me." 3. "I see an opportunity to make a difference in the way this facility provides nursing care." 5. "This change is certainly going to be a challenge, but that's okay."

Which statements would be important for the charge nurse to make when delegating a responsibility?

1. "I think it would be important to our organization if you represent the unit on the policy and procedure committee." 3. "I think your attendance at the task force meeting will be a good reflection on our unit."

A grievance has been filed against a hospital. Which statement by the nurse executive reflects common reasons for grievances?

1. "I think there is a misunderstanding of one of the terms of the contract." 2. "I think this grievance is based on a term in the old contract that is not included in the new contract." 3. "This contract just is not going to work. We need to renegotiate."

Which statement by the formal leader of a nursing unit reflects the personality required to energize the staff and promote creativity?

1. "I would like to thank everyone for your hard work and dedication while we have been short staffed." 2. "I am certain that our new assignment system is going to make the workload more equitable." 3. "I know this week has been rough. I feel a little like sandpaper myself."

In order to develop a succession-planning program as rapidly as possible, the management team has elected to divide the processes up among team members. Which assignments would be expected?

1. "Identify the most important things that managers do." 2. "Decide which current nurses would make good managers." 3. "Analyze management training opportunities."

A hospital is considering implementing the use of critical pathways and case management. Which statements by a nurse would indicate to the nurse manager that more education should be provided?

1. "If we use critical pathways, we won't have physical therapy to help us ambulate clients." 2. "The critical pathway lists discharge outcomes but won't help us with day-to-day guidance of care." 3. "Once the client is on a critical pathway, we must follow it until discharge."

As a part of the strategic planning process, nursing units have been asked to develop strategies to meet designated objectives. Which statements represent strategies?

1. "Initiate intravenous therapy within 30 minutes of the order being taken." 2. "Use scanning mechanisms to record the numbers of supplies used."

Which statement by a newly licensed nurse indicates an understanding of why it is necessary to structure nursing care?

1. "It helps to coordinate care to a group of clients." 2. "It organizes care responsibilities." 3. "It provides skilled care by skilled staff."

An experienced ICU nurse manager is orienting a newly hired nurse manager to the organization. The ICU manager makes occasional notes in a small notebook. The new manager asks why the ICU manager is taking notes. What are the most likely rationales for this behavior?

1. "It saves me time in the long run." 2. "Taking notes helps me to address issues immediately so they do not escalate." 3. "It helps me to remember what to address in staff meetings." 4. "Having notes helps protect me when evaluations are written."

A nurse manager is conversing with a colleague at a national meeting. The colleague states, "I've just never understood why a nurse would want to join a union." What responses by the manager would explain the attraction of unionization?

1. "It's usually a combination of factors such as low wages and high nurse-to-client ratios." 2. "Many nurses have supervisors who think they understand what it's like to work on the unit every day." 3. "Many nurses are frustrated because communication between nurses and administration is so poor."

The nurse manager has four different generations represented in the nursing staff on the unit. What statements indicate the manager is wise about how to deal with this generational mix?

1. "Our Generation Y nurses help keep us all up on new technology." 2. "The most loyal of all my nurses are the traditionalists." 3. "I expect that our next manager will come from my group of baby boomers."

A nurse says, "I don't see what all the fuss is about bullying. Every new nurse has to go through it. It's just a part of the history of nursing." How should the manager respond?

1. "The Joint Commission does not tolerate disruptive or abusive behavior." 2. "The American Nurses Association does not approve of bullying behaviors." 3. "New nurses bring new ideas. Why would you bully them?"

Currently clients on a unit are bathed in the morning between 8:00 am and 11:00 am. The nursing staff is changing bathing clients in the evening between 7:00 pm and 9:00 pm. Which statement reflects an underlying assumption that might affect the staff's ability to think critically about this change?

1. "The day shift just wants to shift work onto the evening shift." 2. "Everyone likes to bathe right before bed." 3. "The physician staff will be upset if we change our morning routine." 4. "If we let them change this, they will want to make lots of other changes, too."

Which statements would the nurse manager interpret as indicating a nurse understands the critical thinking skills necessary for disaster management?

1. "The nurse's prioritization will be different in a disaster." 2. "Clinical judgment skills will be an essential part of nursing's contribution to disaster management." 3. "The nurse's abilities will make the difference in successful management of a disaster."

A nurse manager is directing a team of staff nurses working to solve a clinical problem using evidence-based practice (EBP). Which manager statements would direct these nurses to the forms of strongest clinical evidence? Select all that apply.

1. "The studies we want are built around the scientific approach to solving problems." 2. "Our focus should be on studies that use both experimental and control groups to determine intervention effectiveness."

The supervisor is teaching managers about the use of critical incidents as part of the evaluation process. What information should the supervisor share?

1. "Using these notes will help you identify little problems before they become big problems." 2. "You can expect some negative reactions from staff." 3. "It is okay to tell your staff that you cannot remember all the details of each encounter for evaluation and the notes will help." 4. "Having these notes will help you feel more confident in your evaluation of staff."

Which statements by the nurse manager would demonstrate effective change management?

1. "We cannot lose sight of the mission and values of our institution as we begin to integrate these changes." 2. "Although this task is going to be difficult, we have the full support of our hospital administration."

Which statements by a hospital executive reflect power-coercive strategies to implement change?

1. "We must follow the federal guidelines in the way we bill for our services." 2. "If we don't reduce our nosocomial infection rate, Medicare won't reimburse us." 3. "Administration has to make this change or our accreditation status will be at risk."

Which statements by a nurse in the emergency department are examples of group thinking?

1. "We've already talked about this enough. We need to present a united front on this issue." 2. "The medical unit nurses won't like this decision because it is too much work." 3. "Let's all vote yes on this so we can get back to work."

A nursing supervisor would like the nurse manager to serve as change agent for a needed revision to unit policy. Which statements would alert the supervisor that this manager is not the best choice for this assignment?

1. "Well, we don't want to rock the boat too much." 2. "Do you think we can get enough support from the nurses to make this change?" 3. "We tried making a change like this before and it didn't work out well."

A hospital's disaster management team is reviewing the disaster plan after reading about a hospital that was destroyed by a tornado's direct hit. What questions should team members ask themselves?

1. "What are our current capabilities for evacuation?" 2. "Do we have sufficient resources in any other areas to continue operations if this happens to us?" 3. "Are there physical training needs that we have not filled?" 4. "What education should we provide to the staff and community?"

A nurse manager is focused on team building activities with a group chosen to write new unit policies. As a beginning step in this process, the manager should ask which questions to assess the group's context?

1. "What are the group's current goals?" 2. "How have the members organized the group?" 3. "What is the general culture of the group?"

Which situation would be included in reporting for Joint Commission mandatory national patient safety goals?

1. A client is left in the hallway transport did not contact the client's nurse. 2. nurse gives medication by wrong route. 3. client developed sepsis after urinary catheter. 4. Surgery is done on a client's right eye instead of the left eye.

The nurse is assigned to the Risk Management Team. Which events would be addressed by this team?

1. A client's hand is injured during an arterial blood gas draw. 2. A client leaves the hospital against medical advice (AMA).

Which statement describes the primary difference between group and individual decision making, besides the number of individuals involved?

1. A decision made by a group is often better than a decision made by one person. 2. Groups can provide more input into the process. 3. A decision made by a group can create a greater obligation to achieve results. 4. Routine decisions are more often made by individuals.

The nurse applying for a position is told, "This hospital has a very traditional organizational structure." The nurse would expect the organization to use which structure?

1. A functional structure is a traditional organizational structure. 2. A parallel structure is a traditional structure, even though it is more modern than a functional structure. 3. Matrix is a traditional structure.

Which situation represents an exception to the blame-free environment?

1. A nurse routinely changes nursing notes after a client is discharged. 2. A nurse does not complete an incident report after a medication error

One of the areas of supervision defined by the National Labor Relations Board (NLRB) is "independent judgment." Which nurses fall into this category?

1. A nurse who works twice a month as charge nurse on an acute care unit 2. A nurse who makes team assignments as part of the charge nurse role 3. A nurse whose job includes choosing which assistants to place with which clients

The procedures for managing client pain are being investigated as part of the hospital's total quality management program. Whom should the manager plan to invite to this meeting?

1. A representative from pharmacy 2. A representative from the medical staff 3. A staff nurse who works with clients in pain

In order to delegate, which must be present?

1. Accountability for the assignment on the part of the delegate 2. Accountability for the assignment on the part of the delegator 3. Authority by the delegator to assign the task to the delegate 5. Authority of the delegate to accomplish the task as assigned

A nurse has been hired as a new nurse manager at a hospital that has union representation. Which union-related activities should this manager expect will be included in the role?

1. Actively helping to administer any grievance procedures 2. Participating in issues related to disciplining employees

Which action would help the nurse work with public officials to influence policies?

1. Address only one issue in each correspondence. 2. Always make an appointment before visiting an elected official.

A disagreement has arisen between two staff nurses. Both have discussed the situation with the manager. The manager feels that that problem is likely self-solving. How should the manager approach this situation?

1. Allow some time to pass to see if the situation resolves. 2. Support both nurses as they work through this issue. 3. Provide any resources the nurses may need to help solve the problem. 4. Intervene if the problem begins to impact client care.

Health care providers are preparing for a worldwide outbreak of H1N1 influenza. How would this outbreak be classified in planning literature?

1. As a pandemic spreads around the world 2. As a health disaster spreads around the world 3. As a natural disaster naturally occurring

Which health care situations reflect the philosophy of quality management as designed by Deming? Select all that apply.

1. At 2:00 p.m. the nurse orders a lunch tray for a client who has just been removed from NPO status. 2. A nurse tells the manager that a housekeeper's work is not up to standards. 3. A nurse volunteers to take a Spanish language class to be able to communicate with clients.

The budget committee of a hospital is holding the first meeting of the budgetary cycle in two weeks. The finance department is preparing an information packet to be distributed to members. What statistical information should be included?

1. Average daily census for the facility over the last year. 2. Current community wage ranges for employee classifications. 3. Changes in accrediting body or legislative regulations. 4. Current staff mix across the hospital.

The continuous quality improvement (CQI) coordinator is establishing quality measures for a unit. These measures would be written according to which criteria?

1. CQI coordinator researches studies that show processes improves client outcomes. 2. CQI coordinator has evidence for particular practices effective in decreasing length of stay. 3. Processes measured produces desirable outcome. 4. Few unexpected bad effects from the process.

A nurse manager is looking for evidence-based information regarding wound care. Which criteria should be used to evaluate the usefulness of an intervention?

1. Can the manager find two or more research studies that support the use of the intervention? 2. Is the research study that recommends the intervention rigorous in design and execution?

Pharmacy reports that the medication records of a unit have begun to show frequent corrections. What other signs of diversion would the manager look for on the unit?

1. Chart review on effectiveness of pain control 3. Increase in use of doses of as-needed narcotics that results in wastage 4. Chart review that reveals that clients require much more narcotic pain medication on one shift than on others 5. Narcotic containers that look as if they have been altered

A nurse executive is trying to convince the hospital management team that a clinical ladder system would work well in nursing. Which points should the nurse include in this argument?

1. Clinical ladders keep very good nurses at the bedside. 2. These programs prove to be worth their cost. 3. Similar programs have been shown to improve nurse job satisfaction. 4. Quality of client care increases with these programs.

The nurse manager is facilitating the work of a collaborative team whose mission is to negotiate employment contracts with physicians. The nurse manager does not want to compromise the nurses' concerns in favor of the doctors' concerns. Which strategies would facilitate this outcome?

1. Collaborating focuses on solving the problem and satisfying both parties' concerns. 2. Competing is a victory for one side and a loss for the other.

The hospital has a very formal organizational structure and culture. Which conditions or events would indicate that a counterculture is developing within this hospital?

1. Collaboration and work sharing are becoming more common among nurses in specialty care units. 2. An informal group of nurses, radiology technicians, and physical therapists have been discussing how to better care for clients with hip replacements. 3. Nurses have begun questioning the wisdom of standardizing some nursing procedures.

As part of the disaster plan, the nurse executive is planning an education session on the core competencies for nurses established by the National Emergency Preparedness Education Coalition. Which topics should be included in the handout being written for this session?

1. Communication-Communication is a core competency for nurses established by this group. 2. Technical skills- Technical skills are a core competency for nurses established by this group.

As the RN team leader, identify potential disadvantages of using team nursing to deliver care to assigned clients.

