Leadership Final: Quiz Questions

To establish legal liability on the grounds of malpractice, the injured party must prove which of the following (select all that apply)? A. A duty of care was owed to the injured party. B. An agreement was made to assume another party's liability. C. There was a breach of duty. D. Causation was present. E. Actual harm or damages were suffered by the plaintiff.

A. A duty of care was owed to the injured party C. There was a breach of dute. D. Causation was present E. Actual harm or damages were suffered by the plaintiff. These four elements are required to establish legal liability on the grounds of malpractice.

Cultural diversity refers to the: A. acknowledgment of variation in thoughts, communication, values, and beliefs. B. belief that one's own culture is similar to another's culture. C. realization that all people in a particular culture have the same beliefs. D. view that individuals living in a country should speak the native language.

A. Acknowledgement of variation in thoughts, communication, values, and beliefs. Cultural diversity refers to variations with respect to the thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.

Sentinel event alerts are published by TJC to do which of the following? A. Allow facilities to learn from sentinel events that have occurred in other facilities and incorporate recommendations for prevention into their policies. B. Notify hospitals that if a sentinel event occurs during an alert, the hospital will be subject to withdrawal of Medicare and Medicaid certification and reimbursement. C. Prevent a near-miss from occurring. D. Assist hospitals to find national standardized performance measures to benchmark themselves against other similar hospitals.

A. Allow facilities to learn from sentinel events that have occurred in other facilities and incorporate recommendations for prevention into their policies. Sentinel event alerts are published by TJC to "review the lessons learned" from those facilities that had experienced these sentinel events. The hope is that other hospitals will incorporate the recommendations into their policy to avoid making similar errors.

A staff nurse is facing a dilemma between upholding personal care standards and meeting organizational goals. The nurse manager understands that the best way to assist staff members in resolving ethical dilemmas effectively is to: A. avoid applying any pressure to compromise personal values. B. change their work assignment until the dilemma is resolved. C. continually remind staff of consequences related to ignoring organizational goals. D. refer indecisive staff members for additional training.

A. Avoid applying any pressure to compromise personal values An important way in which those in health care facilities and their managers can assist nursing professionals in resolving ethical dilemmas effectively is by neither explicitly nor implicitly pressuring them to go against their own ethical values (Cooper et al., 2003).

The manager of a rural, thriving, nurse-managed clinic is considering purchasing equipment to furnish two additional examination rooms. The resource he must consider is the _____ budget. A. capital B. expense C. operating D. product line

A. Capital The capital budget is the plan for the purchase of major equipment or assets.

A patient is admitted with congestive heart failure, diabetes mellitus, and dementia. He has a new dark spot on the top of his toes on his right foot. The nurse contacts the primary care physician, consults with the wound care specialist nurse, writes a nursing order for a referral to the diabetic educator, and contacts the discharge planner to facilitate future discharge plans. Which of the following care delivery models best describes how the nurse is providing care? A. Case management B. Group nursing C. Functional nursing D. Private duty nursing

A. Case Management Case management is defined by the Case Management Society of America as a "collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes" (2002, p. 5).

A nursing manager recognizes that the changes that she is expected by administration to implement will be met with staff resistance. She is committed to determining the root of the resistance and communicating positively with her staff. The nurse manager's actions characterize her as a(n): A. change agent. B. implementation expert. C. restructuring motivator. D. supervisory threat.

A. Change Agent The change agent needs to anticipate resistance, determine why it is occurring, and try to determine what the person who is resisting is trying to protect.

Disease management is the monitoring of: A. chronic illness across the health care continuum. B. mental illness in the outpatient setting. C. surgical illness across the health care continuum. D. terminal illness in the hospice setting.

A. Chronic Illness across the health care continuum Disease management programs contain a series of clinical processes and services across the health care continuum that rely on informatics to identify and manage a medical or chronic condition in at-risk populations to improve care, promote wellness, and manage or reduce costs.

The informal performance appraisal process includes: A. coaching. B. mentoring. C. preceptoring. D. teaching.

A. Coaching The informal process includes daily supervision or coaching to moderate, modulate, or refine small parts of performance. Coaching is an approach to developing individuals in an organization that falls somewhere between preceptoring and mentoring. Coaching is a management tool that is ongoing face-to-face collaboration and influencing to improve skills and performance.

The nursing supervisor informs the staff that if they refuse to stay on the nursing unit and work an additional 8-hour shift, they will be reported to the state for patient abandonment. This type of power is known as: A. coercive. B. expert. C. legitimate. D. reward.

A. Coercive French and Raven's five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When coercive power is used, an individual reacts to the fear of the negative consequences that might occur for failure to comply.

Cultural affiliation, health and care beliefs and practices, illness beliefs and customs, and spiritual practices best describe components of a: A. cultural assessment. B. data collection. C. health evaluation. D. medical history.

A. Cultural Assessment A cultural assessment consists of cultural affiliation, health and care beliefs and practices, illness beliefs and customs, interpersonal relations, spiritual practices, world view, and other social structure features.

Methods to overcome procrastination include (select all that apply): A. delegating sections or portions of the task. B. determining personal benefit from completing the task. C. reassessing the purpose and goals of the task. D. waiting until motivated to begin the task.

