3

25. Which action by the nurse indicates placement in the unfreezing phase of Lewin's Change Theory? a. The nurse reconsiders what has caused themself to be resistant to change. b. The nurse begins the process of implementing change. c. The change has become routine. d. The change is permanent.

A Lewin's Change Theory consists of three phases: unfreezing, moving, and refreezing. In the unfreezing phase, the nurse reconsiders what has caused her to be resistant to change. In the moving phase, the nurse begins the process of implementing change. In the refreezing phase, the change has become a permanent, routine part of the nurse's life. PTS: 1 DIF: Cognitive Level: Application REF: p. 230 OBJ: Discuss the change process. TOP: The challenge of change MSC: NCLEX®: Not applicable MULTIPLE RESPONSE

4. Which statement by the nurse manager shows understanding of what initiated the development of the team Strategies and Tools to Enhance Performance and Patient Safety (STEPPS)? a. "The increased need for health care coverage" b. "The need for more qualified nurses" c. "A need for a teamwork system focused on improving communication and teamwork" d. "The increased cost of health care"

C The Department of Defense (DoD) Patient Safety Program, in collaboration with the Agency for Healthcare Research and Quality (AHRQ), developed an evidence-based teamwork system focused on improving communication and teamwork skills in the health care industry to improve patient outcomes. The team was not created to solve health care coverage concerns, search for more qualified nurses or to decrease the cost of health care. The Joint Commission accredits hospitals and health care agencies. The Institute of Medicine provides national advice on issues relating to biomedical science, medicine, and health, and its mission to serve as adviser to the nation to improve health. The Centers for Medicare is not about patient safety but about medical insurance for people older than the age of 65 years. PTS: 1 DIF: Cognitive Level: Application REF: p. 238 OBJ:Discuss Team STEPPS Tools as an evidence-based teamwork system to optimize patient outcomes.TOP:Patient management MSC: NCLEX®: Safe and effective care environment—management of care

8. The nurse manager is attempting to resolve an interpersonal conflict between two nurses. Which action below should be done first? a. Determine the facts related to the situation. b. Schedule a meeting time for resolution. c. Have an accurate understanding of the problem or conflict. d. Have the determination to resolve the conflict.

C The first step is to make sure that the nurse manager has an accurate understanding of the problem of conflict. The quality of the outcome of resolving a problem depends on proper recognition and identification of the problem or issue. This assessment is best addressed by determining the nature of the differences and the reasons for them. After this has been achieved, the next steps would be identifying the conflicting facts and developing ways to implement a plan for resolution. PTS: 1 DIF: Cognitive Level: Application REF: p. 288 | p. 290 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care

15. A nurse is unhappy about the way medications are being administered on the unit. What does the nurse need to do first to facilitate a change in the process? a. Initiate a new method starting with assigned patients. b. Discuss concerns with fellow nurses. c. Develop a better method to administer the medications. d. Inform the charge nurse of how it can be done better.

C The nurse needs to shift into the moving phase, which incorporates taking the lead by being responsible and willing to implement change by sorting out what must be done and by facilitating an appropriate and effective approach. Whenever one is not happy with a situation or procedure, it is important that providing suggestions for change be incorporated into the process. Discussing concerns with fellow nurses does not actively involve the change process. For change to be effective, it must have "buy-in" from other staff and not merely inform the staff or change nurse of how there is a better way to administer the medications on the unit. PTS: 1 DIF: Cognitive Level: Application REF: p. 229 OBJ:Discuss the change process.TOP:Nursing management MSC: NCLEX®: Not applicable

16. A nurse feels angry over a patient assignment and feels that assignments always include the "bad ones." What is the best way to control this anger? a. Ignore the negative feelings. b. Talk about other coworkers behind their backs. c. Face this anger and determine what is being felt. d. Refuse to speak to any coworkers for fear of lashing out.

C The nurse should face the anger and determine what is being felt. Ignoring angry feelings, talking about coworkers behind their backs, and ignoring others will not help to resolve the anger. PTS: 1 DIF: Cognitive Level: Application REF: pp. 297-300 OBJ:Discuss techniques to use in dealing with difficult people. TOP: Dealing with difficult people MSC: NCLEX®: Safe and effective care environment

22. An experienced nursing assistant could be assigned by the nurse to do which of the following? a. Help in the teaching of new diabetic clients to give themselves injections. b. Report on quality and quantity of urine and adjust drip rate on continuous bladder irrigation. c. Assist the client to obtain a clean-catch urine specimen. d. Chart the dietary intake for a client with an eating disorder.

C The nursing assistant can be assigned activities that involve standard, unchanging procedures, such as helping to obtain a clean-catch urine specimen from a client. Teaching, working with complicated procedures (continuous bladder irrigation), and monitoring dietary intake with a person having an eating disorder would need to be assigned to the nurse because they involve assessment and evaluation. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 309-311 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate's performance. TOP:Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care

14. A day shift nurse has come into work and notices that the glucometers were not tested overnight as they typically are. What is the best way for the nurse to question the nurse assistant, in order to give feedback? a. "Why didn't you test the glucometers?" b. "What did you do last night?" c. "How was your night? I noticed the glucometers weren't tested." d. "Couldn't you have asked one of the nurses to check the glucometers if you were busy?"

C When giving an individual negative feedback, the nurse should also ask for the nurse assistant's feedback. If the nurse becomes accusatory, the nursing assistant may become defensive, which does not help solve the issue of the glucometers not being tested. Asking, "How was your night? I noticed the glucometers weren't tested" gives the nursing assistant a chance to responds and explain what happened. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 321 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate's performance. TOP:The right supervision and delegation MSC: NCLEX®: Safe and effective care environment

5. A graduate nurse is observing nurses on a busy surgical unit. The graduate nurse notices that the nurses work together as an interchangeable part of the team and have an appropriate level of skills. When questioned by the charge nurse, the graduate nurse identifies this type of team as a. potential. c. basic. b. pseudo. d. real.