1. Continuity of care may suffer. 2. Client/staff communication may be an issue. 3. Delegation is necessary.

The nurse manager is listening to new nurses discussing nurses as managers and overhears one state, "I don't care how long I am a nurse; I will never be a manager." In which ways do nurses manage regardless of their official role?

1. Deciding on priorities. 2. Being a liaison 3. Coordination of client care 4. Delegation responsibilities.

To be effective in today's health care system, the nurse manager must be aware of which trends?

1. Decreasing resources 2. Increasing numbers of retirees 3. Complicated technology

Which situations are examples of ineffective delegation?

1. Delegating committee attendance to a staff nurse, the nurse manager also attends the meetings. 2. Unit clerk asks the nurse manager to "listen for the phones". 4. Staff nurse asks the UAP to discharge a client. 5. The staff nurse often bathes clients because "I like to give bed baths."

The health care facility has elected to make a significant change in organization strategy. The change has been thoroughly researched and all levels of leadership have been included in the decision. Which roles are commonly undertaken by the nurse manager when such a change is necessary?

1. Disciplinarian 2. Fact manager 3. Liaison 4. Support person 5. Discussion leader

A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change?

1. Disperse information about the change as quickly as possible. 2. Remind staff that change is part of the health care environment. 3. Talk about the change in positive terms.

A nurse makes a medication error and notifies the client's physician. The physician berates the nurse over the phone and states, "You are an idiot." How should the manager deal with this situation?

1. Document the facts of the encounter. 2. Privately tell the physician that the behavior was bullying. 3. Confront the physician during rounds and demand an explanation.

A large metropolitan hospital uses differentiated practice as part of the structure of nursing services. Following this plan, nursing responsibilities are assigned based on which criteria?

1. Educational level 2. Experience 3. Nurse preference

During the first staff meeting, a newly promoted nurse manager says, "I would like a commitment from all the nurses to review and improve the way delegation is done on the unit." Why would the manager be interested in delegation?

1. Effective delegation allows the manager to focus more time on management tasks. 2. Efficiency increases with effective delegation. 3. Focus on managerial duties, provides better advancement. 5. The manager maximuming entire staffs potential.

A nurse practitioner and a physician are considering establishing a medical home. For this venture to be successful, these health care providers should ensure which resources are available?

1. Electronic medical records (EMR) technology 2. An understanding of the complexity of multiple-need clients 3. A plan for compensation for the primary care provided

A hospital has written a well-defined surge call-back system for employees to use in case of a disaster. What are key vulnerabilities of this system?

1. Employees may be unwilling to come back into the disaster. 2. Employees may be personally affected by the disaster. 3. There may be no way to contact employees for call-back. 4. The employee may not physically be able to return to the hospital.

The nurse manager is updating the position control sheet for the fiscal year prior to beginning a new budgetary cycle. What would the manager include in this sheet?

1. FTE factor for an LPN hired this month. 2. Names of all unit clerks working in the unit. 3. Licensure of a nurse working on the unit. 4. Fact that two RNs have retired this year.

A nurse manager has been terminated for failing to follow institutional policy and procedures. Upon reviewing the manager's files, the supervisor discovers multiple unfinished employee evaluations from the last two years. The supervisor is faced with which concerns?

1. Finding someone with enough knowledge of the employee's work to complete the evaluation processes. 2. How to share evaluation information with employees 3. Whether the care provided on the unit has been safe and effective. 4. How long it has been since employees have had a valid evaluation.

A health care organization has provided intensive education to staff regarding benefits and correct methods of delegation. Why has the organization spent the time and money to sponsor these sessions?

1. Good delegation helps to reduce overtime. 2. Absences decrease when delegation is used correctly. 4. Patient satisfaction scores increase when care is efficient and effective. 5. Good delegation increases productivity.

A nurse manager of a medical unit and a nurse manager of a critical care unit are discussing their personnel budgets. The medical unit budget is higher than the critical care unit budget. What are plausible reasons for this difference?

1. Higher turnover rate of nursing staff on the medical unit. 2. Critical care manager is a better manager than the medical unit manager. 3. More staff on the medical unit received premium pay this year.

What should the nurse executive consider when planning the nursing care delivery system of a new hospital?

1. How to optimize use of nursing knowledge 2. How to ensure that clients receive optimal care 3. Skill sets likely to be present in the nurses who will be employed at the hospital 4. What groups of nurses are available for employment

Staff nurses have been asked to comment on the work of a nurse manager as part of the manager's performance review. Which comments by the staff nurses would indicate to the supervisor that the manager is also a leader? Select all that apply.

1. I hope to be as good a manager as he is someday. 2. His example has encouraged me to get to know people in other departments in the hospital.

The female nurse identifies that many of the power positions in her organization are held by male nurses. Which strategies should she use to improve her images and increase her power?

1. Identify what she really wants 2. Prioritize her needs in order of importance 3. Identify her current resources. 4. Determine who stands in the way of what she wants.

A unit secretary is chronically late returning from breaks, work is excellent and always helpful and supportive of nurses and client families. The nurse manager has discussed the lateness with him, but it has not stopped. Showing attention-seeking behavior, the manager decides to use extinction as a strategy. What should the manager do?

1. Ignore the behavior. 2. Plan to be away from the secretary's area during his break times.

Leaders and managers often exercise power differently. Select the powers most frequently used by leaders.

1. Information power 2. Expert power 3. Referent power

In which ways can nurse managers reduce risks for the organization?

1. Investigating a complaint about nursing care from a client's spouse 3. Talking to physicians about ways to improve client care 4. Keeping staff members on task throughout the workday 5. Making sure staff members work minimal overtime

Why does conflict help generate change?

1. It brings more attention to an issue in need of change. 2. People get involved because conflict breeds curiosity.

A nurse manager has scheduled several on-the-job instruction sessions. Why would the nurse choose this format?

1. It is very cost-effective. 2. Travel expenses are minimized. 3. Transfer-of-learning issues are eliminated. 4. The learners are motivated to learn.

A nurse manager is investigating the application of the principles of equity theory to rewarding staff. Which options are rewards that the manager could influence?

1. Job satisfaction. 2. Prestige.

Which statement indicates that a nurse has the skills to be politically involved.

1. Knowing about what is going on in the organization. 2. Nurses has a way of dealing with difficult people and situations. 3. Seeking out this nurse's ideas on how unit problems should be solved 4. The nurse has a sixth sense about when to present new ideas.

An organization has elected to use a behavior-oriented self-evaluation system for nurses. Which statement would be included on the evaluation form?

1. Maintains confidentiality of information. 2. Demonstrates care, respect, and compassion in all interactions. 3. Works well on multidisciplinary teams.

During strategic planning, the committee finds a need to develop a succession plan for the facility. What committee findings would draw attention to this need?

1. Many of the facility's senior nursing managers indicate they will likely retire within 5 years. 2. The nursing shortage in the area continues to worsen.

A nursing assistant has taken long lunch breaks for the last 2 days and today is 15 minutes late returning from the cafeteria. What should the manager do?

1. Meet with the assistant and calmly say, "You have been late back from lunch for 3 days this week." 2. Anticipate that the assistant will give an explanation for the lateness.

A nursing supervisor has introduced a needed change in policy to the nurse managers. The managers have met maximum resistance when attempting to gain support for the change. Which options reflect valid strategies for the nurse managers?

1. Meet with the supervisor and discuss modification of the proposed change. 2. Slow down the change process. 4. Work together to identify strategies to overcome resistance. 5. Proceed with the change.

A hospital administrator receives a call that mass casualty shootings have occurred at several different locations within the city. Early information indicates that up to 50 victims may be arriving at the hospital starting within minutes. What action should the administrator take?

1. Mobilize the hospital incident command system. 2. Notify other administrators and order a rapid needs assessment in all critical areas. 3. Authorize the implementation of the hospital's disaster plan.

A nurse who works for an accrediting agency is reviewing the structure of a health care organization. Which situations would the nurse interpret as indicating the agency is based on classical theory?

1. Much of the care provided is based on standard operating procedure. 2. There is a well-defined chain of command in the organization. 3. The facility's organizational chart reveals departmentalization.

The administration of a health care system advertises that it promotes "a healthy work environment." Which events would cause a nurse working in this system to question this statement?

1. Nurse collaborates with physical therapy establishing mutually treatment schedules lobbies physicians to support nursing's position in any disagreements. 2. When staff nurses ask for the nurse manager's opinion on client care issues, the response is frequently, "I'll leave that decision up to you." 3. Administration has developed a plan in which each week two nurses from each unit are recognized as "best nurse of the week." 4. The nurse executive communicates with managers mostly by email.

A registered nurse will be the case manager of a group of ten clients. What will the nurse expect as part of this assignment?

1. Nurse meet with other disciplines to agree on choices of critical pathways for each client. 2. Nurse work to build consensus with physicians caring for clients teams. 3. Nurse defines expected nursing outcomes for the clients on the team. 4. The nurse will collect and analyze data regarding the clients on the team.

The nurse manager is conducting a nurse's annual performance review. Which events from the previous year would be evidence that this nurse is a successful follower?

1. Nurse participate in testing a new charting system before placed in unit. 2. Critiquing the manager's decision to change the unit's method of client assignments privately. 3. An in-service on a new intravenous access catheter, the nurse used one of the devices the on the next I.V. ordered.

Which nursing interventions would be in line with the chronic care model?

1. Nurse provides client with URL for website dedicated to self-management chronic respiratory disease. 2. Nurse advocates for client who decided to forego further dialysis. 3. Client information is entered into E.H.R. 4. Operating hours of community recreation center, provided to client with CAD.

A nurse manager has just completed a difficult assignment managing a group that was not cohesive. Which group should the nurse identify as likely having good cohesiveness?

1. Nurse who each have 7 to 8 years of experience 2. Staff nurses who are interested in learning about the task of the group 3. Staff nurses who work with one another on a daily basis 4. Staff nurses who are all between 35 and 40 years of age

A nurse manager is using Homans's framework to evaluate the need for team building in a group appointed to work on accreditation issues. Which strategies should the manager use as part of this evaluation?

1. Observe group member behaviors during a meeting. 2. Listen to how group members interact with one another 3. Ask a team member how the work of the group is proceeding.

Which activities are expected from the nurse manager as team leader?

1. Offering constructive criticism 2. Encouraging group discussions 3. Facilitate group processes

The community hospital is considering a redesign initiative. As part of a SWOT analysis, nurses on the strategic planning committee have been asked to distribute surveys to stakeholders. The nurses will contact which groups?

1. Other nurses who work at the hospital 2. Physicians 3. Hospital administrators 4. Representatives from local insurance offices

A health care organization is using the quality concepts of lean thinking and decentralization as part of their redesign efforts. Which initiatives would this organization undertake?

1. Outcome data will be analyzed to identify successful interventions. 2. Previous quality improvement efforts may or may not be discarded.

An emergency department has been notified that hundreds of injuries have occurred following the collapse of bleachers at a football game. The emergency department nurses should prepare to make which types of assessments?

1. Physical 2. Self 3. Situational 4. Family

A hospital administrator has attended a conference on bullying and wishes to address the most likely bullies in the organization. Whom would the administrator invite to the first meeting about bullying behaviors?

1. Physicians 2. Managers 3. Senior nurses

The administrators of a small hospital are revising its disaster plan. What should be the primary focus of this plan?

1. Preparing for a surge of casualties in case of a disaster 2. How to reduce disaster impact on clients and staff

A nurse manager is committed to establishing an environment that supports critical thinking and creativity. What strategies would help in this effort?

1. Provide opportunities for staff to interact with nurses from outside the facility. 2. Give the nurses freedom to design their work environment. 3. Be receptive to ideas even if they seem strange at the beginning.

A nurse is working with a hospital team to create an emergency response plan that will meet Joint Commission requirements. Which sections should be included in this plan?

1. Recognizing disasters imminent or occurring with plans to reduce the disaster's impact 2. Policies and procedures, equipment and personnel in place to handle disasters. 3. Operationalize activities during disasters, describe occurrences immediately after the disaster.

A nursing team consists of an RN, two LPNs, and two UAPs. Which work would be completed by the RN?

1. Reviewing the client's plan of care with the UAPs 2. Discussing the client's increasing shortness of breath with the LPN 3. Updating the care plan of a client who will undergo surgery tomorrow 4. Calling the physician to discuss the client's response to a new treatment

The nurse manager has been assigned the task of developing and implementing a new staff system for the emergency department. The nurse has reached the "directing" phase of this project. On which activities would the nurse focus at this point?

1. Selling the new system to the current emergency department staff. 2. Coach the staff through the implementation of a new schedule. Convincing or "selling" the new idea and coaching and counseling are major roles in the directing phase.