A. Delegating Sections or portions of the task B. Determining personal benefit from completing the task

Factors that affect supply include nursing education factors, work environment factors, and _____ factors. A. demographic B. geographic C. socioeconomic D. psychological

A. Demographic Three factors that affect the supply of RNs are nursing education, work environment, and demographics.

A manager should never delegate: A. disciplining. B. hiring. C. interviewing. D. scheduling.

A. Disciplining Discipline, praise, recognition, and morale issues are aspects of the managerial role that should not be delegated.

Functional nursing: A. divided and distributed nursing tasks. B. enhanced client-oriented care. C. provided a smooth care delivery system. D. was expensive once implemented.

A. Divided and distributed Nursing Tasks Functional nursing focused on task accomplishment rather than individualized and holistic care. Nurses came to work and provided a task such as a "medication nurse" or a "temperature nurse" (Kalisch & Kalisch, 1978).

An example of indirect patient care function is: A. enabling the staff to self-schedule. B. encouraging the patient to verbalize his or her feelings. C. enlisting the patient in self-care activities. D. ensuring that the correct medication is being given.

A. Enabling staff to self-schedule The direct patient care functions in a nursing care model are facilitated by and depend on the management of indirect functions (Fox et al., 1999). Staffing issues are management functions, whether they are delegated or not.

A successful enterprise risk management (ERM) program will (select all that apply): A. identify risks. B. improve quality. C. prevent damage. D. control occurrences. E. control legal liability.

A. Identifies Risks C. Prevent Damage D. Control Occurrences E. Control Legal Liability

There are two important elements associated with dealing with cultural diversity in the workplace. They are (select all that apply): A. increasing employee knowledge of other cultures. B. increasing employer pressure for nondiscriminating hiring practices. C. taking steps to eradicate ethnocentrism. D. taking steps to encourage egocentrism.

A. Increasing employee knowledge of other cultures C. Taking steps to eradicate ehtnocentrism There are two important elements to any workplace effectively dealing positively with the growth of cultural diversity: 1) increasing employee knowledge of other cultures and 2) taking steps to eradicate ethnocentrism in the workforce.

The critical care unit of a hospital utilizes team huddles at change of shift. This is an opportunity for the clinical supervisors to connect with team members and review the upcoming shift or any quick topics that need to be communicated. This is an example of a(n) _____ meeting. A. information-sharing B. opinion-seeking C. problem-solving D. strategy

A. Information Sharing An information-sharing meeting occurs when a group is gathered to disseminate information.

A nursing preceptor is giving feedback to a new nurse who currently is being oriented. Her preceptor suggests a better method of interacting with a family member by saying, "You might want to be cognizant of your nonverbal behaviors when talking with clients. Rather than continuing to chart when you are talking with an American family, stop charting, move closer to the family and client, look at them during the conversation, and take time to let them share their concerns." This preceptor is giving advice about: A. interpersonal communication. B. clarity. C. image. D. intention.

A. Interpersonal Communication If the verbal message is clear, but the nonverbal communication is not congruent, then listeners may misinterpret, distrust, or not even hear the intended message. In this situation, the nurse's nonverbal behavior may suggest that she is not interested in interacting with the family.

Key examples of health care practices and interventions outcomes are (select all that apply): A. mortality. B. birth rates. C. health status. D. quality of life. E. ability to function.

A. Mortality C. Health Status D. Quality of Life E. Ability to Function

The _____ is a tool which is useful in assessing the readiness for organizational change. A. Organizational Change-Readiness Scale (OCRS) B. five-dimensional scale C. Rapid Cycle Change D. plan-do-study-act model

A. Organizational Change-Readiness Scale (OCRS) The OCRS is a 76-item inventory that is used to analyze the ability of an organization to manage change effectively. There are five dimensions that are a part of this assessment tool.

Strategic management, long used in business to ensure a competitive advantage over similar enterprises, involves (select all that apply): A. setting targets. B. establishing goals. C. evaluating success. D. developing an action plan. E. defining the core purpose. F. conducting an environmental scan.

A. Setting targets B. Establishing goals C. Evaluating success D. Developing an action plan F. Conducting an environmental scan

Which of the following behaviors build trust between leaders and employees in an organization (select all that apply)? A. Sharing relevant information B. Encouraging competition via winners and losers C. Reducing controls D. Meeting expectations E. Avoiding discussion of sensitive issues

A. Sharing Relevent Information C. Reducing Controls D. Meeting Expectations

Good leaders need to be able to demonstrate an intuitive skill of empathy and expressiveness when dealing with others in the workplace. This requires sensitivity and awareness of the emotions and moods of others and is known as: A. Social Awareness B. Self-Awareness C. Self-Management D. Relationship Management

A. Social Awareness Social awareness is an intuitive skill of empathy and expressiveness in being sensitive and aware of the emotions and moods of others.

The division of work by occupation or function is a form of: A. specialization. B. interdependence. C. uncertainty. D. technology.

A. Specialization The division (or differentiation) of work by occupation or by function is a form of specialization. Specialization is the extent to which work is divided and assigned to positions and divisions.

Referring to a patient as Hispanic or Mexican can contribute to: A. stereotypes. B. cultural competency. C. spiritual competency. D. diversity.

A. Stereotypes In patient care of a Mexican versus Hispanic person, the failure to identify differences not only perpetuates stereotypes evaluations but also can cause the clinician to fail in accurately assessing potential conflicts with the cultural values of the patient or important communication barriers.