D Each person on a real team has the skills and abilities to be goal and group oriented. Each member has the ability to work as an interchangeable part of the team and is accountable for the team's outcomes. The other options are not types of team. PTS: 1 DIF: Cognitive Level: Application REF: pp. 275-276 OBJ:Discuss team building.TOP:Team building MSC: NCLEX®: Not applicable

10. A nurse is respected by peers for clinical skills and effective interpersonal relationships. The nurse has studied diabetic patient educational needs and consults with several units. What type of power does this nurse possess? a. Informational c. Reward b. Legitimate d. Expert

D Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others. Those who have information that others need to perform their duties have informational power. Legitimate power is based on the person's position within an organization. Reward power occurs when an individual has the power to give or withhold rewards. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222 OBJ: Differentiate between power and authority. TOP: Nursing management MSC: NCLEX®: Not applicable

13. A nurse is aware that an area of conflict between nurses and patient's families is quality of parental care. Which action would not help the nurse reduce conflict? a. Become frustrated with the parents for lack of participation in care b. Model positive parenting techniques c. Encourage parents to meet other parents d. Give out information about parenting classes

A To reduce conflict that nurse can model positive parenting techniques, encourage parents to meet other parents and give out information about parenting classes. The nurse should avoid becoming frustrated with parents because this will likely cause conflict. PTS: 1 DIF: Cognitive Level: Application REF: pp. 288-290 OBJ: Identify common factors that lead to conflict. TOP: Conflict MSC: NCLEX®: Safe and effective care environment

16. A nurse is meeting with the nurse supervisor to discuss an issue with a coworker. Which of the following statements would help the nurse effectively communicate with the supervisor? a. "This is all my coworker's fault. I never do anything wrong." b. "My coworker always makes 100 excuses to get out of work." c. "I knew you would be on their side." d. "I feel upset that my coworker seems to have less work than I do."

D When communicating with a nurse supervisor, the nurse should avoid blaming others and exaggeration. The nurse should instead focus on using "I" statements to express themself. PTS: 1 DIF: Cognitive Level: Application REF: p. 279 OBJ:Describe the basic components of communication. TOP: Communication in the workplace MSC: NCLEX®: Safe and effective care environment

20. A nurse manager has an adequate understanding of their nursing role when making which of the following statements? a. "A manager selects or assumes a role." b. "I have the same function as a floor nurse." c. "I have the same authority as the director of the hospital." d. "I was appointed to my role."

D Whereas a manager is assigned or appointed to a role, a leader selects or assume a role. The nurse manager functions differently than a floor nurses, and although the nurse manager has some authority, it is less than the director of the hospital. PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ:Differentiate between management and leadership. TOP: Management versus leadership MSC: NCLEX®: Not applicable

11. Which action by the nurse has a potential for creating role conflict? a. Arguing that the nurse on the next shift is responsible for weighing a patient b. Failing to discuss differences with a coworker the nurse is angry with c. Placing the nurse's personal achievement over that of coworkers d. Trying to change another nurse's personality

A Arguing with another nurse about whose responsibility it is to weigh a patient is an example of a role conflict. Failing to discuss differences is a communication conflict. Placing personal achievements about those of others is goal conflict. Trying to change another nurse's personality is personality conflict. PTS: 1 DIF: Cognitive Level: Application REF: p. 287 OBJ: Identify common factors that lead to conflict. TOP: Conflict MSC: NCLEX®: Not applicable

3. What do the responsibilities of the nurse manager include? a. Planning and organizing how nursing care can most effectively be delivered on the nursing unit b. Establishing the nursing care standards to be implemented on the unit c. Developing educational programs to assist staff to meet licensure requirements d. Assisting staff to adhere to organizational policies and procedures

A Managers must be attentive to both dimensions of their job: the mission and goals of the organization and planning with the staff to meet the nursing care goals of the unit within the overall goals of the institution. Both levels must be addressed—the organization as well as the needs of the individuals. Other options are not as comprehensive and could be included within the first option. PTS: 1 DIF: Cognitive Level: Application REF: pp. 208-210 OBJ: List characteristics of an effective manager and an influential leader. TOP:Nursing management MSC: NCLEX®: Safe and effective care environment—management of care

3. What is the best strategy for resolving the conflict in a situation in which two staff nurses request the same vacation weeks? a. Accommodation c. Competition b. Collaboration d. Avoidance

B Collaboration is the strategy that involves confrontation and problem solving. Needs, feelings, and desires of both parties are considered to create a win-win outcome. Avoidance is a lose-lose strategy for conflict resolution, which is unassertive and uncooperative. Competition is a win-lose situation in which the use of force or the use of power occurs. Accommodation is the lose-win situation in which one person accommodates the other at his or her own expense but often ends up feeling resentful and angry. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 288 | p. 290 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care

1. What is the most consistent concern of the nurse as manager? a. To develop long-range career goals b. To coordinate patient care while meeting the agency goals c. To maintain harmony within the agency d. To organize the subordinates to meet agency goals

B The role of the nurse as manager has evolved into a complex one that includes organizing patient care, directing personnel to achieve agency goals, and allocating resources. The most consistent concern of the nurse as manager is not to develop long-range career goals, maintain harmony within the agency, or organize subordinates to meet agency goals. Although having long-range career goals is a good idea for the nurse manager, it is not a day-to-day concern. Organizing subordinates in not a role of the nurse manager, but instead it is directing or supervising them to achieve patient care needs. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 208 OBJ: List characteristics of an effective manager and an influential leader. TOP:Nursing definition MSC: NCLEX®: Safe and effective care environment—management of care

18. A nurse is caring for a Latino patient. The nurse is aware of the importance of cultural competency and providing the patient with culturally competent care. What can be done to enhance communication with this patient? a. Use jargon or slang. b. Obtain an interpreter if needed. c. Give longer explanations to enhance understanding. d. Speak loudly to the patient.