The chief nurse officer (CNO) is planning the budget for the coming year. A new position has been added to the nursing administration cost center. The CNO is determining how many benefit hours should be allocated for this new position. Which days should the CNO include in this calculation?

1. Sick days 2. Vacation days 3. Holidays 4. Bereavement days

A nurse executive is assigned to a task force working on a surge system for the hospital in case of a disaster. This group should write strategies to cover which procedures?

1. Supplies 2. Physical space 3. Management infrastructure 4. Personnel

As part of a career advancement strategy, the nurse has identified a need to increase personal power in the organization. Which abilities should the nurse focus on improving?

1. Technical competence and knowledge 2. Ability to access data 3. Relationships with people who are influential in the organization 4. Being friendly, helpful, and likable

The nurse executive wishes to hire nurse managers who embody the service leadership mission of the organization. Which specific attributes should this nurse look for in applicants?

1. The ability to be empathetic to clients and staff. 2. Awareness of the needs of clients and the organization. 3 Use of persuasion as a leadership technique.

A nurse manager who is retiring is helping the new manager learn about the position. As part of this education, the current manager has the new manager make all decisions that can be made under certainty. What conditions will these decisions have in common?

1. The alternatives are known. 2. The conditions of each alternative are clear.

Which quality improvement initiatives would help the health care organization meet Institute of Healthcare Improvement (IHI) goals?

1. The amount of material opened and wasted for surgical procedures will drop by 25 percent this fiscal year. 2. Wait times in the emergency department will decrease by 15 percent this year. 3. Fewer than 5 percent of clients will report inadequate pain control while hospitalized.

A client who was discharged yesterday is very upset about the quality of care received during hospitalization for gastric surgery. What options for reporting concerns does this client have?

1. The client can indicate dissatisfaction on the survey often sent to clients after discharge. 2. The client can call the hospital administration. 3. The client can make a public report through the Agency for Healthcare Research and Quality.

The hospital administration is considering adopting primary nursing as its model of nursing care delivery. Disadvantages of this method are that

1. The client may have multiple primary nurses if transfers within the facility are necessary. 2. Staff nurses cannot be held legally liable for care provided outside their work hours. 3. All persons caring for the client must have excellent communication skills.

A nurse manager often uses negative reinforces as part of operant conditioning in order to inhibit undesirable behaviors. What often results from this action?

1. The employee ducks into a client room each time the manager is seen. 2. No improvement in the frequency of the undesired behavior is seen. 3. The employee calls in sick more often. 4. The manager must constantly monitor the situation.

Which findings associated with an employee are likely to be considered when discussing performance?

1. The employee has been tardy on one occasion when an unexpected snow fell just before shift change. 2. The employee found a purse containing $200 in the cafeteria and turned it in to security. 3. The employee made two work errors requiring incident reports in the last year.

What characteristics would cause the manager to classify an employee as marginal?

1. The employee's work does not improve with coaching. 2. The employee just made an error for which discipline has already been done twice.

A nurse manager is aware that there is a strong "grapevine" communication system on the unit. The manager elects to use this grapevine to distribute information about an upcoming change in unit policy. In making this decision, the manager should consider which possibilities?

1. The information may be rapidly disseminated. 2. The information may be altered as it moves across the grapevine.

Which leadership activities exemplify a quantum leadership style?

1. The leader is accepting of change. 2. The leader encourages staff nurses to help clients access internet sites about their disease process. Rationale: Change is excepted by the quantum leader. Informational power is shared by the quantum leader.

The nurse leader wishes to develop a culture of shared visioning for the health care organization. How should the nurse proceed with this plan?

1. The leader should survey employees regarding what is important to them for the organization's future. 2. The leader should encourage innovative ideas.

A nurse manager's supervisor reports that many staff members have complained about the manager's rigidity. What situations reflect this rigidity?

1. The manager has historically used trial and error as a decision-making strategy. 2. The manager uses old ways of thinking to solve the day-to-day issues of the unit.

An organization has begun using critical incidents as part of the evaluation process. The supervisor is meeting with a manager to review the manager's use of critical incidents since training last week. Which finding would concern the supervisor?

1. The manager's notes are all written at the same time on the same day. 2. There is no indication that the critical incidents recorded have been shared with staff. 3. One note states, "This nurse has an abrasive personality."

Which situations would cause concern about liability with regard to delegation?

1. The nurse asks the LPN to change a central line dressing. 2. The nursing supervisor asks the nurse for details about a client's history. 4. The supervisor asks the charge nurse to give a nurse a difficult assignment.

Which job responsibilities indicate that a nurse has supervisory capacity?

1. The nurse assigns a nurse assistant to care for a team of clients. 2. The nurse hires staff to manage units. 3. The nurse retains responsibility for the actions of nurses assigned to provide client care.

Which job behaviors would the nurse executive consider troublesome no matter which unit employed the nurse?

1. The nurse made two medication errors today that resulted in poor client outcomes. 2. A manager reports that a nurse used a piece of equipment that had been taken out of service for malfunction. 3. A nurse did not report to work for 2 days and did not call in the absence.

The manager has determined that a nurse is marginal, but elects to ignore the situation for now, hoping the nurse's work will improve. What risks has the manager taken by choosing this strategy?

1. The nurse may harm a client. 2. Other nurses on the unit may become disgruntled by having to cover for this nurse. 3. The nurse may never become a good employee. 4. The morale of the unit may decline.

A group member has failed to complete assigned tasks for three of the last four meetings, despite reminders that incomplete work slows down the entire team. At each meeting the noncompliant member promises to complete tasks for the next meeting. What group actions are likely to occur?

1. The remaining group members may begin to use manipulation to get the tasks done. 2. The other group members may attack the noncompliant member. 4. The remainder of the group will ignore the noncompliant member.

The leader of a continuous quality improvement (CQI) team has asked that an information packet be distributed to members of the resource group. The secretary would prepare packets for which people?

1. The resource group is made up of senior management and establishes overall policy, vision, and values associated with CQI. 2. The resource group is made up of senior management such as the CEO and vice presidents.

A terminated employee files a grievance against the nurse manager. Which situations would benefit the employee's claim?

1. The terminated employee's last evaluation discusses problems with performance, but no coaching is described. 2. In one note, the manager describes the employee as "petulant, immature, and uncaring."

A group of nursing students have just arrived on the unit. Which actions by staff would be considered uncivil to these students?

1. The unit clerk groans when the instructor enters the nursing station with the students. 3. A nurse whispers, "Not students again today." 5. A transport worker says, "Just great, more students to get in the way today."

A nursing unit has just completed a 6-month trial of using team nursing to provide care. The overwhelming opinion of the staff is that the experiment was a disaster. What are the most common reasons team nursing is not successful?

1. There are problems with delegation. 2. Communication on the team or with the nurse manager is flawed.

A hospital increased its RN-to-client ratio 1 year ago. What effects is the hospital likely to see as a result of that choice?

1. There has been a decrease in client deaths. 2. The overall quality of care has increased. 3. The nosocomial infection rate has dropped.

A risk manager generally uses root cause analysis to investigate incidents. What are the likely outcomes of this action?

1. There is disagreement over the cause of the incident. 2. There are insufficient resources to make needed changes to prevent similar incidents.

The vice president for nursing services is aware that many of the problems in the nursing staff result from poor management at the unit level. What are some reasons that nurse managers are sometimes ineffective in their role?

1. There is little training available for nurse management positions. 2. Entry-level educational programs for nurses do not contain sufficient managerial content. 3. Management techniques are often learned "on the job." 4. Nurses often experience poor supervision in their own careers.

A nurse has accepted the position of vice president in charge of nursing in an organization that has a functional structure. What issues should the nurse be alert for?

1. There may be lack of coordination of services across the different departments in the organization. 2. Senior nursing managers may be overwhelmed with work and decisions 3. Managers have limited knowledge of general management techniques

A nurse executive says, "I would really like to develop our current nurses so they can take a greater leadership role in the future." Why is this a good management plan?

1. This method of developing leaders has proved to be cost-effective. 2. The leadership development can be varied according to the needs of the nurse. 3. When leaders are developed from within, management is already aware of their strengths and weaknesses. 4. The specific needs of the organization can be served.

A nurse manager looks through a file that contains information regarding critical incident reports filed within the past year. For which reasons does the manager review and use this information?

1. To decrease the possibility of lawsuits by the employee being evaluated. 2. To increase manager-employee communication. 3. To decrease recency error. 4. To increase the accuracy of the evaluation.

Why is post disaster follow-up an essential part of disaster planning?

1. To evaluate the performance of those involved 2. To initiate any improvements needed 3. To evaluate the overall effectiveness of the plan

Which situation is an example of a major weakness of service-integrated structure?

1. Two different units have purchased a demonstration model that could be used by both units. Duplication of resources is a major weakness of service-integrated structures.

The nurse manager is reviewing the previous month's budget and notes a favorable efficiency variance of the full-time equivalents (FTEs). Which options may be reasons for this favorable variance?

1. Understaffing the unit 2. Low client acuity

An unfavorable rate variance has occurred in the salary budget of a unit. When investigating this variance, the nurse manager should look for which situations?

1. Were any unexpected bonuses awarded? 2. Did agency personnel hours exceed the number predicted in the budget?

An organization has changed its performance appraisal process and is conducting training for managers. What topics should the trainer include in the agenda for this session?

1. What a reasonable job performance should look like. 2. How to complete the evaluation form. 3. How to give the employee feedback on evaluation. 4. Use of anecdotal notes.

A nursing committee has been organized to help plan a new intensive care service at the hospital. Which questions are essential for this committee to consider?

1. Where will the service be housed? 2. When will the service begin? 3. Who will provide the services? Planning and implementation are critical.

The nurse manager has determined that changes are necessary in the way holiday shifts are assigned. When assessing the political climate surrounding this potential change, the nurse manager would ask which questions?

1. Who is in control of the way holiday shifts are being assigned? 2. Who will lose when holiday shift assignments are changed? 3. Who is benefiting the most from the way holiday shifts are currently assigned?

A nurse manager is selecting nurses to serve as teachers in on-the-job instruction. What qualifications should these nurses hold?

1. Willingness to teach new nurses. 2. Ability to explain procedures accurately and clearly.

Which actions diminish the image of power for nurses?

1. addressing colleagues in endearing terms. 2. using power plays to achieve goals 3. aggressively advocating for clients 4. accepting orders without question.

The nurse supervisor would like to delegate accreditation preparation activities to the nurse manager. The manager is unsure of what is expected and has no experience with accreditation. How should the manager respond?

1."I will need some education on the accreditation process before I can accept this task." 2. "Please tell me more about what this assignment entails."

Which statements by a nurse manager would the supervisor interpret as indicating an understanding of why collective bargaining is complicated for nurses?

1."The determination of who is eligible to join a union is complicated." 2. "In some institutions, nurses have formed their own unions."

A hospital's budget is incremental. Which statement by the nurse manager reflects use of this type of budget?

1."The finance department sent me the budget worksheet with last year's expenses." 2. "We have $1,000 left in our account we need to spend before the year is over, any ideas?" 3. "I like this type of budget preparation, it is simple and straightforward."

A health care system is considering applying to the Magnet Recognition Program. The leaders of this health system should prepare to address ________ qualities or "Forces of Magnetism."

14 Rationale : There are 14 qualities or "Forces of Magnetism" that must be demonstrated to achieve Magnet status.

Fire departments from a three county area have responded to a wildfire that has threatened several homes and a hospital in a wooded area. The fire is now under control and the fire chief is completing paperwork on the response. The disaster should be classified at level ______.

2- A level 2 disaster is one that requires a regional response—in this case, fire departments from three counties.

Which situations are examples of the nurse directing rather than delegating?

2. A staff nurse asks the assistant to sit with the roommate of a client who has just died. 3. During a code blue situation, a nurse tells another nurse to start an I.V. 4. A nurse tells an assistant to move a client into the hallway during severe weather.

A nurse manager is delegating a new, complex task to the unit secretary. Which strategies should the manager use?

2. Make eye contact with the secretary when explaining the task. 3. Talk to the secretary in person rather than by telephone or in e-mail. 5. Discuss the importance of the task to the organization.

The staff is transitioning to a major change in the provision of nursing care in a large hospital. Which behaviors should the nurse manager watch for that would indicate possible problems?

2. Nurses are doing both the old work and the new work. 3. A nurse says, "I guess everything we've done for years is wrong." 5. Nurses are doing parts of the old procedure and parts of the new procedure.

A problem has arisen on a unit whose nursing staff is composed primarily of members of Generation X. Which strategies should the nurse manager employ to get staff input into solving this problem?