Clinicians tend to buy into the need for practice change when (select all that apply): A. there is a strong evidence base. B. the topic addresses an identified need. C. the practice change offers a relative advantage. D. the practice change is endorsed by organizational executive leadership. E. data demonstrate an opportunity for practice improvement within the clinical area.

A. There is a strong evidence base B. The topic addresses an identified need C. The practice change offers a relative Advantage E. Data demonstrate an opportunity for practice improvement within the clinical area

Examples of nursing care delivery models include (select all that apply): A. team nursing. B. quality nursing. C. primary nursing. D. private duty nursing. E. patient-focused care.

A. team nursing C. Primary Nursing D. Private Duty Nursing E. Patient-focused care A nursing care delivery model "is defined as a method of organizing and delivering nursing care in order to achieve desired patient outcomes" (Deutschendorf, 2010, p. 444). Examples of nursing care delivery models include patient-focused care, team nursing, private duty nursing, total patient care, functional nursing, primary nursing, and various combinations.

An experienced critical care nurse left a CCU staff nurse position to finish a master's degree. Periodically, he would return to work as a per diem nurse in the CCU. The staff was impressed with the nurse's performance; however, one staff member complained that he was unfamiliar with the new telemetry monitors when he first returned to work several months ago. This comment showed up in his evaluation, resulting in a poorer overall evaluation from the nurse manager compared with previous evaluations. This is an example of: A. a halo effect. B. a horn effect. C. recent behavior bias. D. similar-to-me effect.

B. A horn Effect A horn effect occurs when a manager perceives one negative aspect about an employee or that employee's performance and generalizes it into an overall poor appraisal rating.

Which of the following is an example of case management or would require the expertise of a case manager? A. A blood pressure screening clinic is started at the senior citizen center. B. A person with multiple chronic illnesses is admitted to the hospital. C. A program is started to address diabetes in the Native American population. D. An initiative is developed to promote fluoride treatments in schools.

B. A person with multiple chronic illnesses is admitted to the hospital Case management involves an intensive focus on an individual patient in relation to one or more health conditions. It is an intervention strategy used by multiple health care providers and systems to advocate for clients, coordinate health care delivery, and facilitate outcomes of both cost and quality.

Team dynamics can become dysfunctional over time. What are some factors that can contribute to team dysfunction (select all that apply)? A. Taking accountability B. Absence of trust C. Negotiating expectations D. Fear of conflict E. Lack of commitment

B. Absence of Trust C. Fear of Conflict D. Fear of Conflict Dysfunctional team behaviors can occur related to an absence of trust, fear of conflict, lack of commitment, avoiding accountability, and inattention to results. Articulating and negotiating expectations for healthy interpersonal behavior benefits team development.

A hospital administrator is involved in contract negotiations with the nursing union leaders. To resolve issues: A. nurses should be assertive to make certain that their view predominates. B. both sides should strive to meet the interests of both parties. C. the negotiator should use independent problem-solving skills. D. the budget should dictate the conditions of the negotiation.

B. Both sides should strive to meet the interests of both parties Both sides should strive to maintain the poise of the other party in a win-win situation, also known as interest-based bargaining. Each party should gain something, and the solution should be acceptable to both sides. Problem solving, consensus building, and integrative decision making are techniques used to achieve this goal.

The future projected demand for nurses is related to the aging population and the increase in: A. acute illnesses. B. chronic illnesses. C. medication costs. D. primary prevention.

B. Chronic Illnesses The future projected demand for nurses is related to the aging population and the increase in chronic illnesses.

Situational leadership focuses on three competencies deemed necessary for a leader's success. Which of the following are correct statements (select all that apply)? A. Communicating is a behavioral competency. B. Communicating is a process competency. C. Diagnosing is a behavioral competency. D. Diagnosing is a cognitive competency. E. Adapting is a behavioral competency.

B. Communicating is a process competency D. Diagnosing is a cognitive competency E. Adapting is a behavioral competency Situational leadership focuses on the following three competencies deemed necessary for success. Diagnosing is a cognitive—or cerebral—competency. It is the understanding of what the situation is now and knowing what it can reasonably be expected to be in the future. The discrepancy between the two is the problem to be solved. This discrepancy is what the other competencies are aimed at resolving. Adapting is a behavioral competency. It involves adapting behavior and other resources in a way that helps close the gap between the current situation and what the leader wishes to achieve. Communicating is a process competency. Leaders need to communicate effectively. If leaders cannot communicate in a way that people can understand and accept, they will be unlikely to meet their goals.

The art of being able to structure and transmit a message in a way that another can understand easily and accept is: A. articulation. B. communication. C. evaluation. D. pronunciation.

B. Communication Communication is the art of being able to structure and transmit a message in a way that another can understand easily and accept.

A patient has arrived at the critical care unit with a head injury. On admission, the patient is talking and is a little drowsy but oriented. Two hours later, the nurse discovers that the patient is talking at a rapid pace and keeps repeating his words. Which of the following examples best depicts Benner's stages and appropriate critical-thinking processes in this situation? A. Advanced beginner—thinks that the patient is trying to be funny B. Competent—thinks that the patient is experiencing effects from cerebral edema C. Novice—thinks that the patient is stressed and has had a surge of adrenaline D. Proficient—thinks that the patient is waking up from a coma

B. Competent- thinks that the patient is experiencing effects from cerebral edema The competent nurse uses the information about head injury, change in mental status from talking and drowsy but oriented to talking at a rapid pace, and the potential for the patient to deteriorate to discern that the patient is experiencing cerebral edema or increased intracranial pressure.