B To communicate effectively with this patient, the nurse may need to obtain an interpreter. The nurse should also avoid jargon or slang, give shorter explanations, and speak in a normal volume and tone to the patient. PTS: 1 DIF: Cognitive Level: Application REF: p. 262 OBJ: Apply effective communication skills in common nursing activities. TOP:What does my image communicate to others? MSC: NCLEX®: Psychosocial integrity

17. Which statement by the nurse is true regarding sexual harassment? a. "Sexual harassment no longer occurs in the workplace." b. "Sexual harassment is only caused by men." c. "The most common sexual harassment complaint is inappropriate remarks and touching." d. "Nothing can be done to prove sexual harassment."

C The most common sexual harassment complaint is inappropriate remarks and touching. The statements that "sexual harassment no longer occurs in the workplace," "sexual harassment is only caused by men," and "nothing can be done to prove sexual harassment" are false. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 300-302 OBJ: Identify situations of sexual harassment in the workplace and discuss possible solutions. TOP:Sexual harassment in the workplace MSC: NCLEX®: Safe and effective care environment

21. Which of the following actions is consistent with a nurse leader? a. A nurse who encourages staff to give excellent patient care b. A nurse who performs chart audits on her staff c. A nurse who writes yearly staff evaluations d. A nurse who gives pain medication to an assigned patient

A A nurse leader is someone who influences others, such as a nurse who encourages staff to give excellent patient care. A nurse who performs chart audits and writes staff evaluations is functioning as a nurse manager. Giving pain medications is a function of the staff or bedside nurse. PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ:Differentiate between management and leadership. TOP: Management versus leadership MSC: NCLEX®: Not applicable

4. Based on the goal of making optimal use of the level of preparation of the licensed practical nurse (LPN), which task should the nurse (RN) delegate to the LPN? a. Assisting with a lumbar puncture b. Transporting a patient to the radiology department c. Restocking the sterile supplies d. Distributing afternoon nutrition supplements

A Assisting with procedure, such as a lumbar puncture, is within the scope of practice of the LPN. The nurse must select the right task for a competent person in a selected situation. Transporting clients, restocking supplies, and passing nutrition supplement are nursing interventions that can be carried out by a certified nursing assistant (CNA). PTS: 1 DIF: Cognitive Level: Application REF: p. 310 OBJ: Select the right person for the task. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care

14. The nurse manager is giving a presentation on the disadvantages of democratic leadership in group functioning. Which statement shows an understanding of this type of leadership? a. "Requires more time and effort to make decisions and accomplish goals" b. "Discourages participation from quieter members of the group" c. "Increases the possibility of "scapegoating" or argumentative behavior" d. "Is difficult to control the outcomes and decisions of the group"

A Because of the encouragement of participation in decision making and the democratic leadership's emphasis on group function, decision making becomes more involved with consensus and is less timely. Democratic leadership encourages group participation and works to reduce any type of scapegoating behavior among members because everyone has equal voice. The group democratically makes decisions and determines outcomes that are not controlled by management. PTS: 1 DIF: Cognitive Level: Application REF: p. 212 OBJ: Discuss theories of management and leadership. TOP: Nursing management MSC: NCLEX®: Not applicable

2. Of the following common areas of conflict between nurses and their patients and families, which does the nurse interpret as the most easily resolved? a. Issues of concern about quality of care b. Issues surrounding treatment decisions c. Issues of family involvement d. Issues about quality of parental care

A Families typically are concerned with how well their loved one is being attended to. Conflict often arises out of concerns related to quality of care. Whereas this is something that the nurse can directly address, issues of treatment decisions, family involvement, and quality of parental care often require more discussion and intervention. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 288 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care

18. A nurse is working with a nurse aide to care for a group of patients. Which of the following activities would be inappropriate to delegate to the nurse aide? a. Providing discharge instructions to a patient b. Refilling water containers c. Obtaining a lift to help a patient out of a chair d. Feeding a patient who is unable to feed himself

A It is the nurse's responsibility to provide discharge instructions to patients and to assess their understanding of them. This task cannot be delegated to the nursing assistant. Refilling water containers, obtaining a lift to help a patient out of a chair, and feeding patients are all tasks that can be delegated to the nursing assistant. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 251-252 OBJ: Identify criteria for supervising and delegating care provided by others. TOP: Managing others MSC: NCLEX®: Safe and effective care environment

7. How can the "grapevine" best be controlled? a. Providing factual information in anticipation of employees' questions b. Using an authoritarian communication style c. Putting everything in writing d. Having a strong union to represent employees

A Providing factual information in anticipation of employees' questions is an effective way to reduce the "grapevine." Most employees get secondhand information, and few employees get enough of the factual information that they need. Even if information is put in writing, it is important to communicate verbally to employees by answering their questions. A strong union does not necessarily reduce the grapevine. PTS: 1 DIF: Cognitive Level: Application REF: p. 261 OBJ: Identify effective ways of communication with other health care workers. TOP: Effective communication MSC: NCLEX®: Not applicable

19. A nurse manager is educating staff on how to give effective presentations. Which statement indicates an understanding of this? a. "To give an effective presentation, you should always maintain a positive attitude." b. "You should avoid planning and should create the presentation as you go." c. "Give the same presentation regardless of the audience." d. "To reduce anxiety, avoid making eye contact with the audience."