2. Post a notice on the bulletin board explaining the issue. 3. Ask nurses individually for input.

The work of a task force is completed and the leader has compiled a written report of findings and recommendations. What actions are necessary by this leader?

2. Share the report with the full task force prior to presenting it to administrators. 4. Brief key administrators regarding the report prior to the administrative presentation.

The nursing supervisor is assessing a unit that has received several written complaints. The nurse manager seems overwhelmed and stressed trying to address many client situations. The charge nurse is trying to help everyone at once. Based on this assessment, what might this supervisor conclude?

2. The unit culture may foster distrust and poor communication among staff. 3. Client complaints are usually an indicator of a larger unit problem. 4. Nurses on the unit are in need of additional training and skills.

The nursing supervisor is planning an education session on collaborative communication between nurses and physicians. Which topics should be on this agenda?

2. Understanding the role of the physician 3. Understanding the role of the nurse 4. Communication across disciplines 5. Active listening skills

A tornado destroyed 65% of the businesses and homes in a small Midwestern city. Aid would be requested based on categorization as a level ______ disaster.

3- Tornado damage of this magnitude would require statewide or national assistance, which is the definition of a level 3 disaster.

The nurse has made several "near errors" in client care in the last 2 months. The nurse manager says, "These are simple errors. You just aren't listening." How could the nurse improve listening skills in this situation?

3. When listening to instructions, the nurse should ask anyone who interrupts to wait a moment. 4. The nurse should get sufficient time away from work to rest. 5. The nurse should be careful not to prejudge what the speaker is going to say.

To meet the Institute of Medicine (IOM) recommendation, nursing should strive to have ____ % of nurses prepared at the baccalaureate or higher level by 2020.

80 Rationale : The IOM recommends increasing the level of education of all nurses. The goal is 80% at baccalaureate level or higher by 2020.

To balance the rights of employees and the public, Congress passed a special set of procedures for settling labor disputes in the health care industry. These include a specification that one party must notify the other of intent to change or terminate a contract ______ days before the contract expires.

90 Rationale : The time period for this notification in the health care industry is 90 days.

Which factor best represents a driving force in the process of change?

A budget in the red necessitates change and pushes participants in the desired direction.

Every month the chief financial officer (CFO) reviews the budget with the hospital's board of directors. The CFO requests a million dollars to purchase a new MRI (magnetic response imaging) unit for the radiology department. Which category best describes this request?

A capital expense is an expense that is above a set dollar amount such as $10,000 and that must be approved by the board of directors.

The hospital is conducting a drill of its emergency operations plan (EOP). A nurse is acting as triage officer. Which client would be triaged for immediate care?

A client with a minor forearm laceration that will require a simple bandage and tetanus immunization-The least serious people are seen first in a disaster.

The hospital has an annual campaign in which the staff is divided into two teams to raise money for hospital special events. The team raising the most money gets possession of a "trophy" designed by the administrative staff. This is an example of which type of conflict?

A competitive conflict that is positive to the work environment

The hospital has initiated a new fall risk assessment tool. The nurse manager would like to reward those staff members who use the tool regularly. Which method of reinforcement would be most successful in getting long-term compliance?

A coupon for a free lunch for staff members who, according to a medical record review of nursing documentation, consistently use the tool correctly.

A housekeeping employee is questioning the employees' agent regarding the role of administering the ratified contract. The agent should explain to the employee that this role belongs to which person?

A designated hospital staff nurse may serve as the union representative. It is the duty of this nurse to provide fair and equal representation to all members of the unit.

The nurse manager tells the staff that this year's budget numbers will not change, even if census drops over the rest of the year. How should the staff interpret this information?

A fixed budget is one in which budgeted amounts are set regardless of changes that occur during the year, such as patient volume or program activities.

A nurse practitioner and a physician have opened an office together. The nurse regularly collaborates with the physician in client care and is a general partner in the business of the office. This is an example of which diversification method?

A joint venture is a partnership in which each partner contributes different areas of expertise or resources to create a product or service.

Which is the most effective method of creating a blame-free environment?

A just culture provides an environment in which employees can question policies and practices, express concerns, and admit mistakes without fear of retribution.

A newly licensed nurse received specific knowledge of management skills while in nursing school. What does the nurse need now?

A manager who can help with skills transfer from school to work The manager is an essential component in helping the new nurse transfer this learning into the "real" world of bedside care.

A client has been told that chemotherapy must be postponed until he is hydrated. The client refuses the intravenous hydration and demands to go home. How would the nurse best categorize this situation?

A medical-legal incident occurs when a client or family refuses treatment as ordered.

The nurse manager is reviewing the current staff to determine who should precept a newly licensed nurse. Which nurse is the most logical choice?

A nurse who is clinically competent and has the desire to assume the responsibility to train new staff

The health care organization's monthly newsletter has a headline reading "Nurse Promoted to Leader of Specialty Care Units." What is the error inherent in this headline?

A person cannot be promoted to the role of leader. Organizations cannot promote someone to a position of leader. Interpersonal skills influence others to accomplish a specific goal. The organization can promote a person who may become a leader.

Which would be the most effective way for nursing to improve the power of its images?

A powerful image would best be created by nurses dressing, acting and speaking in a professional manner.

The nursing task force is developing measurable goals for each client on the orthopedic unit. The statement "Each client will have a written assessment and plan of care document within eight hours of admission" is an example of which component of quality management?

A process standard is a written statement that defines actual delivery of nursing care to a specific population

The nurse manager should be most careful not to hold preconceived beliefs when listening to which person?

A staff nurse the manager has worked with for 25 years Rationale 2: When there is a long-term relationship, the listener sometimes thinks they know what the other person is going to say. Careful listening is necessary in these situations.

Which action will have the greatest impact on the successful implementation of a planned change?

A supportive work environment for those experiencing the change is the strategy most likely to result in an easier transition.

The medical-surgical nursing manager notices the education expenditure for the month is over budget. How should the manager deal with this difference?

A variance report provides a rationale for over expenses for the month that could result from a variety of unexpected expenses

"We want to be the hospital of choice in the Midwest" is which type of statement?

A vision statement describes the goal to which the organization aspires—in this case, to be the hospital of choice in the Midwest.

A nurse is working in a unit with several less-experienced nurses. Which attribute displayed by the senior nurse would make her leadership of the less-experienced nurses most effective?

Ability to inspire the others to commit to the team's goals. A nursing leader must be a visionary in order to empower others to make needed changes for the good of the group.

The nursing supervisor identifies ineffective communication as a problem among the managers. According to Lippitt's phases of change, which action by the supervisor reflects the final stage of improving this issue?

According to Lippitt's phases of change, the final stage is terminating the helping relationship.

Coaching and discipline have failed and the nurse manager is faced with no alternative but to terminate an employee. Which aspect of this situation requires the most careful planning?

Accurately documenting all stages of the situation. Before termination there must be sufficient and accurate documentation to support the termination.

The nursing faculty would like to incorporate problem-based learning into the curriculum. Which action is essential?

Add more information to existing care plans as the study unfolds. Rationale 3: Problem-based learning exists when students are exposed to "what comes next" in a case study. Additional information is revealed as the case study progresses.

What is the most important reason that excellent communication skills are essential for nurses?

All nursing activities occur in relationships. Rationale: Nursing activities occurring in relationships make communication skills essential.

A nurse believes that milk is part of the healthy adult's diet. The nurse frequently offers milk to adults as a between-meal beverage. This action is based on which concept?

An underlying assumption Rationale 2: The nurse's assumption is that milk is good for adults.

The nursing supervisor would like to delegate an information-gathering task. All the people listed have the ability to perform the task. In general, whom should the supervisor ask to do this work?

An unlicensed nursing assistant Rationale: The rule of thumb is to ask the lowest person in the hierarchy who has the requisite capabilities.

The nurse manager asks a staff nurse why a procedure is done in a certain manner. The nurse replies, "I don't know why I started doing it this way. I've never read any research on it, but this technique always works for me." The manager would place this technique into which category of evidence?

Anecdotal Anecdotal evidence is derived from experience

Following a barium swallow, a client noticed hives and shortness of breath. no known allergies prior to this incident. diagnosis- allergic reaction to preservatives in the barium. Which is the correct risk category for this incident?

Any incident occurring before, after, or during a procedure is categorized as a diagnostic procedure complication.

Nurse manager has been working with a disgruntled employee for several weeks. The employee comes to the manager's office with yet another complaint about a new hospital policy. Manager says, "I am sick of your complaining. Leave me alone so I can get some work done." What should the manager do now?

Apologize to the employee for being unprofessional and ask what the issue with the policy is. The manager must remain professional at all times. In this case, when the manager was not professional, an apology is in order.

The nurse is using critical thinking skills to decide which of several options is the best. Which question is most important for the nurse to take into consideration?

Are there different situational effects or contexts to be considered? Critical thinking involves choosing the best alternative from several, depending on the situation in which the problem occurred. This is the context of the problem.

An outbreak of smallpox has followed a national sporting event. Terrorist activity is suspected. How would this event be categorized?

As a man-made, biologic disaster. The dispersion of the biologic agent in this case is thought to be man-made.

A nurse admits to diverting narcotic drugs while working. The manager says, "All nurses who admit diverting narcotics have to be reported to the state board of nursing." How should the nurse interpret this statement?

As false, because in some states reporting depends on other factors. In some states if the nurse completes a substance abuse program, reporting is not done.

A nurse educator is asked by the chairperson of the department to submit a list of equipment that could be used to meet the department's goals. The list includes projectors, computers, office supplies, and computer-assisted programs. How would the educator categorize the materials?

As part of the capital budget.

A nurse working in a rehabilitation center notices clients frequently asking for something to drink. Which response indicates the use of creativity in finding a solution to this problem?

Asking all employees to write down their ideas about a solution Rationale 2: Asking others to think about different options opens up the possibilities beyond one individual's ideas. This is part of the preparation stage of creativity.

The nurse administrator has been asked to work with other administrators to make a change in a long-standing hospital policy. What should be the nurse's first action?

Assessment is always the first action for a nurse in any situation.

The staff nurse would like to improve personal communication with peers, patients, and the medical staff. Which strategy would be most effective for this nurse?

Attend the hospital-based communication training. Rationale: Attending training on communication would be the best plan for this nurse. The strategies described in the other options would likely be included in this training.

A disaster planning task force has been asked to focus on communication. Which instruction should this group provide to nursing staff?

Be certain to maintain the client tracking system. A system to track the client's presence in the facility should be a part of the disaster plan. It is essential to maintain this system so that victims can be accounted for by rescuers

Approximately half of an organization's employees decide they are not happy with their current contract, which will expire in 4 months. The union representative informs the group that they can work to change the contract. What is the next step in this process?

Before changing or terminating a contract, one party must notify the other of its intent to do so 90 days prior to the contract expiration date.

A staff nurse says, "I have so much to do. Why should I spend time being politically aware and active?" Which response by the nurse manager would be most appropriate?

Being politically active helps you influence events and the decisions of others. Rationales: Nurses can influence those in the decision making roles.

As part of the process of promoting quality improvement, the nursing manager is comparing data between two hospitals on average length of stay for a total hip replacement. This comparison is an example of which process or step?

Benchmarking is the comparison of data with other reliable sources internally and externally with the goal of quality improvement.

A staff nurse has experienced disagreements with one of the medical residents about several issues. The resident reacts to this conflict by belittling the nurse in front of colleagues. This behavior is most characteristic of which type of conflict?

Both parties are engaged in activities to reduce, defeat, or eliminate the opponent, which result in irrational, unproductive behavior. This is disruptive conflict.

Which situation best exemplifies the nurse manager as a team leader?

Building the team up by praising team accomplishments best exemplifies the nurse manager as team leader.

The nurse executive works hard to create a civil workplace that does not tolerate harassing behaviors. How would this nurse best explain the reason for this emphasis on civility?

Bullying and incivility are not proper work practices, but this is not the primary reason for excluding them from the workplace.

A nurse manager does not like conflict and would like to allow instances of bullying to "go away on their own." What rationale by the manager's supervisor is the most important?

Bullying behavior tends to escalate if ignored. "If you let bullying go, it just gets worse and more frequent."

An error made in client care last week has just been discovered. A nurse who cared for the client during that period is asked about the error and states, "That probably happened when the nurse covering for me at noon or for my breaks was in charge." How should the manager interpret this statement?

By raising the possibility (and being very sure) that the other nurse was in charge, the nurse has created a scapegoat. This is a form of lateral violence.