Case management is an interventional strategy used by health care providers to: A. advocate for nurses. B. coordinate health care delivery. C. facilitate cost accounting. D. investigate medical errors.

B. Coordinate Health Care Delivery Case management is an intervention strategy used by health care providers and systems to advocate for clients, coordinate health care delivery, and facilitate outcomes of cost and quality.

A staff registered nurse (RN) has been struggling with the delivery system from central supply. He documents a delay of 1 to 3 hours from the time that the order is sent to central supply to the time that the requested equipment is sent to the floor. The RN asks, "Why does a central supply unit need to service the entire hospital? Why not consider a decentralized central supply established for each floor?" This is an example of what type of thinking? A. Amiable thinker B. Critical thinker C. Traditional thinker D. Unrealistic thinker

B. Critical Thinker A critical thinker challenges and questions the norm.

Hospitals must submit specific quality performance data regarding Medicare patients or risk: A. an increase in federal tax. B. decreased payments. C. fewer physician referrals. D. sanctions by The Joint Commission (TJC).

B. Decreased Payments One of the first actions resulting from the Hospital Quality Initiative has been to require hospitals to submit their quality performance data for 10 measures to comply with the Medicare Prescription Drug Improvement and Modernization Act. Organizations that do not submit this data were to receive 0.4% smaller Medicare payments.

Transferring the authority to perform a selected nursing task in a selected situation to a competent individual is: A. authorization. B. delegation. C. empowerment. D. supervision.

B. Delegation The National Council of State Boards of Nursing (1995) defines delegation as transferring the authority to perform a selected nursing task in a selected situation to a competent individual.

Some of the major disadvantages to group decision making are premature decisions, individual domination, and: A. autonomous conclusion. B. disruptive conflicts. C. group synergy. D. inaccurate data interpretation.

B. Disruptive Conflicts Group decision making can be derailed at a number of points in the process. The main disadvantages commonly noted about group decision making are the potential for premature decisions, individual domination, and disruptive conflicts (Veninga, 1982).

Shared governance is a model of organizational structure in which staff nurses are: A. employed to establish mutual goals with clients. B. empowered through autonomy and accountability. C. engaged in problem-solving strategies and techniques. D. equipped with evaluative thinking methodologies.

B. Empowered trhough autonomy and accountability Shared governance is a model of organizational structure in which staff nurses are empowered through autonomy and accountability.

A hospital with a large surgery department is concerned about surgeons starting their own surgical centers. In relation to the strategic plan evaluative process, this is an example of: A. an economic monopoly. B. an external threat. C. marketplace competition. D. political strength.

B. External Threat

An organizational chart with one line of management and one line of staff reflects which of the following types of organizational structures? A. Authoritarian structure B. Flat structure C. Power structure D. Vertical structure

B. Flat Structure A flat or horizontal structure has few administrative layers between management and employees. Employees have more decision-making power in this type of hierarchy.

A group of nurses is showing resistance to changes the manager is making with regards to staffing. Which of the following ways can the manager deal with the emotionality of the situation (select all that apply)? A. Use persuasion. B. Give the nurses adequate notice of change. C. Avoid discussion. D. Explain the rationale and patient impact. E. Inform staff that senior leadership made the decision.

B. Give the nurses adequate notice of change. D. Explain the rationale and patient impact. A factor in determining how change is accepted depends upon how it is managed. The way to deal with emotionality is to avoid persuasion and to allow people to express their feelings. Staff should be given as much notice as possible when making changes in staffing or scheduling, and discussion is encouraged. Staff should be informed about the rationale for the decision as well as patient impact. Effective managers possess self-confidence to explain the change without blaming.

The most difficult to change is: A. attitudes. B. group behavior. C. knowledge. D. individual behavior.

B. Group Behavior Group behavior and performance changes are the most difficult to change and take the longest time.

Which of the following is an example of a nurse-sensitive indicator? A. Cardiac patient mortality B. Hospital-acquired pressure ulcers C. Pulmonary embolus after knee surgery D. Iatrogenic pneumothorax after central line placement

B. Hospital Acquired Pressure Ulcers Nurse-sensitive indicators refer to the structure, process, and outcomes of professional nursing care. These include falls and falls with injury, hospital-acquired pressure ulcers, health care-associated infections, nursing care hours per patient day, nursing care hours, nursing turnover, physical restraints, RN survey, and skill mix.

A nurse believes that she should provide optimal care to all clients, regardless of their cultural background. She is struggling with her emotions when caring for a client with a violent criminal background. What would be the best course of action for this nurse? A. Avoiding the client as much as possible but providing care B. Identifying her biases but providing care C. Requesting another patient assignment D. Taking sick days while the patient is hospitalized

B. Identifying her biases but providing care Identifying her biases but yet still providing care to the client is a step in providing culturally competent care.

Group problem solving is known to be more effective over individual problem solving because of a larger knowledge and information base, increased acceptance of solutions, more approaches to a problem, lower economic costs, and the ability for: A. group development. B. individual expression. C. hierarchical bonding. D. organizational team building.