A To give an effective presentation the nurse should always maintain a positive attitude, plan the presentation ahead of time, spice up the presentation and make changes according to the audience, and make eye contact. PTS: 1 DIF: Cognitive Level: Application REF: pp. 264-265 OBJ: Apply effective communication skills in common nursing activities. TOP: Components of effective communication MSC: NCLEX®: Not applicable

6. What would be the best example of delegation? a. Transferring to another nurse the responsibility of caring for a patient requiring a blood transfusion b. Providing guidance to an LPN to hang blood on a patient c. Assigning a series of nursing unit tasks to the certified nursing assistant d. Assisting a new nurse to understand the rules and regulations of the Nurse Practice Act

A Transferring to another nurse the responsibility of caring for a patient requiring a blood transfusion is the best example of delegation. Delegation involves transferring to a competent nurse a specific task or responsibility for nursing care. The person who delegated the responsibility maintains responsibility for following guidelines for appropriate delegation. Providing guidance to an LPN and explaining to a new nurse about the Nurse Practice Act would be teaching and/or supervision rather than delegating a specific task or responsibility. Assigning to a CNA certain tasks is not delegation because there is no transferring of a specific task or responsibility of nursing care to that person. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 305 OBJ: Define the operational terms delegation, supervision, and accountability. TOP:Definition of delegation MSC: NCLEX®: Safe and effective care environment—management of care

23. Which of the following actions by the nurse manager would indicate an autocratic management style? a. Allows staff members to make most of the decisions b. Makes most of the decisions without input from the staff members c. Exerts little control over staff d. Emphasizes effective group functioning

B The autocratic manager uses an authoritarian approach to direct the activities of others. This manager would make most of the decisions without input from the staff members. Allowing staff members to make most of the decisions and exerting little control over staff is a laissez-faire management style. Emphasizing effective group functioning is common for a democratic management style. PTS: 1 DIF: Cognitive Level: Application REF: p. 211 OBJ:Differentiate the concepts of power and authority. TOP: Management versus leadership MSC: NCLEX®: Not applicable

14. Your team leader reminds you that you have forgotten to complete an assigned task. What is an assertive response? a. "Not now; I'm busy." b. "You're right. I did forget. I'll do it now." c. "It's not my fault. You should have reminded me sooner." d. "I'm so sorry I've disappointed you. It won't happen again."

B When using assertive communication, a person would respond to criticism by acknowledging the issue and taking direct action to correct the problem. An apologetic response is not assertively taking responsibility for the forgotten task. Telling the person "you should have reminded you sooner" is placing the responsibility of the forgotten task onto another person. Telling the person you are busy is denying the issue. PTS: 1 DIF: Cognitive Level: Application REF: p. 279 OBJ: Apply effective communication skills in common nursing activities. TOP: Effective communication MSC: NCLEX®: Not applicable

3. A member of a nursing committee frequently disregards the rules of the group and feels that the rules do not apply to the member personally. The president of the committee recognizes the term that best describe this person a. critical conservative. c. self-server. b. motor mouth. d. mouse.

C Self-servers are not willing to serve as a functioning part of the group, although they may appear to be group members when they perceive a personal benefit by the interaction. The critical conservatives typically have criticism for any suggestion other than their own. Motor mouths often interrupt others to get their points across. The mouse is known as a silent observer. PTS: 1 DIF: Cognitive Level: Application REF: p. 272 OBJ:Analyze group member roles.TOP:Team building MSC: NCLEX®: Not applicable

17. Which statement made the by the nurse indicates understanding of how to control the grapevine? a. "Grapevine rumors are generally true." b. "Avoid face-to-face communication." c. "Avoid spreading rumors." d. "Keep rumors circulating."

C To control the grapevine, the nurse should avoid spreading rumors. The nurse should also promote face-to-face communication, obtain information from the source, and stop the circulating of rumors by not engaging in gossip. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 261 OBJ: Identify effective ways of communication with other health care workers. TOP:What does my image communicate to others? MSC: NCLEX®: Safe and effective care environment

3. The nurse has a full assignment. The charge nurse adds a newly admitted patient who will require close monitoring. Which task can the nurse delegate to the CNA who is co-assigned to the same patients? a. Teaching Mr. Z insulin self-administration b. Updating Mrs. W's care plan c. Evaluating goal attainment for Mr. Y, who is learning to walk with a below-the-knee prosthesis d. Bathing Miss X, an unconscious patient

D Bathing a patient is an appropriate nursing intervention within the role and responsibilities and scope of practice of the CNA. The nurse must determine what needs to be done and then identify whether this is a task that can be delegated to someone else. The role of the nurse involves the coordination and planning of care, with the primary focus on identifying with the patient and the physician the desired outcomes for the patients. Teaching clients, updating nursing care plans, and evaluating patient responses to treatment plans are within the scope of practice of the registered professional nurse. PTS: 1 DIF: Cognitive Level: Application REF: p. 310 OBJ:Delegate tasks successfully based on outcomes. TOP:Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care

8. What are critical points to communicate during a shift report or hand-off communication? a. Patient name, current physical status, activities that have contributed to current status, problems that have occurred during the shift, nursing care to address problems, and a readback or response b. Patient name, room number and date of birth, changes in current orders, provider's visits, laboratory tests that have been completed, and physical activity of the patient c. Patient name, health care provider, diagnosis, review of all current orders, family visits and involvement in care, review of history leading to hospitalization, and current status of the patient d. Physician orders for past 24 hours, patient name and date of birth, medical and social history prior to hospitalization, and review of health problems since hospitalization