The nurse's friend says, "I've been thinking about going to that health care clinic in the grocery store so someone can look at my daughter's rash. What do you think?" Which response by the nurse is appropriate?

Care in these clinics is provided by nurse practitioners with physician backup. If the nurse practitioner believes additional studies or assessment should be done, referrals are made.

The hospital's management team wishes to institute case management to improve the quality of nursing care. As a beginning step, the team is choosing specific medical diagnoses on which to focus. What criteria should the team use when choosing these diagnoses?

Case management is used with high-risk diagnoses.

In order to organize services needed to achieve specific client outcomes, hospital administrators should consider what type of client care delivery system?

Case management organizes client care by major diagnoses and focuses on attaining predetermined outcomes within a specific time frame.

A nurse manager encourages nursing staff members to assist in developing a new creative staffing pattern that can respond quickly when staff resign or go back to school. This is an example of the use of which organizational theory?

Chaos theory posits that an organization is dependent on its adaptability and response to change in its environment. Nurse managers must create an environment that accepts change, tolerates conflict, and promotes creative solutions

The nurse manager is working on a committee whose task is to review and revise job descriptions for nursing employees. In which job description would the committee most likely include the phrase "Management responsibilities include shift-by-shift coordination and promotion of quality client care"?

Charge nurse Rationale: The charge nurse is unique to the health care setting and assists with the shift coordination and promotion of quality client care as well as efficient use of resources.

A nurse comes to a mandatory education session wearing a shirt with a picture and slogan that is degrading to nursing. What should the manager do first?

Check the human resources policies regarding appropriate dress. Before the manager does anything else, he or she must be certain that policy backs up the planned actions.

In the morning care conference, the nurse instructs the assistant to feed breakfast to the clients in beds 2234, 2230, and 2241. The assistant indicates understanding of the assignment and repeats the bed numbers back to the nurse. What is the nurse's next step?

Check with the assistant to see how the assignment is going during the time breakfast is served.

The nurse manager is planning to initiate new policies in the department and is reviewing several change theories. Which step of Havelock's model will the nurse find most closely resembles Lewin's moving stage?

Choosing a solution and gaining acceptance are most like Lewin's moving stage. Previous to this stage in both models, the work is to convince participants that change is necessary and to secure resources for the change. After solutions are identified and implemented, the final stage begins.

The registered nurse has had recent difficulty finishing and documenting client care during the assigned shift. The nurse has historically had very good appraisals, and the climate of the unit has not changed. Which would be the best approach to correct recent behaviors?

Clarify expectations.

What action is necessary by a delegate accepting delegation?

Clarify the timeline and expectations. Rationale: It is important for the delegate to make sure the timeline and expectations are clearly defined, and he or she may opt to outline the specifications in writing

Medical residents do not answer pages very quickly, do or at all. The nursing staff complains to nursing supervisor. Several weeks, conflict spiraled into heated disagreement. Which is the most important reason to make the necessary changes to settle this conflict?

Client care and satisfaction will suffer should it be allowed to continue

The nurse manager is facing resistance to change from many staff nurses. Why should the manager work hard to address this resistance?

Client care is always the most important reason that nurses do what they do. If the change does not improve client care in some respect, is it worth the effort?

An experienced nurse often answers less experienced nurses' questions about client care and teaches hemodynamics during orientation to the unit. The nurse has also participated in research into hemodynamic monitoring of ICU clients. Which clinical ladder designation does this nurse best exemplify?

Clinical expert-The clinical expert combines teaching and research with practice.

A nurse became nurse manager of a high-acuity unit 3 months after being licensed-struggles with the responsibilities of the position and is often unable to make decisions. Which component management competencies does this nurse probably lack?

Clinical practice knowledge. Rationale: To effectively manage a high-acuity unit, the nurse must have sufficient experience to develop clinical practice knowledge. three months is not long enough for that to occur.

One of the nurses often fails to attend educational offerings available to the staff. The nurse manager who implies the nurse may receive a negative evaluation is using which type of power?

Coercive Rationale: Coercive power is based on penalties a manager might impose on an employee. A negative evaluation is a penalty.

Difference in opinion regarding methods to care for clients on mechanical ventilators. Nurse manager ask nurses to review evidence-based practice related to the situation. Each nurse volunteers to gather data prior to the next meeting. This is an example of which type of problem solving?

Collaboration occurs when all parties use their expertise to problem solve. The group focuses on problem solving as opposed to competition.

A nurse comes to the unit manager to report a coworker's behavioral changes. The nurse has noticed that the coworker's handwriting has become shaky and illegible, that the coworker has mood swings, and that the coworker has had increased tardiness. Which should be the manager's first action?

Collect additional information regarding behaviors, absenteeism, and/or tardiness. The manager should obtain information and documentation to determine if there is a problem.

The nurse manager is concerned about the apparent lack of staff motivation to improve client care on a unit. How should this manager use motivational theories to help improve this situation?

Combine theories to develop a plan for this specific unit.

What is the most common skill shared by effective nurse leaders in leadership theories or models?

Communication Rationale: Regardless of the type of leader or the type of unit a nurse manages, communication skills are the key to effective leadership.

The novice nurse manager is hesitant to delegate tasks to competent, experienced staff nurses. Fear of which factor is most likely to explain this hesitancy?

Competition and criticism Rationale: The novice nurse manager may be insecure and fear that another staff member could perform the task more effectively. There is a fear that a successful delegate could threaten the nurse manager's credibility as a leader.

Which statement may reveal that the team member making the comment has a hidden agenda?

Concern over adding items to one's resume could indicate that the team member is more interested in personal achievement than in the goals of the team.

The nurse has expressed job dissatisfaction to the unit manager. The manager assigns another staff member as a coach for this nurse. What is the most important aspect of the coach's job?

Conduct the relationship in a confidential manner.

A nurse manager states, "I cannot stand all these conflicts in my department. Nothing good can come out of it." Which indicates the best reason the manager's statement is untrue?

Conflict can stimulate more people to become involved in a situation, thus creating more innovative solutions to the issue

It has been reported to the nurse manager that an employee is repeatedly parking in the patient/visitor parking area. What action should the manager take?

Confront the employee. When there is a policy violation, it is necessary to confront the employee. The steps of confrontation are similar to those of coaching.

Nurse manager assesses two staff nurses engaged in a conflict; having negative impact on client care. Manager meets with the nurses involved, identifies the conflict. Attempt is made to resolve the conflict through knowledge and reason. What strategy is this manager using?

Confrontation- most effective means of resolving conflict. Conflict is brought out in the open and deliberate attempts made to resolve it through knowledge and reason.

The nurse manager presents an issue to the nursing staff for a decision. The group assesses the problem, and a decision is made meeting the needs of both the nurse manager and the nursing staff. This is an example of which conflict management strategy?

Consensus occurs when the problem is fully explored, the needs and goals of both parties are addressed, and a mutual decision is made.

A registered nurse is dissatisfied with the wages and health benefits available in his current position and decides to seek other employment. This employee's frustration is most linked to which motivational theory?

Content theory: explain why a person behaves in a particular manner, emphasizing the individual's needs or the rewards that satisfy those needs—in this case, wages and health benefits.

To address the problem of increasing costs of staffing agencies, a hospital has developed a plan for an internal float pool of nurses to be used when scheduled staff nurses call in sick. What type of planning has the administrative staff done?

Contingency Rationale: Contingency planning is a proactive response to problems that may interfere with getting work done.

A nurse manager is participating in the health care organization's strategic planning committee. Which factor is the primary driving force and controlling factor in new initiatives this committee might recommend?

Cost of care Today's health care environment, the cost of providing care is still the primary issue. Cost of care controls access, availability, and even quality.

The nurse manager is challenged to find an innovative way to adequately staff the unit and provide quality nursing care. Which ability would be most useful to the nurse in this situation?

Creativity Rationale 1: Creativity is a part of the critical-thinking process that fosters the development and implementation of new approaches to different situations.

A nursing task force has been created to determine whether a new model of differentiated practice would be more effective than the current model. The task force analyzes data as a basis to examine alternatives. Which activity does this represent?

Critical thinking Rationale 2: Critical thinking is a higher-level cognitive process that involves the examination of assumptions, interpretation and analysis of arguments, and the development of a conclusion that can be justified.

The nurse manager tells a newly hired nurse that the unit practices functional nursing. What should the new nurse expect?

Functional nursing breaks down client care into tasks assigned to the appropriate professional or skilled caregivers. This may result in one nurse (the "med nurse") administering all the medications on the unit.

A graduating nurse student is deciding which nursing specialty would be a good place to begin a nursing career and ensure long-term stability. Which specialty is most likely to have the greatest growth in need?

Geriatric nursing As baby boomers age, geriatric nursing will be needed more than any other specialty. Not only are the baby boomers a large segment of the population, but better health practices are resulting in people living longer.

The nurse manager is facilitating change to a new documentation system in the unit. If the manager wants to use the most common method to overcome resistance to the change, which strategy would be chosen?

Giving information is the most common method of changing individuals' perceptions, attitudes, and values.

The nurse manager has established a program that recognizes a different staff member each month for contributions to client care. As a result, overall staff productivity and the number of client compliments have increased. This is an example of which concept of organizational theory?

Hawthorne effect The Hawthorne effect is the tendency of people to perform as expected because of special attention.

The person who has just been promoted to nurse manager is male. If this nurse communicates in a way that is considered typical for men, what can the staff expect?

He will prefer to ask questions rather than make statements Rationale 4: Women are more apt to ask questions to seek input.

Which is the most important reason that practicing and mastering effective delegation skills is essential for nurses?

Higher client satisfaction Rationale: When effective delegation takes place in an organization, everyone benefits. This leads to higher client satisfaction, which is the ultimate goal of nursing care and nursing management.

The nursing administration has instituted a "horizontal promotion" system within the nursing department. What benefit is this program to the staff nurse?

Horizontal promotion is a reward for clinical excellence

The nurse manager of a critical care unit creates the operating budget with the knowledge that a minimum of two professional nurses must be paid per shift regardless of the patient census. Which group determines this standard?

Hospital administration

Which statements exemplify the attributes of critical thinking essential to nurses?

I am always curious about why we do things the way we do." Can you help me understand your perspective a little better?" "I don't think I can make that decision until I have more information."

The nurse educator has recruited nursing preceptors to work with senior nursing students. The educator is teaching the preceptors about power and the education process. Which statement by a preceptor indicates learning has been effective?

I can use power to teach the student how to motivate, communicate, and achieve outcomes. Rationale: Nurses must use power to influence others.

The nurse has been asked to assume a first-level management role on the nursing unit. Which statement indicates that this nurse will need further mentoring in the new role?

I won't be able to increase my team's motivation. That has to come from within them. Rationale: Manager can affect motivation by developing strategies and possible incentives.

Which situation is an example of organizational culture?

ICU nurses know to take turns covering each other's clients to facilitate eating breakfast and lunch on the day shift.The nurses have created this system of coverage informally as part of their daily work.

The nurse has received a commendable progress evaluation and will receive a 3 percent merit raise. The base salary for an RN is $48,000. Based on this information, the new projected base salary for this RN will be $_____.

If a 3 percent merit raise is projected and the base salary for an RN is $48,000, then the new base becomes $49,440

A hospital has used capital funds to purchase a new piece of diagnostic equipment. The hospital's chief financial officer (CFO) says, "The cost of this equipment will be expensed out across all units that use it." How should the nurse manager interpret this statement?

If clients on the manager's unit require the use of this equipment, a portion of the cost will be charged to the unit.

The mother of a staff nurse is critically ill and the nurse must miss several shift of work. If the leadership style of the nursing manager is transactional, which approach to covering these shifts is most likely?

If you work overtime tonight I will authorize double your hourly pay rate. Rationale: Transactional leadership is based on the principles of social exchange theory. The primary premise is that individuals act in their own best interest.

The nurse has established a reputation for advocating for clients through honesty and hard work. The nurse has worked in the organization for 30 years and often volunteers in local and national political campaigns. This nurse is using which attribute to increase political effectiveness?

Image Rationale: A person who portrays an image of success and trust will be politically effective.

Two staff members have a long-standing dislike of one another. Generally they hide their feelings, but occasionally they engage in name-calling and derogatory remarks. Today their dislike erupted into a shoving match in the break room. How should the manager handle this situation?

Immediately call for security. Security should be notified immediately when physical violence occurs or is imminent.

The nurse manager has been asked to assemble several groups to work on tasks to improve the unit's performance and client satisfaction scores. This manager would put the fewest people in a group working on which type of task?

In a conjunctive task, the group succeeds only if all of the members succeed, so it makes more sense to have fewer members on the team. However, the members should be highly qualified for the work.