B. Individual Expression Individual expression is one of the major advantages of group problem solving (Veninga, 1982).

A disagreement or differences between the members of two or more groups over authority, territory, and resources is called _____ conflict. A. intragroup B. intergroup C. interpersonal D. intrapersonal

B. Intergroup Intergroup conflict refers to disagreements or differences between the members of two or more groups or their representatives over authority, territory, and resources.

The hospital units most likely to employ a decentralized staffing model include (select all that apply): A. the telemetry unit. B. labor and delivery. C. the medical-surgical unit. D. the emergency department. E. the neonatal critical care unit.

B. Labor and Delivery D. The Emergency Department E. The NICU In a decentralized model, individual department managers and directors are responsible for daily staffing allocation. Units with decentralized staffing are typically units whereby volume and/or acuity may be most unpredictable, and the nursing competencies are unique to that area (e.g., emergency department, labor and delivery, critical care).

Strategic management is defined as the management of an organization based on its: A. goals. B. mission. C. plan. D. objectives.

B. Mission Strategic management is defined as the management of an organization based on its vision or mission.

"To provide the best care to every patient every day through integrated clinical practice, education, and research" is an example of a(n): A. accountability agreement. B. mission statement. C. organizational standard. D. vision and value proposal.

B. Mission Statement The mission statement of an organization is a concise statement that answers the question, "What business are we in today?" (Pelletier, 1999).

The major responsibility for upholding patient care standards belongs to the: A. chief executive officer of the facility. B. nurse manager. C. on-call physician. D. staff nurse providing patient care.

B. Nurse Manager Nurse managers carry the major responsibility for developing and upholding the standards of care for staff nurses.

A new cancer center is being built in the local hospital. A patient survey has revealed that patients are not certain which caregiver is the registered nurse (RN) during their hospital stay. A group is formed to recommend methods to help patients identify which caregiver is their RN for the new cancer center. Which of the following groups best represents those who should be involved in forming recommendations? A. Chief medical officer, public relations vice-president, and human resources B. Oncology clinical nurse specialist, nurse's aides, and RNs C. Physicians, unit secretaries, and vice-president of finance D. Vice-president of nursing, decentralized pharmacist, and licensed practical/vocational (LPN/LVN) nurses

B. Oncology clinical nurse sepcialist, nurse's aides, and RNs Involving individuals at all levels of the organization will ensure a variety of perspectives and more "buy in" to the final product. Including the patient's perspective may provide additional insight about the issue. Ideally, those involved in all levels of patient care, such as the vice-president of nursing, nurse manager, oncology clinical nurse specialist, LPN/LVNs, and nurse's aides, as well as patients of the RN, may need to be included to gain additional perspective.

Evaluation of the effect of nurse staffing on quality patient, financial, and organizational outcomes is known as: A. patient acuity. B. staffing effectiveness. C. nurse-to-patient ratio. D. nursing workload.

B. Staffing Effectiveness Staffing effectiveness is the evaluation of the effect of nurse staffing on quality patient, financial, and organizational outcomes.

Group as well as individual accountability exists within a: A. work group. B. true team. C. pseudoteam. D. committee.

B. True Team A true team occurs when there is a collective entity in which leadership rotates and is shared by various members of the team. There is group as well as individual accountability.

Staff nurses' involvement in budgeting is essential because they: A. have the final authority on the annual budget. B. have the ability to contain costs at the unit level. C. have a unique perspective on the budgetary process. D. are the largest user of the budgeted funds for the unit.

B. have the ability to contain at the unit level In many organizations, staff nurses are expected to be aware of their unit's financial performance and the impact their decisions may have on it. Staff nurses' involvement is essential to the ability to contain costs at the unit level, because they make many decisions about supply and resource use.

_____ has garnered considerable attention in health care because of its potential to save money, improve effectiveness, and increase quality of care. A. Disease management B. Development research groups C. Case management D. Diagnosis-related groups

C. Case Management Case management has garnered considerable attention in health care. It has been suggested that the processes associated with case management have the potential to save money, improve effectiveness, and maintain or improve the quality of care.

The process of identifying the specific costs related to the delivery of nursing care to each client so that nurses have data to identify the actual amount of services received is: A. personnel budget development. B. evaluating budget expenditures. C. costing out nursing services. D. strategic financial planning.

C. Costing out nursing services Costing out nursing services is defined as the determination of the costs of the services provided by nurses. By identifying the specific costs related to the delivery of nursing care to each client, nurses have data to identify the actual amount of services received.

What is the definition of the process of making choices that will provide maximum benefit? A. Critical thinking B. Problem solving C. Decision Making D. Leading

C. Decision Making Decision making is the process of making choices that will provide maximum benefits.

An approach for decreasing nursing RN skill mix was implemented in a "one size fits all" approach across organizations in the 1990s. These changes in skill mix led to: A. decreases in RN workload. B. increased nursing satisfaction. C. decreased patient satisfaction. D. decreased patient safety concerns.