A According to the I-SBAR-R tool—Identification (patient name), Situation (current physical status), Background (activities that contributed to current status), Assessment (problems that occurred during shift), Recommendation (nursing care to address problems), Readback or Response (receiver acknowledges information)—these are critical areas. All of the other options contain items that are not critical to a shift report. PTS: 1 DIF: Cognitive Level: Application REF: pp. 243-244 OBJ:Utilize a standardized hand-off communication tool (I-SBAR-R) for receiving and giving change-of shift-report.TOP:Communication MSC: NCLEX®: Safe and effective care environment—management of care

10. Which action by the nurse shows a major characteristic of aggressive behavior? a. Achievement of personal goals at the expense of others b. Indirect expression of personal feelings c. Communication of personal needs d. Ability to restrict personal rights

A All of us have a style of communication that reflects our own personality and self-concept. Achievement of the nurse's goals at the expense of others shows an aggressive behavior. Indirect expression of one's feelings describes passive behavior. Being able to communicate one's own needs describes an assertive behavior. Restricting one's own rights does not describe an assertive style of communication. Aggression is not an indirect expression of one's feelings but a very direct expression. Aggressive communication is angry and dominating where the person attempts to humiliate or "put down" other people. PTS: 1 DIF: Cognitive Level: Application REF: p. 279 OBJ: Describe an assertive communication style. TOP: Effective communication MSC: NCLEX®: Not applicable

4. On the unit in which you work, one nurse's aide is usually pleasant and helpful; the other is often abrasive and angry. What is the most important basic guideline to be observed by a nurse who must resolve a conflict between the two nurse's aides? a. Deal with issues, not personalities. b. Require the aides to reach a compromise. c. Weigh the consequences of each possible solution. d. Encourage ventilation of anger and use humor to minimize the conflict.

A Dealing with the issues and not the personalities is one of seven important key behaviors in managing conflict. Whereas issues tend to be more concrete, personalities involve emotional issues. Although weighing the consequences is one of the seven key behaviors, it does not apply to this situation which involves the behaviors of the nurse's aides. Asking parties to compromise may not always be the best approach in resolving the conflict. Although encouraging ventilation of anger and using humor are successful approaches, it is important to always deal with the issue at hand and not the personality of the person. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 288 | p. 290 OBJ:Discuss techniques to use in dealing with difficult people. TOP:Conflict management MSC: NCLEX®: Safe and effective care environment—management of care

16. What should the nurse do to assess competence before delegating a task to an LPN? a. Ask if the LPN has previous experience performing the task. b. Ask if the LPN is willing to perform the task. c. Ask another nurse if the LPN is competent. d. Assume the LPN is competent due to her years of service.

A In order to assess competence, the nurse should ask the LPN if he or she has experience performing the task. Based on the answer, the nurse can then ask more questions if needed to determine competency. PTS: 1 DIF: Cognitive Level: Application REF: p. 314 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: The right circumstances MSC: NCLEX®: Safe and effective care environment

5. The nurse manager is updating unit staff on findings by The Joint Commission. Which of the following statements shows an understanding of untoward events in the hospital setting? The primary cause of untoward events is a. "unclear, ineffective communication." b. "unclear chain of communication for reporting." c. "ineffective reporting of the untoward event." d. "lack of consistent supervision of nursing staff."

A Ineffective communication was identified as the root cause for nearly 70% of all sentinel events reported. The majority of those untoward events involved communication failure. The other options were not identified as the majority of all sentinel events. PTS: 1 DIF: Cognitive Level: Application REF: p. 238 OBJ:Analyze effective communication as it relates to patient safety. TOP:Communication MSC: NCLEX®: Safe and effective care environment—management of care

18. What types of changes in management can be anticipated with the introduction of generations X and Y to the nursing work force? a. More flexible work time and increased personal responsibility for work outcomes b. Increased loyalty to the institution and the need for a well-defined work environment c. Increased interest in the goals and needs of the institution d. Increased structure within the nursing environment to more effectively predict outcomes

A Members of generations X and Y are more independent and place higher value on personal time. They are not characteristically team players, but they are very creative and want to be responsible for their work outcomes. Baby Boomers are focused on building careers and are invested in organizational loyalty. The silent or veteran generation places high value on loyalty, discipline, teamwork, and respect for authority. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 218 OBJ: Identify distinguishing generational characteristics of today's workforce. TOP: Generations X and Y MSC: NCLEX®: Not applicable

2. The clinical instructor interprets the development of mutual goals and guidelines as a. norming. c. storming. b. performing. d. informing.

A Norming begins with the development of guidelines and mutual goals. Successful task completion helps to redefine individual behavioral roles in the group. In the performing phase, everyone knows each other, and the group makes changes in a seamless way. The storming phase involves acting out roles normally portrayed in the presence of peers. Informing is not a phase in the group process. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 271 OBJ: Identify different types of groups and group process. TOP: Group process MSC: NCLEX®: Not applicable

9. The charge nurse is assigning patient care activities to the nursing care team. In supervising the team, what is the most effective activity to determine that the nursing care has been completed satisfactorily? a. Have hourly checks with personnel to determine how effectively nursing care is being completed. b. Review with personnel at the end of the shift regarding the status of patients and how care was delivered. c. Discuss with each person the status of their assigned patients and what type of nursing care each will require. d. Schedule routine patient care rounds to evaluate the patients and the nursing care that has been completed.