Hospital administrators are considering changing from the traditional method of creating work schedules to a system in which the nurses will choose their own workdays. Choices will be made according to seniority. Which change strategy would likely be best for this endeavor?

In most cases, the normative-reeducative approach to change is effective in reducing resistance and stimulating personal and organizational creativity.

The leader of the task force group announces that tentative plans for Nurses' Week activities have been approved by the hospital administration. The task force has also been given a new task of developing criteria for the nursing awards. What must the group accomplish now?

In the re-forming stage, the group must refocus its activities and recycle through the four stages. The leader explains the new direction and provides guidance in the process.

The hospital is opening its first intensive care unit. The nurse executive should plan to staff this unit according to which model of care?

In total patient care, one nurse cares for a client and, being totally accountable for the client, can give continuous, holistic, and expert care.

A nurse manager believes that a staff nurse is rude to clients. In the past year, other nurses and staff from other departments have reported that the nurse has treated them rudely. The manager reviews the staff nurse's employee file and finds last year's appraisal as exceptional. What is the manager's best course of action during this year's evaluation?

Include documentation of these issues in the evaluation that is discussed with the nurse and provide a plan of action.

The nurse manager has scheduled a series of meetings with employees to solve a unit problem. The manager purposefully created a 2-week gap in the meetings to allow which portion of the creative process to occur?

Incubation Rationale 4: The period of lapsed time before a decision is made is the "incubation" time.

As a member of the budgeting committee, the nurse manager reviews the salaries for file clerks in the accounting department. These salaries should be included in which budget item?

Indirect costs are expenditures that are necessary but do not affect client care directly.

A nurse manager enters the staff break room. The manager overhears the nursing staff discussing wages and paid time off as issues to consider during the bargaining process. Which action by the manager would be appropriate?

Inform staff they are not to talk about their bargaining issues during work time or at the work site. The manager should address the issue of employees not discussing collective bargaining while at work or on the work site.

The local hospital has recently been acquired by a larger hospital corporation. The nurse manager encourages staff to attend the next unit meeting by hanging a poster announcing that the new wage scale and benefits package will be discussed. This is an example of which type of power?

Information power Rationale: The nurse manager has info the employees desire. The only way to gain the information is through the manager, so the manager has information power.

The staff nurse is unsure of the correct protocol for calling in sick to work. The nursing supervisor told the nurse to call the nursing office; however, the nurse manager told the nurse to call the unit. This issue is likely the result of which distorted communication?

Intersender conflict Rationale: Intersender conflict occurs when a person receives two conflicting messages from different sources.

The nurse manager asks the staff nurse to work a double shift because the census is high. Although the nurse realizes the staffing for the night shift is low, the nurse has already made a family commitment for the same night. This is an example of which concept?

Intrapersonal conflict occurs when the consequence of real or perceived differences in mutually exclusive goals, values, attitudes, beliefs, feelings, or actions occurs within one individual.

Although the postoperative assessment of a client reveals no abnormalities, the nurse believes the client's condition is deteriorating and orders frequent vital signs. This intervention was made on the basis of which type of problem solving?

Intuition Past experience

The staff nurse has challenged the appraisal rating given by a new nurse manager. What should the nurse manager do?

Investigate the staff nurse's challenge and change the rating if it is justified.

A staff nurse is not meeting job expectations. The manager has followed some standard strategies such as counseling to try to motivate the nurse, but they have not been successful. When discussing the situation with the supervisor, the manager says, "I think I will try shaping strategies." What can the supervisor expect of the staff nurse's performance?

It should gradually move toward the expected behaviors.

A nurse manager writes the following note: "Over personnel budget by $1,250 in April due to late snowstorm. Nurses unable to get to work. Overtime wages paid." Why is this note important?

It will help the manager create the budget for the next year.

A nurse manager is trying to educate the staff regarding efficiency and how it affects the unit's costs. Strategies to increase efficiency could include which of the following?

Labeling the cost of each item in the clean supply closet

A night shift charge nurse frequently points out nurses' faults in front of coworkers. The manager of the unit has submitted a written warning to the charge nurse. What term should the manager use to label this behavior?

Lack of civility is defined as disrespectful or rude behavior.

The nurse manager is educating staff about the collective bargaining process. Who should this nurse say controls collective bargaining in health care?

Laws have been enacted by Congress to guide and control labor relations between employees and employers.

Which data would be of most interest to an organization using Lean Six Sigma as a means of quality improvement?

Lean Six Sigma focuses on eliminating waste, such as an increase in expensive overtime wages, and would focus on processes that may be allowing this to occur.

A nurse manager gives a staff nurse an exceptional appraisal. The other nurses learn of the appraisal and are upset because this nurse has had numerous complaints from peers regarding laziness. The manager informs a colleague the nurse obtained an exceptional appraisal because the nurse "will always work for me when I need extra help to come in." This is an example of which problem in evaluating?

Leniency error indicates the manager is allowing tolerance, which may not provide an accurate account of the nurse's performance.

Which organization would the hospital management team contact to pursue certification as a Magnet hospital?

Magnet Recognition Program The Magnet Recognition Program, developed by the American Nurses Credentialing Center, designates health care organizations that provide nursing excellence.

An employee has consistently violated policy and has not responded to coaching. The manager has decided that discipline is required. What should the manager do first?

Make certain that the information regarding policy violations is correct.

A nurse is overheard saying, "I just don't want to be involved in this power struggle. I don't want power; I just want to do my job." What is a common reason nurses may feel power is not desirable?

Many nurses view power as oppressive. Rationale 2: The idea of having power "over" someone or "power-grabbing" is oppressive. Many nurses hold this view of power.

A client's spouse is concerned about the cost of hospitalization. The nurse says, "Since your spouse is on Medicare, the hospital will be paid according to the DRG." What does the nurse mean by this statement?

Medicare will pay based on a set amount for the specific condition for which the client was hospitalized.

During an evaluation conference, the nurse manager observes nonverbal messages, including nodding in agreement and smiling. These behaviors are examples of which aspect of communication?

Metacommunication Rationale: Metacommunications are nonverbal messages conveyed by body language and environmental factors.

The nurse manager orienting newly hired nurses has explained the organization's blame-free environment. Which remark by one of the nurses indicates understanding of the policy?

Mistakes should be reported and reflected upon so that the same mistakes will not be made again.

A manager has documentation to suspect substance abuse by a nurse. The manager meets with the human resources (HR) director to determine which course of action should be taken to abide by the organization's policies. Which statement by the HR director is appropriate?

Most health care organizations offer substance abuse programs for employees.

The nurse manager assesses that there is conflict between two of the charge nurses. The decision is made to postpone an intervention and allow the conflict to escalate. Why might the nurse manager make this decision?

Motivate the participants to seek resolution.

Nurses and nursing administration have experienced conflict about scheduling, their intent is to arrive at an agreeable solution between both parties. Which option does this process best exemplify?

Negotiation involves a reciprocal "give and take" on issues among the parties. The desired outcome is to achieve agreement even though consensus will never be reached.

A proposed change in a health care organization is controversial and will require cooperation from all parties involved. Which change strategy should the change agent use?

Normative-reeducative strategy uses collaboration as its primary decision-making technique. It is most likely to result in the greatest number of people being happy with the decisions made.

Procedural changes are being planned on the unit as a direct result of client satisfaction surveys. Which person is most strategically placed to handle how these changes are initiated?

Nurse manager The nurse manager is situated on the front lines but is also responsible to upper management. The manager can be supportive of the staff's feelings while at the same time adequately and appropriately representing the needs and wants of the administration

The CEO of the hospital approaches the chief nurse with a request that the nurse act as the primary change agent in the implementation of a new hospital-wide policy. Why would the nurse be a good choice for this assignment?

Nurses are client advocates who routinely interact with multiple disciplines in the provision of quality care.

The organization that awards Magnet status would look for environments where which practices are the norm? Select all that apply.

Nurses are involved in decision making. Magnet status designates organizations that foster independence, autonomy, and creativity among the nursing staff. Nurses are involved in decision making in these institutions.

An accreditation visitor observes the following situation in a healthcare organization. Which situation would this visitor interpret and document as evidence of the shared governance type of shared leadership?

Nurses formally organized to make decisions regarding practice standards. Rationale: Shared governance is a formal process. Decision making is done by designated nurse representatives.

Which part of Six Sigma is vastly different from other quality management programs?

One of the Six Sigma themes is aiming for perfection but tolerating failure.

A nurse executive is considering initiating a blog to enhance communication among staff nurses, managers, and supervisors throughout the organization's different campuses. What serious considerations should the nurse make prior to starting a blog?

Open access to the blog may damage recruiting efforts. Users of the blog must be very careful not to divulge any information that would violate client confidentiality. The organization's reputation may be altered by a blog.

The staff development nurse has elected to use coaching as a staff development technique. Which situation is an example of this technique?

Pairing a nurse with conflict management experience with an employee who has expressed dissatisfaction with the job

A hospital administrator is investigating why the turnover rate is so high and why it is difficult to attract new nursing employees. Which situation is most likely to have resulted in this problem?

People do not like to be bullied. If the hospital has this reputation it is unlikely to attract new employees and older employees are likely to leave.

A nurse who is a chronic complainer comes back from lunch 20 minutes late. When confronted by the manager the nurse says, "The nurses who smoke always take longer lunches. No one says anything to them." What is the manager's major consideration before replying to this statement?

Policies must be consistently applied to all employees. No matter the situation, policies must be consistently applied.

A nurse manager and an employee meet to discuss the employee's appraisal. They disagree on the content of the employee evaluation. The disagreement turns into an argument. Which is the best managerial strategy in this situation?

Postpone the interview.

A newly licensed RN is beginning a job search. This nurse would be best served by working in an organization that provides which nursing care delivery system?

Practice partnerships allow for two personnel to work together in giving client care. Ideally, a senior RN can be paired with a novice RN.

The nurse has determined that in order to provide the highest quality care it is important to become more creative. What is the most effective way for the nurse to increase creativity?

Practice the steps of the process as often as possible. Rationale 4: The most effective of these methods would be practicing the steps. Creativity is a skill that can be learned and improved through practice, just like technical skills.

The newly licensed nurse is delighted to have been hired at a Magnet hospital and says, "They even assigned me a mentor." What is erroneous about this statement?

Preceptors are assigned; mentors choose protégés

The nurse works in a school clinic that is part of an integrated health care network. How would this nurse explain to parents and teachers the focus of care provided in the clinic?

Primary care is the focus of integrated health care networks.

Which statement reflects a characteristic common to all methods of quality management?

Quality management is not designed for the purpose of placing blame on an individual.

The nurse manager consistently refocuses the staff on achieving outcomes and directly involves the staff in decision making to achieve those outcomes. How would this style of leadership be described?

Quantum Quantum leadership is based on the concepts of chaos theory, with the focus on outcomes.

During the review of an organization's appraisal policies, a nurse consultant finds that the facility uses a traditional rating scale based on general performance. What would be the consultant's greatest concern with this choice of appraisal style?

Ratings are based on the supervisor's idea of satisfactory performance.

The nurse manager generally uses a stepwise method to arrive at decisions that are logical and that serve to maximize the achievement of the desired objective. Which decision-making model does this manager use?

Rational decision-making model Rationale 3: The rational decision-making model is a series of steps that managers take to make logical, rational choices that maximize the achievement of successful outcomes.

Adopting which strategy would be helpful in reducing recency error in staff appraisals?

Recording critical incidents as they occur.

A nurse who has accepted a position as an assistant ICU manager is discussing unionization with the human resources (HR) director. The HR director says the nurse cannot join the union. What rationale should the HR director offer for this statement?

Registered nurses hired as management are not eligible for collective bargaining

In a leadership training class, which statement by a student indicates learning has been successful?

Relationship building is essential to successful leadership. Rationale:Authentic caring in relationship is an important method of improving respect and competence as a leader.

Which assignment would be in the best interest of a nurse reentering practice following treatment for abuse of mood-altering drugs?

Removal of the temptation is a positive step for the recovering nurse. The best action would be to temporarily have the nurse reassigned to a unit where there are no mood-altering drugs.

The RN leader of a team overhears one of the UAPs on the team say, "I'll sure be glad when I get my RN license. All they do is sit around doing paperwork." How does the RN interpret this comment?

Resentment against the team leader for not doing "real nursing" is a common drawback of team nursing.

A newly licensed nurse is considering a job offer at a hospital that offers a residency program. The nurse should expect to be in this program for up to _____ months.

Residency programs are 12- to 18-month programs designed to acclimate new graduates to the work environment.