C. Decreased Patient Satisfaction The approach for decreasing nursing RN skill mix was implemented in a "one size fits all" approach across organizations and often lacked evaluation of the skill mix change and other changes on the quality of care and nurse job satisfaction and retention (Eck, 1999; Norrish & Rundall, 2001). This was most apparent in California where a leaner RN skill mix was tried by Kaiser Permanente Northern California in the early 1990s. Skill mix was reduced from 55% RNs to 30% RNs in 1995 (Robertson & Samuelson, 1996). The changes in skill mix led to widespread real and perceived increases in RN workload, patient safety concerns, and nurse and consumer complaints.

Utilizing the DECIDE acronym for the process of decision making, what are the first and final steps in the process (select two that apply)? A. Develop and implement an action plan for problem solution. B. Establish criteria for what you want to accomplish. C. Define the problem and determine why anything should be done about it. D. Evaluate the decision through monitoring, troubleshooting, and feedback. E. Determine the best choice or alternative.

C. Define the problem and determine why anything should be done about it D. Evaluate the decision through monitoring, troubleshooting, and feedback. The first step in the decision-making process using DECIDE is to define the problem and determine why anything should be done about it and explore what could be happening. The final step in the process is to evaluate the decision through monitoring, troubleshooting, and feedback.

The transferring of authority, responsibility, and freedom to act and the inspiring of self-confidence is known as: A. actualization. B. authorization. C. empowerment. D. ratification.

C. Empowerment Empowerment is the transfer of actual power and inspiring self-confidence (Kramer & Schmalenberg, 1990).

Evidence-based practice includes: A. collaborative practice dynamics between health care professionals. B. documentation of patient care as evidence of nursing practice. C. integration of research with clinical expertise and patient values. D. mutual goal setting and application in the clinical setting.

C. Integration of reasearch with clinical expertise and patient values Evidence-based practice is a process of shared decision making in a partnership between patients and providers that involves the integration of research and other best evidence with clinical expertise and patient values in health care decision making (Sackett et al., 2000).

A staff nurse has a concern about a co-worker who may be diverting medications. The staff nurse would like to report the concern to a supervisor, but she is fearful of retaliation from her colleagues. The staff nurse knows that the ethical thing to do is report the concern for the sake of patient safety. This nurse is experiencing: A. stress. B. procrastination. C. moral distress. D. burnout.

C. Moral Distress Moral distress occurs when clinicians know what is the ethical action to take, yet are prevented by either external or internal obstacles. Moral distress will contribute to stress and eventual burnout if the staff nurse does not take action.

The nursing chief executive officer (CEO) works in a major rehabilitation and subacute facility network. Her span of control refers to the number of: A. miles in which the network resides. B. ancillary staff accountable to her. C. nurses and non-nurses reporting to her. D. inpatients that the facilities service.

C. Nurses and non-nurses reporting to her Span of control refers to the number of nurses and non-nurses reporting to a manager.

Staffing management is one of the most critical activities for nurse leaders at every level of the health care organization today because it affects: A. delegation and supervision. B. unit leadership productivity. C. organizational outcomes. D. professional development and quality control.

C. Organizational Outcomes Staffing management is one of the most critical yet highly complex and time-consuming activities for nurse leaders at every level of the health care organization today (Abdoo, 2000; Sullivan et al., 2003). How well or poorly nursing leaders execute staff management impacts the safety and quality of patient care, financial results, and organizational outcomes, such as job satisfaction and retention of registered nurses (RNs) (Beyers, 2000).

To determine whether her patient has responded favorably to a nursing intervention, a staff nurse should observe the client for: A. improved health. B. increased complaints. C. outcome indicators. D. signs and symptoms.

C. Outcome Indicators Indicators are defined as "valid and reliable measures related to performance" (Oermann & Huber, 1999). According to the American Nurses Association, indicators measure how nursing care affects clients and therefore would provide evidence of a patient's response to treatment.

The field in health care that aims at a better understanding of the end results of health care practices and interventions is called: A. patient safety. B. risk management. C. outcomes research. D. quality management.

C. Outcomes Research Outcomes research aims at a better understanding of the end results of health care practices and interventions, such as the impacts of care that are most important to patients, families, payors, and society.

A human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading is known as: A. advisement. B. consultation. C. persuasion. D. suggestion.

C. Persuasion Persuasion is a human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading.

Performance management includes the processes of human resources management. The purpose of this system as related to the employee includes job productivity, compensation, job performance recognition, and: A. compensation administration. B. job analysis. C. planning for professional development. D. structuring educational programs for staff.

C. Planning from professional Development Performance management includes the processes of human resources management. The purpose of this system as related to the employee includes job productivity, compensation, job performance recognition, and planning for professional development. For the organization, the processes include worker requirements, job analysis, compensation administration, training needs analysis, and employee promotion or discipline evaluation.

Decentralization occurs when: A. equipment is being purchased from approved vendors. B. hiring decisions are made at the executive level. C. power is distributed to those closest to the work of caregiving. D. supplies are distributed from one central supply area in the hospital.

C. Power is distributed to those closest to the work of caregiving Decision-making authority rests at lower levels in the organizational framework, closer to the point of care, rather than being passed up through the chain of command to an executive.

The degree to which health services for individuals and populations increases the likelihood of desired health outcomes that are consistent with current professional knowledge is known as the: A. care delivery quotient. B. excellence index. C. quality of health care. D. standard of care.

C. Quality of Health Care Quality of health care is defined as the degree to which health services for individuals and populations increases the likelihood of desired health outcomes that are consistent with current professional knowledge (Lohr, 1990).