A Supervision entails providing direction, evaluation, and follow-up by the nurse regarding the nursing care assigned. The only way the nurse can determine whether the care has been done satisfactorily is to monitor the task (hourly checks with personnel) and evaluate the patient. Waiting until the end of the shift could lead to problems not being assessed early to prevent complications. Discussing with the health care provider about the patient is a good practice, but determining the outcome of the care is what needs to be evaluated not just telling them what type of care is required. Scheduling rounds allows the nurse to evaluate the patient; however, communication with the nursing team is important to determine if care is administered satisfactorily. PTS: 1 DIF: Cognitive Level: Application REF: p. 253 OBJ: Identify criteria for supervising and evaluating care provided by others. TOP: Supervision MSC: NCLEX®: Safe and effective care environment—management of care

11. The nurse manager on a surgical unit receives notification that multiple victims of a plane crash will arrive at the hospital momentarily. What is the most appropriate leadership style to adopt in this situation? a. Authoritarian c. Laissez-faire b. Democratic d. Eclectic

A The authoritarian style of management has its emphasis on the tasks, which would be effective during an emergency or disaster situation; hence, the autocratic manager may be most effective in a crisis situation. The laissez-faire manager maintains a permissive climate with little direction or control exerted. This manager allows staff members to make and implement decisions independently and relinquishes most of his or her power and responsibility to them. The democratic manager is people oriented and emphasizes effective group functioning. The environment is open, communication is both ways, and staff members are encouraged to participate in decision making. Eclectic is not a specific leadership management style. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 211 OBJ: Differentiate between power and authority. TOP: Nursing management MSC: NCLEX®: Not applicable

23. The nurse is preparing assignments in a pediatric unit for the night shift. Which of the following would be appropriate to assign the LPN/LVN? a. A 5-year-old child who had an appendectomy about 6 hours ago b. A 4-year-old child admitted for severe epiglottis who is running a fever of 102° F c. A 6-year-old child admitted with dehydration and receiving IV therapy d. A 7-year-old child who has inhalation burns 2 days ago and has a tracheostomy

A The child who is postoperative for the appendectomy would be an appropriate assignment for the LVN/LPV. This child's problem has a predictable outcome. The question doesn't mention any unstable symptoms that would have to be handled outside the LVN/LPN's scope of practice. The children with epiglottis, dehydration, and burns will need to be evaluated and monitored for complications, which is the scope of practice and responsibility of the nurse. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 309-311 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate's performance. TOP:Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care MULTIPLE RESPONSE

4. The nursing staff on a busy unit enjoys autonomy and needs minimal direction for patient care. Which leadership style would be most effective on this unit? a. Democratic c. Laissez-faire b. Authoritarian d. Bureaucratic

A The democratic manager is people oriented and emphasizes effective group functioning. The environment is open, communication is both ways, and staff members are encouraged to participate in decision making. The manager is also willing to take responsibility to make decisions when staff participation is not necessary. An authoritarian leader makes decisions without the input of others. The laissez-faire manager maintains a permissive environment. The bureaucratic leader follows a close set of standards to maintain order. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 212 OBJ: Describe various types of management. TOP: Nursing management MSC: NCLEX®: Safe and effective care environment—management of care

6. The nurse manager is beginning the process of problem solving. Which action should be taken first? a. Define the problem. c. Analyze the information. b. Gather information. d. Consider the alternatives.

A The good manager will guide the process of defining or identifying the problem by asking the what, when, and where of the problem. Before the manager can perform any of the other steps of problem solving, the problem must be identified. Importance is placed on management's ability to differentiate between facts and opinions and to attempt to break down the information to its simplest terms. PTS: 1 DIF: Cognitive Level: Application REF: p. 224 OBJ: Apply problem-solving strategies to clinical management situations. TOP: Nursing management MSC: NCLEX®: Not applicable

4. Which term refers to the group member who watches others take the risks and responsibility for group input and agrees with everyone in the group? a. Mouse c. Self-server b. Motor mouth d. Know-it-all

A The mouse is less confident of his or her abilities and is therefore less aggressive in the group dynamics. The motor mouth often interrupts others to get his or her point across. The self-server does not serve as a functional part of the group unless there is a benefit to them. The know-it-all is not a term used to describe group members. PTS: 1 DIF: Cognitive Level: Application REF: p. 272 OBJ:Analyze group member roles.TOP:Team building MSC: NCLEX®: Not applicable

20. Which statement would be most appropriate for the nurse to make when practicing assertive behavior? a. "I feel upset when Dr. Smith yells at me in front of my patients." b. "I can't believe what a jerk Dr. Smith is; the doctor should be fired!" c. "Dr. Smith was right in her action." d. "I am reporting Dr. Smith to the medical director."

A The nurse practicing assertive behavior would state: "I feel upset when Dr. Smith yells at me in front of my patients." The statement is direct and uses "I" statements. When the nurse says, "I can't believe what a jerk Dr. Smith is; the doctor should be fired" and "I am reporting Dr. Smith to the medical director," the nurse is using aggressive behavior. Statements such as: "Dr. Smith was right in her action" indicate passive/avoidant behavior. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 279 OBJ:Describe an assertive communication style. TOP: Assertive styles of communication MSC: NCLEX®: Safe and effective care environment MULTIPLE RESPONSE

21. A female patient in the medical-surgical unit is diagnosed with anemia and complains of weakness. Which of the following assignments could be given to the nursing assistant? a. Organize the patient's meal tray for dinner. b. Talk with the patient about managing her rest and activities. c. Get a diet history and list of the patient's favorite foods. d. Take an apical pulse and listen to the lungs for crackles.