A grievance has been filed against a hospital whose nursing staff has just established a union. What is the nurse executive's first step?

Review the agreement for information about grievances. The nurse executive's first step should be to review the agreement with the union. This agreement will describe the steps and progression of a grievance.

There is a shortage of nurses on weekends. The unit manager asks nurses to work every other weekend in return for an additional 8 hours of paid vacation per month. Which type of power is this manager using?

Reward power Rationale: Reward power is based on the inducements a manager can offer a staff. In this case the manager can offer increased benefits.

A nurse manager has discussed behavioral and unprofessional behaviors with a nurse. During the performance appraisal the manager addressed these issues and the two nurses have developed a specific plan to address the performance areas that can be strengthened. What should the manager's next course of action be?

Schedule a follow-up session to determine if the nurse has made progress in the areas specified.

The nurse plans to seek employment in an acute-care setting after graduation. Which form of communication would be most effective in applying for a position?

Send a written letter and résumé in the mail.

A nursing group cannot complete a task assignment because information from another group has not been provided. Because the nursing group cannot complete its task, a group from physical therapy will not be able to complete its task. This is an example of breakdown in which task format?

Sequential interdependence In sequential interdependence, activities must be coordinated with others in a designated order.

What is occurring as the traditional parallel structure found in hospitals is being replaced by service-line structure?

Service-line structure is appropriate when environmental uncertainty is high and the organization requires frequent adaptation and innovation.

Which structure is reflected by the statement "Nursing practice is best determined by nurses"?

Shared governance is a form of participative decision making. Nurses gain control over practice, are more accountable, and feel empowered.

Why would the strategic planning committee choose shared visioning as a strategy for change?

Shared visioning makes change easier. Rationale 1: If leaders and followers share in a vision for the future, it is easier for changes to be made.

A newly hired certified nurse's aide (CNA) has been 15 minutes late returning from mealtime 4 days this week. The nurse manager coaches the employee and finds the CNA thought meal breaks were 45 minutes. What is the most appropriate response from the nurse manager?

Show the CNA the break hours in the employee handbook. The first step is to determine whether the employee is aware of the policy.

A newly hired nurse is asked to join a group working on unit protocols. This nurse is verbal and dominates the conversation of the group. The group leader identifies the disruption this nurse causes as being from which phenomenon?

Status incongruence means that the status of the newly hired nurse is not congruent with being a dominant player in the group

The novice nurse manager is acting in the role of change agent for the unit. Which statement indicates that this manager needs further training in regard to change?

Staying available the whole time is not realistic and will make it difficult for the change agent to maintain the energy it will take to make the change more successful.

A task force leader says, "At the beginning of our next meeting we are going to do some team-building exercises." Which comment by a group member indicates a need for further education about team building?

Team-building exercises were originally used to improve interpersonal workplace relationships and this group member may still think of them in that vein.

While providing continuing education about group dynamics and team building, the nurse manager attempts to explain the difference between a group and a team. Which statement by the manager is most effective?

Teams have a designated task and line authority. Groups may be either formal or informal.

A hospital has sustained massive destruction after being struck by a tornado. The disaster plan has been activated. The administrator would expect help from which agency to coordinate the disaster efforts?

The Federal Emergency Management Agency (FEMA). Congress directed FEMA to coordinate disaster efforts.

Hospital administration is working with a university school of nursing to establish a nursing residency program. Why is this a desired action?

The Institute of Medicine has proposed residency programs for nurses. The IOM has made this proposal.

Which statement represents a situation is which delegation is ineffective or inappropriate?

The RN asks the LPN to assist with admissions by assessing the clients as they get to their rooms.

RN receives morning reports. Delegates to LPN and NA. Busy, with physician visits and new orders, and RN communicates orders to LPN and NA. RN meets with case manager to discuss nursing home placement. What type of nursing care delivery system is in place in this hospital?

The RN in this case is leading a team. A variety of skilled caregivers cares for a group of clients.

A nurse has been invited to discuss health care costs at a senior citizens' club. What information should the nurse plan to include in this discussion?

The United States spends more money on health care than any other country.

During discussion about the hospital's disaster plan, the administrator says, "I am concerned about our current surge capacity." How should the members of the group interpret this concern?

The administrator is worried about the hospital's ability to respond to a large influx of clients from a disaster. Surge capacity, when discussed in disaster planning, describes the facility's ability to mobilize when suddenly confronted with a vast increase in client demand

A director has performed an annual appraisal of the ICU manager, which reflects several issues in regard to the manager's attitude. At the end of the interview the manager expresses disagreement with the appraisal. The director instructs the manager to sign the appraisal and ends the interview. The manager reports this situation to the human resources director for which reason?

The appraisal could be interpreted as discriminatory.

A manager has conducted a nurse's evaluation, focusing a large portion of the appraisal on the nurse's personality. The nurse does not agree with the appraisal and contacts the human resources director. What is the soundest basis on which to dispute the appraisal?

The appraisal is not valid.

The staff nurse has been appointed to a task force. What can the nurse expect regarding this group?

The assignment will be time limited. A task group is charged with accomplishing a specific time-limited assignment.

A manager has been informed by a reliable registered nurse that an assistant lied about bathing a client. The manager calls the assistant into the office with a written warning. Why is this action inappropriate?

The assistant should be allowed to discuss the matter. The manager should investigate the matter and listen to the assistant's reasons for the registered nurse's complaint.

A nursing assistant tells a nurse, "I am going to have to call in sick tomorrow because I don't have a babysitter." How should the nurse respond to this information?

The assistant should use personal time, not sick time for this situation.

Computerized charting will be initiated on select units of the hospital. Orientation to this new system will be provided to each nurse by a team of nurses educated in nursing informatics. This is an example of which type of change strategy?

The assumption of the empirical-rational model is that people are rational and will follow their rational self-interest if that self-interest is made clear to them.

The nurse manager realizes that power must be used to influence a change that is needed on the unit. What should this nurse remember when exerting this power?

The best strategy is to undertake all power interactions in a polite manner. Rationale 4: Being polite is an essential part of using power effectively.

The newly hired nurse manager is involved in the first budgetary cycle since being hired. The manager lists some capital equipment needs and is surprised when they are not available for staff use two months after the request. What is the reason for this?

The budgetary cycle takes up to 1 year to occur.

Which nursing care delivery situation best reflects the concept of a clinical microsystem?

The burn unit likely has a core team of caregivers, a defined population to receive care, informational systems in place, support staff, equipment, and an environment that facilitates provision of care.

The RN working on an orthopedic unit is caring for a postoperative client with a hip replacement who is not transferring well from bed to chair. The client is behind on the mobility training program. What action is the nurse's priority?

The case manager tracks all variances, reports to the collaborative team, and may revise the critical pathway.

The nurse is working on a unit with a blame-free environment and makes an error that puts a client at risk. What should the nurse do first?

The client's safety is always the priority.

What is the primary belief behind the evolution of the clinical microsystem as a nursing care delivery system?

The clinical microsystem method allows those who are involved in the smallest unit of care to make the decisions for that unit.

New triage area in emergency department causes conflict between nurse manager and nurses. The design is not "user friendly." Repeated complaints, manager asks maintenance to change arrangement of the room. What is the most important reason this change occurred?

The complaints motivated the nurse manager to make the change to increase unit effectiveness.

The manager overhears a nurse say to a client, "I am having trouble getting your IV started because you are so fat." The manager determines that a critical incident form should be completed. Which entry is appropriate to document on the form?

The critical incident form must contain the event with accuracy and without judgment. Documentation should include the facts and the sequence of events.

After shift change the nurse discovers that a client's IV heparin has been turned off at the IV controller. The amount of fluid left in the IV bag indicates that the client received half of the dose ordered. Which statement should be documented in the client's medical record?

The documentation in the chart should be a statement of the facts as well as the client's physical status after the incident.

The following documentation was entered in the client's medical record: "The client was found lying on the floor. Dr. X was notified. Apparently the restraints were improperly applied." Which statement best describes this documentation?

The documentation is not appropriately written because it implies that someone was to blame for the incident.

When faced with the prospect of change, the nurse states, "We have always done it this way and never had any problems." A few weeks later, the same nurse remarks, "This new way seems to work better than the old way did." This statement is characteristic of which type of change response?

The early majority prefers the status quo but eventually accepts change.

An ICU nurse manager prefers to use a "results-oriented system" when evaluating employees. Why would the manager prefer this system?

The employee knows in advance what is expected.

The nurse manager becomes aware of frequent incorrect narcotics counts on the night shift. This is verified by the pharmacy. What should be the first action taken by the manager?

The first step is to assess the problem. By checking the staffing pattern on the nights in question, the manager can rule out some employees.

The new chairperson of the nursing department has determined that the faculty's teaching is stagnant and outmoded. The chairperson would like to encourage the faculty to adopt more innovative teaching strategies. According to Lewin, what is the first step in initiating this plan?

The first step is to unfreeze the existing equilibrium by asking staff to become part of the process of change, particularly in the first phase.

A new IV pump has just been purchased by the facility. Which statement by the nurse manager reflects Rogers' first step in making the change to this new equipment?

The first step of the diffusion of innovation occurs when the decision-making unit is introduced to the innovation and knowledge is gained.

Hospital concerned about low customer satisfaction ratings and poor evaluation on quality indicators. Nurse managers implement nursing delivery system that is cost-effective and improves both customer satisfaction and quality of care. Which nursing delivery system should the managers implement?

The focus of patient-centered nursing is the promotion of efficiency, quality, and cost control.

Which situation is an example of the overall goal of quality management in today's health care activities?

The focus of quality management is on ways to prevent problems and improve quality of care. This nurse may have prevented a fall.

A staff nurse is the manager of a command group consisting of other staff nurses, a nurse manager, a physician, and physical therapist. What line authority does the group manager hold?

The group manager has line authority in relation to the group members individually. The group manager has line authority in relation to all member of the group collectively.

A hospital administrator on a disaster planning team says, "I am worried about our liability in using volunteers to provide care during a disaster." What should this team consider?

The hospital could have liability for the volunteer's performance and for his or her safety. Hospital liability could extend to actions taken by the volunteer and for anything that happens to the volunteer.

A hospital successfully implemented its disaster plan to manage providing care during a massive 3-day snow storm. What is the most likely way additional costs for this service will be paid?

The hospital will absorb the additional costs. It is likely that the hospital will absorb the additional costs.

A client needs a high-risk surgical procedure. According to the Leapfrog Group, the client should choose which hospital for care during this procedure?

The hospital with the highest performance ratings for this procedure The Leapfrog Group focuses on quality indicators including the use of higher-performing hospitals for high-risk procedures.

Which situation is an example of reverse delegation?

The licensed practical nurse asks the nurse manager to administer insulin to her client.

A nurse writes some scathing remarks about another nurse's professionalism on a social media site. A complaint of bullying is lodged with the nurse manager. Which statement by the manager is appropriate?

The manager must do an assessment of the complaint before acting.

An emergency department nurse manager is preparing for a night-shift nurse's annual appraisal. The manager is apprehensive because there are issues to address regarding rudeness and unprofessional behavior. How should the manager prepare for conducting this appraisal?

The manager should arrange a 20-30 minute meeting with the nurse to discuss the evaluation privately.

A nurse manager has planned orientation activities for a new registered nurse. The new nurse is required to observe shift report and UAP delegation, take shift report and delegate UAP assignments for a week. What is the rationale for making this orientation assignment?

The manager should focus on those skills specific to the new nurse's role.

The nurse executive is reviewing statistics about the nursing staff. Which statistic shows that the staff reflects national trends?

The number of nurses under age 30 has increased in the last two years The number of nurses under age 30 is increasing.

A hospital uses a results-oriented evaluation system. During a nurse's hiring process, the manager states, "Once you have been officially hired, I want to meet with you regarding evaluation." What will be the focus of this meeting?

The nurse and the manager will work together to write work objectives for the nurse.

Which statement reflects the most important use of power in nursing?

The nurse can use power to impact and improve client care. Rationale: The most important use of power is to impact the quality of client care.

Which situation reflects the primary service provided by home health care?

The nurse changes the client's abdominal dressing daily. Nursing care is the primary service provided by home health agencies

Which action is most likely to undermine the political power of a nursing department?

The nurse executive does more talking than listening in meetings. Rationale 4: Talking more than listening can undermine credibility in the politics of the organization.

A hospitalized client is complaining of abdominal pain that has developed since admission. The nurse says, "I am going to call the hospitalist." How should the client interpret this statement?