A situation in which the demand for employment of nurses (how many nurses employers would like to employ) exceeds the available supply of nurses willing to be employed at a given salary is known as a nursing: A. abundance. B. deficit. C. shortage. D. surplus.

C. Shortage The number of nurses that employers would like to employ in relation to the number of nurses willing to be employed at a given salary is known as a nursing shortage. In a nursing shortage, the demand for employment of nurses exceeds the available supply for employment at a given salary.

SWOT is an acronym for: A. stability, wealth, opportunistic, and timeliness. B. strategies, work ethic, oppositions, and team. C. strengths, weaknesses, opportunities, and threats. D. strong, worthy, oppositional, and tactical.

C. Strengths, Weaknesses, Opportunities, Threats SWOT is an acronym for strengths, weaknesses, opportunities, and threats. SWOT analysis is used in developing strategic plans for an organization.

The five rights of delegation are right task, right circumstance, right person, right direction and communication, and right: A. interaction. B. outcome. C. supervision. D. time.

C. Supervision Right supervision is the fifth right of delegation as outlined by the National Council of State Boards of Nursing (1995).

A small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable and whose membership should be consistent is known as a: A. committee. B. group. C. team. D. unit.

C. Team A team is a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable and whose membership should be consistent (Katzenbach & Smith, 1993; Manion et al., 1996).

The total number of nurses who left a unit in 1 year divided by the total number of nurses employed on that unit is the _____ rate. A. actualized B. employable C. turnover D. vacancy

C. Turnover The total number of nurses who left a unit in 1 year divided by the total number of nurses employed on that unit is the turnover rate.

The instruments that give voice to the organization's philosophy include which of the following (select all that apply)? A. Goals B. Focus C. Vision D. Mission E. Core values

C. Vision D. Mission E. Core Vlues The mission, core values, and vision are the instruments that give voice to the organization's philosophy. The mission is an aim to be accomplished. It influences the philosophy, goals, and objectives of an organization. The vision is a mental image or the power of imagination to see something that is not actually visible.

The Joint Commission's (TJC's) staffing regulation states: A. staffing ratios are recommended in perinatal and critical care areas. B. Incorrect Response nurse managers may determine the nurse-to-patient ratio as long as the patient's needs are being met. C. hospitals must also provide the right number of competent staff members to meet the patients' needs. D. hospitals may limit the number of admissions to ensure there are an adequate number of staff members to meet patient needs.

C. hospitals must also provide the right number of competent staff members to meet the patients' needs. TJC noted the following (2006): The goal of the human resources function is to ensure that the hospital determines the qualifications and competencies for staff positions based on its mission; populations; and care, treatment, and services. Hospitals must also provide the right number of competent staff members to meet the patients' needs. (p. HR-1)

The core concept of the synergy model for patient care is based on the nurse-patient relationship and acknowledges: A. frontline charge nurses make informed patient care assignment decisions. B. organizing and delivering nursing care achieves desired patient outcomes. C. the needs or characteristics of the patients and families drive the competencies of the nurse. D. the clinical nurse leader champions innovations that improve patient outcomes, ensures quality care, and reduces health care costs.

C. the needs or characteristics of the patients and families drive the competencies of the nurse. The synergy model for patient care is presented by the American Association of Critical-Care Nurses (Hardin & Kaplow, 2005). The core concept of the model is based on the nurse-patient relationship and acknowledges that the needs or characteristics of the patients and families drive the competencies of the nurse. Synergy, or optimum outcomes, results when the needs and characteristics of the patient clinical unit, or system, are matched with a nurse's competencies (Kaplow & Reed, 2008).

The nursing shortage cycles over the past few decades have been primarily driven by factors including which of the following (select all that apply)? A. Aging of current nurses and inability of hospitals to meet nursing salary demands B. Younger nurses in the workforce and their preference for nontraditional nursing jobs C.Significant changes in the health care delivery system as the nation moves into health care reform D. Aging of the American population and struggles to expand capacity to meet demand for care E. Lower numbers of students entering nursing as a career and a shift in need for both bachelor's- and master's/doctorate-prepared nurses

C.Significant changes in the health care delivery system as the nation moves into health care reform D. Aging of the American population and struggles to expand capacity to meet demand for care E. Lower numbers of students entering nursing as a career and a shift in need for both bachelor's- and master's/doctorate-prepared nurses The nursing shortage cycles over the past few decades have been primarily driven by six factors: aging of current nurses in the workforce and their preparation for retirement, lower numbers of students entering nursing as a career and a shift in need for both bachelor's- and master's/doctorate-prepared nurses, aging of nursing faculty and inability of schools of nursing to meet education demands, aging of the American population and struggles to expand capacity to meet demand for care, and significant changes in the health care delivery system as the nation moves into health care

Authentic respect for others requiring time, presence, engagement, and intention to seek common ground is called _____.

Civility Civility is authentic respect for others requiring time, presence, engagement, and intention to seek common ground

The nurse manager within a small department has requested that the staff decide department coverage over the holidays. The department is not associated with patient care and serves as a supportive role to the organization. The staff is to present the manager with the coverage plan during the month of December. This is an example of which type of decision? A. Autocratic decision procedure B. Consultative decision procedure C. Joint decision making D. Delegated decision procedure

D. Delegated Decision Procedure A delegated decision procedure occurs when the leader allows participants to make the final decision. An autocratic decision procedure occurs when the leader makes all of the decisions. A consultative decision procedure occurs when decisions involve employee participation but the leader still makes the decision. Joint decision making occurs when the entire group decides by vote or consensus.