A The only assignment that fits the scope of practice for the nursing assistant would be to organize the patient's tray. Talking with the patient and obtaining a diet history would be nurse functions, as would listening to the lungs for crackles. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 309-311 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate's performance. TOP:Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care

1. A newborn has several congenital anomalies incompatible with living beyond 1 month. The newborn cannot retain formula, and the temperature drops when the newborn is removed from the warmer. Two nurses who alternate caring for the baby argue about whether or not to attempt bottle feedings and whether the newborn should be removed from the warmer to be held. What is the origin of the conflict described? a. Ethical values c. Personal goals for advancement b. Nursing role concerns d. Personality differences

A This situation depicts personal issues based on two separate sets of ethics or values regarding the newborn's care. One nurse places value on nutritional needs and the other on the need for bonding. This conflict is not personality driven among the two nurses. The role of the nurse is to care for the newborn. They both want to care for the newborn, so they are meeting their nursing role; however, the conflict is based on an ethical issue about feeding and bonding. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 287 OBJ: Identify common factors that lead to conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care

4. Which of the following describes reward power used by the nurse manager? (Select all that apply.) a. A nurse manager who uses fear of consequences to motivate staff b. A nurse manager who uses salary increases to motivate staff c. A nurse manager who is perceived as an expert due to specialized knowledge d. A nurse manager who is well liked by the majority of staff e. A nurse manager who has information that others need to perform their jobs

A, B Reward power occurs when nurse managers provide or withhold rewards. A nurse manager who is perceived as an expert has expert power. A nurse manager who is well liked the majority of staff has referent power. A nurse manager who has information needed by others to perform their jobs has informative power. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222 OBJ:Differentiate the concepts of power and authority. TOP: Power and authority in nursing management MSC: NCLEX®: Not applicable MATCHING Match the leadership theory with the appropriate description. a. Development of trust in relationship; uses democratic concepts of management and views the tasks to be accomplished from the standpoint of a team member b. Holds power and control over followers by providing incentives when the followers respond in a positive way to the leader's vision and the actions needed to reach that vision c. Situation is analyzed and leadership style is selected that will best address issues d. Process in which leader and followers work together in a way that changes or transforms the organization, the employees or followers, and the leader e. Leadership is flexible enough to address varying situations f. Needs to look at systems, such as those in health care organizations, as patterns of relationships and the interactions that occur among those in the system 1. Complexity theory 2. Transformational leadership 3. Contingency leadership 4. Transactional leadership 5. Situational leadership 6. Interactional leadership ANS: 1.F PTS:1DIF:Cognitive Level: Application REF: p. 216 OBJ: Discuss theories of management and leadership. TOP: Nursing management MSC: NCLEX®: Not applicable 2.D PTS:1DIF:Cognitive Level: Application REF: pp. 214-215 OBJ: Discuss theories of management and leadership. TOP: Nursing management MSC: NCLEX®: Not applicable 3.E PTS:1DIF:Cognitive Level: Application REF: p. 213 OBJ: Discuss theories of management and leadership. TOP: Nursing management MSC: NCLEX®: Not applicable 4. B PTS:1DIF:Cognitive Level: Application REF: pp. 214-215 OBJ: Discuss theories of management and leadership. TOP: Nursing management MSC: NCLEX®: Not applicable 5.C :1DIF:Cognitive Level: Application REF: pp. 213-214 OBJ: Discuss theories of management and leadership. TOP: Nursing management MSC: NCLEX®: Not applicable 6.A :1DIF:Cognitive Level: Application REF: p. 214 OBJ: Discuss theories of management and leadership. TOP: Nursing management MSC: NCLEX®: Not applicable

6. Which statement(s) will help the nurse give feedback to a coworker? (Select all that apply.) a. "Can you tell me what happened?" b. "You did a great job positioning the postoperative patient." c. "What do you think can be done to ensure that the blood pressures are charted?" d. "I don't understand why you didn't do what I asked you to do." e. "I only gave you one job to complete."

A, B, C When giving feedback, the nurse should practice using the feedback formula. This includes asking for the other person's input ("Can you tell me what happened?"), giving credit for accomplishments ("You did a great job positioning the postoperative patient"), and asking for the others person's thoughts on resolutions ("What do you think can be done to ensure that the blood pressures are charted?"). The statements "I don't understand why you didn't do what I asked you to do " and "I only gave you one job to complete" would not be helpful in providing feedback to the coworker because they could cause the coworker to become defensive. PTS: 1 DIF: Cognitive Level: Application REF: p. 321 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate's performance. TOP:The right supervision and evaluation MSC: NCLEX®: Safe and effective care environment

3. Which actions by the nurse show an understanding of what the nurse is accountable for? (Select all that apply.) a. Assessing patients according to priority b. Determining the need to delegate a task to a nursing assistant c. Deciding that the nursing assistant is competent to perform the task delegated d. Following up to determine completion of the task that was delegated e. Delegating assessments of low-acuity patients to the nursing assistant

A, B, C, D Nurses show understanding of what they are accountable for by assessing patients according to priority, determining the need to delegate, deciding whether the nursing assistant is competent to perform that task, and following up to determine completion of the task that was delegated. Nurses should not delegate assessment of any patient to a nursing assistant. Assessment must be completed by the nurse. PTS: 1 DIF: Cognitive Level: Application REF: p. 306 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Delegation MSC: NCLEX®: Safe and effective care environment

4. The charge nurse is determining tasks that can be delegated to keep the unit running smoothly. What factors should the charge nurse consider before delegating? (Select all that apply.) a. Staff who are working b. Acuity of patients c. Community needs d. Teaching obligations of the nurses e. How many patients are waiting for beds on the unit

A, B, C, D The charge nurse should consider other factors such as the staff that are working, acuity of patients, community needs, and teaching obligations of the nurses before beginning to delegate. These factors will determine what kind of delegation can be safely handled by the staff. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 308 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Delegation MSC: NCLEX®: Safe and effective care environment

1. What action(s) by the staff nurse is an effective way to deal with a sexual harassment issue in the workplace? (Select all that apply.) a. Tell the person to stop. b. Tell your best friend about the incident. c. File a formal grievance. d. Explain the situation to your spouse. e. Play along with the person and document the activities. f. Threaten the person with a sexual harassment lawsuit.