The nurse is going to call a physician who cares for inpatients. A hospitalist provides care only to hospital inpatients

Which event would likely improve a nurse's position power within an organization?

The nurse is promoted to nurse manager. Rationale 1: Position power is determined by job description, assigned responsibilities, recognition, advancement, and authority. Being promoted to nurse manager increases position power.

A nurse has been discovered using drugs on the unit. Investigation reveals the nurse has likely been diverting and abusing narcotics for some time. What is the likely the worst outcome for this nurse?

The nurse is terminated with no report made. If the nurse is terminated, employment at another facility may occur and the cycle may continue.

A nurse manager elects to ignore a nurse's performance problem, hoping it will go away. What does this strategy indicate about the nurse's management ability?

The nurse is using a valid strategy. Ignoring a performance problem may be a valid strategy

Which action by the nurse manager is a demonstration of satisficing?

The nurse manager agrees with a proposed budget that does not provide badly needed new client beds.

Which situation requires an adaptive decision?

The nurse manager discovers that two clients require the use of a new piece of equipment and that the one the hospital has is the only one in the state.

A staff nurse asks the nurse manager, "What assignment are you delegating to me today? I would like to begin to organize my day before shift report begins." What is the error inherent in this statement?

The nurse manager is not delegating but rather making daily assignments.

During a performance evaluation the nurse manager states, "My span of control is just too large." How should the unit supervisor interpret this statement?

The nurse manager may have too many staff members to manage. Span of control addresses the number of employees a manager can effectively supervise.

At a strategic planning meeting the nurse executive recommends instituting patient-centered care as a model of care delivery in the hospital. Which statement by the hospital CEO indicates understanding of this concept?

The nurse manager's role in patient-centered care requires considerable time. The nurse manager must be a strong leader.

A nurse is suspected of abusing narcotics. A thorough investigation has been performed, and the nurse will now be notified of the suspicion and investigation. How should this notification be handled?

The nurse should be approached at work with no prior notice and asked to come to the nurse executive's office.

Hospital administration is considering the purchase of a robotic pharmacy system. What would be the advantage of this system to the nurses who work in the hospital?

The nurse should get medications more quickly because the robot can work more consistently without breaks. Robots should be able to get medications to the floor more quickly

During a nurse's interview for a new job, the health benefits are described as being provided by a health maintenance organization (HMO). What should the nurse expect from this coverage?

The nurse will have to choose a provider from within the HMO. An HMO is a geographically organized system that provides an agreed-upon package of health maintenance and treatment services. Providers must be chosen from those in the HMO.

During appraisal interviews, the nurse manager defends the choice of rating by emphasizing the negative aspects of the nurse's performance. What is the likely outcome of this strategy?

The nurse will pay less attention to maintaining what is done well.

A long-term care facility's organization reflects a functional structure. Which facility practice reflects a basic weakness in this organizational strategy?

The nursing department is responsible for writing the client's comprehensive care plan. In functional structure, individual departments are grouped and responsible for specific tasks.

A change in nursing care delivery system is being considered by hospital administrators. Which information should the nurse executive add to this discussion?

The nursing process reflects nursing care and consists of assessment, planning, implementation, and evaluation.

The nursing supervisor states, "I really don't have the time to delegate this task to a nurse manager. I can do it faster!" What is the most likely basis for this statement?

The nursing supervisor is concerned that staff is ill-prepared to assume additional responsibilities.

A group of nurses is developing a poster presentation titled "Nursing Care Delivery Through the Ages" for the hospital's annual Nurses' Day celebration. What form of nursing care delivery should they depict as occurring prior to 1930?

The original model of nursing care delivery was total patient care or the case method. During the 1920s, total patient care was the typical delivery system, with much RN care being provided in the home.

The nurse manager knows that maximum power will be needed to achieve a desired change and has identified a key person on the organizational chart who will be affected by the change. What is important for the nurse manager to do?

The people just above and just below this person will be important to the way this key player reacts to the change.

The nurse manager's goal is to adequately staff the unit and use minimal supplementary staff. The manager has added the cost of this supplementary staff to the unit's operating budget. A colleague informs the manager it should have been added to which budget?

The personnel budget projects the salary costs that will be paid and charged to the cost center in the budget period.

The nurse manager asks staff members to work as a group in planning the activities for Nurses' Week. The nurse manager should report to the supervisor that which type of group has been formed?

The purpose of a task group is to deal with specific issues involving a specific need within a given time limit. Because this group is working on "Nurses' Week," the project is time limited.

For the nurse to effectively and legally delegate, which document must be consulted and followed to reduce the likelihood of liability?

The regulations of the state nurse practice acts

The nurse has a concern regarding the quality of care being provided in the hospital. What should the nurse consider first before communicating this concern?

The relationship between the nurse and the receiver of the message

The nurse manager tells a newly licensed nurse that having a mentor is a benefit to career development. What should the new nurse expect from a mentor-protégé relationship?

The relationship will develop through stages.

A union has won a representative election. What right does that union now hold?

The right to be the bargaining agent for a group of employees. The union that wins the election then has the right to enter into contract negotiations with the organization on behalf of the employees.

In a group meeting, one of the members always arrives early and places the chairs in a circle so all members can interact. This person is responsible for confirming that the room is available for the monthly meetings. Which person does this describe?

The role of the procedural technician is to support group activities by arranging the environment and providing necessary tools.

Which relationship is an example of staff authority in classical theory?

The staff nurse's mentor calls to see how the nurse's first day on a new unit progressed. The staff nurse/mentor relationship is one in which the mentor offers advice and recommendations to the staff nurse but is not responsible for the care the nurse provides.

The group leader often arrives several minutes late to meetings with excuses about workload, telephone calls, or traffic. Today's meeting was scheduled to begin 5 minutes ago and the leader has not arrived. What should the group members do?

The work of the committee should not be delayed because the leader is late. One of the members should begin the meeting.

As part of a shared visioning initiative, a new medication administration system has been adopted. A staff nurse has been chosen to relay the unit's dislike of the system to the evaluation committee. Which would be the most effective method to communicate the unit's disapproval?

There has been a 40 percent increase in medication errors on 3M since the new system began. We believe there is a problem. Rationale: Preparing data focuses on why there is need for action to address a problem.

The nurse is trying to understand why it has taken so long for electronic health records (EHRs) to be used in health care. Which statement is a reason for this delay?

There have been concerns about privacy and confidentiality The most overwhelming issue in using these records has been the profession's and public's concerns regarding privacy and confidentiality.

Which situation represents an obstacle to delegation?

There is a budget shortfall for the current fiscal year Rationale: Resources such as qualified nurses, finances, and educational resources may be limited, which are obstacles to delegation.

The hospital is preparing for a tabletop test of its emergency operations plan. What is the potential for an interruption in services from this drill?

There is little potential for interruption as the drill is all done in a meeting.

Which statement regarding the use of electronic medical records (EMR) is accurate as associated with quality improvement?

There is not enough research on using EMR and the quality of care provided to determine the impact.

A newly licensed nurse working on a unit committee challenges every detail of a proposal the committee is developing. How should other committee members interpret this behavior?

This nurse is learning to be creative. Rationale 2: Challenging details is a part of the preparation portion of learning to be creative.

The nurse executive is reviewing client satisfaction surveys. Which trend would the nurse evaluate as indicating the nursing care delivery system in use is not effective?

This response may indicate that the RN is not able to provide the skilled care needed. There may be a lack of RN presence in patient care.

A nurse manager has just posted the membership list for a newly formed quality management task force. Which statement, overheard by the manager, indicates the most potential for problems on the team?

This statement may reveal that members assigned to the team have problems working together. The manager should be watchful for any personality issues that might arise.

Which statement explains why nurses must be leaders to be successful in client care?

To direct client care activities and get the outcomes you desire, you need good leadership skills. Rationale: Nurses must direct client care in order to successfully achieve client outcomes in a timely fashion.

What is the primary reason a nurse manager would confront a nurse who has been reported for violating infection control policy?

To encourage the correct behavior.

A long-term-care facility is considering implementing total patient care. Prior to implementing this system, what must be available?

Total patient care means that all the care for the clients or residents is provided by the RN.

The hospital organization has developed a philosophy based on the client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. In which quality management process are these characteristics typically seen?

Total quality management (TQM). TQM is a management philosophy emphasizing a commitment to excellence throughout the organization. It is founded on four core concepts: client, organizational involvement, quantitative measurement of outcomes, and processes for improvement.

A community hospital has been purchased by a large health care conglomerate. Nursing administration has the task of changing the nursing practice model followed for 50 years. To best achieve this change, which leadership theory will the executive nurse follow?

Transformational leadership This is concerned not with the status quo but with effecting revolutionary change in organizations and human service.

The nurse manager makes an error that results in the unit being $20,000 short on operating budget for the fiscal year. When asked about the error, the nurse takes full responsibility. This statement reflects which component of emotional intelligence?

Transparency Rationale: Transparency is displaying honesty and integrity.

Newly promoted nurse manager fears that previous coworkers will undermine her in the position. She does not share info with these coworkers on needed changes that are going to occur in the organization. Which emotional intelligence self-management competency is this nurse most clearly violating?

Transparency Rationale: Transparency is displaying honesty, integrity, and trustworthiness. this nurse is not displaying these traits.

A small creek has flooded, requiring the rescue of one person from a stranded automobile. Electrical service was interrupted for a short period and traffic to diverted around flood. The newspaper should report that the town suffered a level 1 ______ disaster.

True. If the response at the local level is sufficient, the disaster is categorized as level 1.

A nurse manager has had issues with a marginal employee. Staff members have complained several times to the manager regarding this employee's competence. Which action by the manager would be appropriate?

Using progressive discipline to manage the employee allows for communication regarding poor performance and allows the employee the opportunity to improve their performance.

The nurse manager is creating the budget for the next fiscal year. Because the client census has been higher in the past year, more supplies were used. Which type of cost does this reflect?

Variable costs depend on and change in direct proportion to client volume and acuity, such as client care supply expenses.

As a cost-saving initiative, the hospital administration has asked the night staff nurses to refill drug supplies at night while the pharmacist is not present. The nurses file a grievance and nurse managers become involved. How would this grievance be classified?

Violation of federal and state laws Nurses cannot act as substitute pharmacists.

The nurse works in a federal hospital that is beginning the collective bargaining process with nurses. The nurse is disappointed to discover that which concern cannot be addressed in negotiations?

Wages cannot be negotiated in federal institutions

The nurse is working on a committee charged with the responsibility for making policy decisions for the health care organization. During the work, the nurse has developed a strong belief that the focus of the committee is incorrect. Which statement by the nurse would be most appropriate?

We are a good team, but we need to look at this problem from a different viewpoint. Rationale: When offering criticism, one should always begin the conversation with a compliment.

The quality management director of a large health care conglomerate wishes to initiate benchmarking strategies to assess care. Which directive should this manager publish?

We will compare outcome indicators with other health care conglomerates of similar size and organization. Benchmarking uses an organization's outcome data and compares it with that of a similar organization to address strengths and challenges

Which statement reveals the most dangerous result of using measured standards as part of the CQI process?

When innovation is sacrificed because of the work involved in CQI or because variance is discouraged, stagnation occurs. This is the biggest danger of using standardization.

Which is the most important consideration in choosing a structure for nursing care?

While all four options are important, client need takes precedence over the others because nursing provides a service to the client.

Night shift nurse is assuming a day shift nurse's assignment. Includes two clients-pain controlled with oral hydrocodone (Lortab). Both clients complain of pain. Day shift nurse reports both clients had just received two hydrocodone (Loratab) tablets for pain. What action should the night shift nurse take?

While there is no clear indication that the day shift nurse is diverting drugs, the manager must be made aware of the situation so it can be investigated. The nurse and manager must determine if the clients actually received the medication and, if so, what time they were administered.

A client who is being discharged from the hospital will need follow-up for wound care. The client's spouse is not capable of providing bed baths for the client. The nurse case manager who is planning care for this client should contact which agency?

With shorter hospital stays, home health agencies are frequently used to provide clients with intermittent or temporary follow-up care such as wound care and bathing.

The job description of the staff nurse states the nurse is responsible for attending hospital committee meetings as assigned. The nurse manager asking the staff member to attend a risk management meeting is an example of which concept?

Work assignment Rationale: This assignment reflects duties listed in the nurse's job description so asking the nurse to attend a meeting is work assignment.

A successful nurse manager is mentoring a newly promoted nurse manager. Which comment by the mentor reflects the most important consideration of all nurse managers?

Your most important role is to ensure client care accountability. Rationale: Managers most important role is assuring quality client care, managers are accountable for quality care.