Which organizational theory emphasized the informal aspects of organization social structure and was influenced by the Hawthorne experiments? A. Bureaucratic theory B. Scientific management school C. Classical management theory C. Human relations school

D. Human Relations School Theorists in the human relations school emphasized the informal, rather than formal, aspects of organization social structure. Hawthorne experiments were influential in this school of thought.

The purpose of a root-cause analysis (RCA) is to: A. discipline the staff involved in the patient safety event. B. disclose the medical error to the patient/patient's family. C. identify the person(s) responsible for committing the error. D. identify the systems issues that led to a sentinel event.

D. Identify the systems issues that lead to a sentinel event

A group of tenured nursing faculty at a major university votes on whether a faculty member should receive tenured status. This type of decision making is referred to as: A. autocratic decision procedure. B. consultative decision procedure. C. delegated decision procedure. D. joint decision making.

D. Joint Decision Making Joint decision making occurs when the entire group makes the decision by two-thirds vote, a simple majority, consensus, or some other process. In this process, the group members have as much power as the leader.

The workload standard commonly used in nursing when calculating staffing patterns is: A. patient days. B. patient acuity system. C. average length of stay. D. nursing care hours per patient day.

D. Nursing care hours per patient day The amount of work performed by a unit is referred to as its workload, and workload volume is measured in terms of units of service. The workload standard commonly used is nursing care hours per patient day, although the validity of this measure is disputed.

The consequence of an intervention or treatment is known as a(n): A. achieved benefit. B. benchmark. C. expected response. D. outcome.

D. Outcomes The term outcomes has been defined as the conditions in patients and others that health care delivery aims to achieve (Peters, 1995). Donabedian (1985) described outcomes as changes in the actual or potential health status of individuals, groups, or communities.

Intravenous lines being dressed using sterile technique with a 2-´2-inch gauze and occlusive sterile tape versus a transparent dressing are being evaluated for infection rates. These data are collected and compared with current research to suggest an opportunity for improvement. This is an example of: A. best practice evaluation. B. current practice critique. C. practice difference analysis. D. performance gap assessment.

D. Performance Gap Assessment Performance gap assessment is a strategy of demonstrating an opportunity for improvement at baseline outlining current practice related to specific indicators. This is helpful in encouraging commitment for practice changes.

Interpersonal communication and the ability to apply _____ are two critical skills every nurse needs to enhance professional practice. A. Vision B. Supervision C. Delegation D. Problem Solving

D. Problem Solving Every nurse needs two critical skills to enhance professional practice. One is a skill at interpersonal relationships. This is fundamental to leadership and the work of nursing. The second skill is applying the problem-solving process. This involves critical thinking, problem identification, and the development of objectivity.

A group of people who believe they are a team but fall short of the definition of a true team is known as a: A. club. B. group. C. meeting. D. pseudoteam.

D. Pseudoteam A pseudoteam is a group of people who believe they are already a team, although clearly they fall short of the definition of a true team.

Individuals join groups because of: A. monetary rewards. B. mandatory obligations. C. physical needs. D. psychological drives.

D. Psychological Drives The reasons individuals join groups vary but may include psychological drives and primary needs.

How is the refreezing stage of change similar to the nursing process? A. Refreezing is similar to the assessment phase of the nursing process. B. Refreezing is similar to the problem identification phase of the nursing process. C. Refreezing is like the planning and implementation phase of the nursing process D. Refreezing is like evaluation in the nursing process.

D. Refreezing is like evaluation in the nursing process.

Responding to a code called in the psychiatric unit where she works, a staff nurse finds that a patient has committed suicide. The staff nurse correctly identifies this as a: A. benchmark incident. B. quality improvement issue. C. performance breach. D. sentinel event.

D. Sentinel Event A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.

The provision of guidance or direction, evaluation, and follow-up by the licensed nurse for accomplishment of a nursing task delegated to unlicensed assistive personnel (UAP) is: A. authorization. B. delegation. C. observation. D. supervision.

D. Supervision Supervision is the provision of guidance or direction, evaluation, and follow-up by the licensed nurse for accomplishment of a nursing task delegated to UAP (National Council of State Boards of Nursing, 1995).

On admission, the patient was found to have a blood glucose level of 218. The RN knows that except in emergency situations, it is hospital policy to obtain physician's orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. Because of the nurse's actions, the admitting hospital may be found to be: A. a judicial risk. B. an ostensible authority. C. indemnified. D. vicariously liable.

D. Vicariously Liable If a nurse negligently injured a client during the course of and within the scope of employment, not only would the nurse be directly liable for damages, but also the health care organization would be vicariously liable.

Nurses who are successful at time management: A. display an ability to set measurable goals and objectives. B. frequently volunteer for new and creative projects. C. hesitate to delegate because of perfectionist characteristics. D. tend to accomplish specific activities within a time frame.

D. tend to accomplish specific activities within a time frame Time management is accomplishing specific activities during the time available. It is a process of managing the things an individual does with his or her available time.