A, B, C, D There are two ways to deal with sexual harassment workplace conflict, informally and formally through a grievance procedure. Start with the most direct measure. Ask the person to STOP! Tell the harasser in clear terms that the behavior makes you uncomfortable and that you want it to stop immediately. In addition, put your statement in writing to the person, keeping a copy for yourself. It is also important to tell other people (e.g., family members, friends, your personal physician, your minister) that this is happening and how you are dealing with it. PTS: 1 DIF: Cognitive Level: Application REF: pp. 300-302 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care

2. Which of the following are common factors of conflict encountered in nursing? (Select all that apply.) a. Ambiguous boundaries around work responsibilities b. Unclear communication to family members about visiting hours c. Nursing assistant placing personal achievement above everything d. Chief of medicine demanding that the nurse/patient ratio be increased e. Consideration of 26-week termination of pregnancy by a physician because of mother's health f. Vacation schedules posted with new staff members having to work at least one day during all holidays

A, B, C, D, E, F All of these areas are potential factors that can precipitate conflict in a nursing situation—roles, communication, goals, personalities, and conflicting ethics and values. PTS: 1 DIF: Cognitive Level: Application REF: p. 287 OBJ: Identify common factors that lead to conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care

1. Which of the following actions is consistent with a manager? (Select all that apply.) a. Planning the agenda for a staff meeting b. Directing nurse assistants in how to divide up patient care assignments c. Organizing a group of nurses to present a topic at a staff meeting d. Giving blood at the local hospital blood drive e. Assume control of the guidelines for how hourly rounding will work on the unit

A, B, C, E Managers plan, direct, organize. and control activities designated to their staff. Giving blood at the local hospital would not be an action that is consistent with a nurse manager role. PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ:Differentiate between management and leadership. TOP: Management versus leadership MSC: NCLEX®: Not applicable

2. A nurse manager is delegating a task to another nurse. Which of the following action(s) would help the manager effectively communication with the nurse? (Select all that apply.) a. Get the full attention of the nurse. b. Ask the nurse to repeat back what he or she heard. c. Give directions to the nurse as the nurse is walking away. d. Give clear, simple instructions. e. Give instructions while multitasking.

A, B, D The nurse manager should first get the full attention of the nurse before the nurse manager begins to communicate with the nurse. The nurse manager should give clear, simple instructions and ask the nurse to repeat back what he or she heard. PTS: 1 DIF: Cognitive Level: Application REF: p. 259 OBJ:Describe the basic components of communication. TOP: Communication in the workplace MSC: NCLEX®: Safe and effective care environment

5. The nurse is preparing to delegate work to the nurse aide. What can be done to ensure that work is delegated in a manner that is understood by the nurse aide? (Select all that apply.) a. Determine if the nurse aide understands what is being asked b. Ensure that the directions giving are in accordance with policy c. Delegate more difficult tasks because the nurse aide is experienced d. Ask the nurse aide if he or she has the info needed to complete the task e. Refrain from delegating and complete the tasks themselves

A, B, D The nurse should determine if the nurse aide understands what is being asked. The nurse can do this by asking the nurse aide to repeat the directions back or read-back. The nurse should also ensure that the directions given are in accordance with policy and ask the nurse aide if her or she has the info needed to complete the task. The nurse should not delegate more difficult tasks because the nurse aide is experienced or refrain from delegating and completing all tasks by themself. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 319 OBJ: Apply the "four C's" of initial direction for clear understanding of your expectations TOP: Delegation MSC: NCLEX®: Safe and effective care environment

3. Which of the following statement by the nurse reflect transformational leaders? (Select all that apply.) a. Lifelong learners b. Courageous change agents c. Slow to change d. Value-driven visionaries e. Hesitant to follow

A, B, D Transformational leaders are lifelong learners, courageous change agents, and value driven visionaries. They are not slow to change or hesitant to follow. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 214 OBJ:Describe theories of management and leadership. TOP: Management versus leadership MSC: NCLEX®: Not applicable

1. Which of the following actions can the nurse take to communicate with the supervisor? (Select all that apply.) a. Keep the supervisor informed. b. Focus on problem solving. c. Use "you" statements. d. Calm down before speaking. e. Choose words wisely.

A, B, D, E To communicate openly and effectively with the nursing supervisor, the nurse should keep the supervisor informed, focus on problem solving, use "I" statements, calm down before speaking, and choose words wisely. PTS: 1 DIF: Cognitive Level: Application REF: pp. 257-258 OBJ:Describe the basic components of communication. TOP: Communication in the workplace MSC: NCLEX®: Safe and effective care environment

3. Which actions can the nurse take to improve personal credibility? (Select all that apply.) a. Wear well-fitting clothes. b. If female, wear a reasonable amount of make-up. c. Be as original as possible at work. d. Maintain a flattering, neat haircut. e. Maintain a reasonable weight.

A, B, D, E To improve the nurse's credibility, the nurse should wear well-fitting clothes and a reasonable amount of make-up (if female). The nurse should maintain a flattering, neat haircut and maintain a reasonable weight. The nurse should reserve individuality for outside of work. PTS: 1 DIF: Cognitive Level: Application REF: p. 259 OBJ: Identify effective ways of communication with other health care workers. TOP: What does my image communicate to others? MSC: NCLEX®: Not applicable

2. A nurse manager is in the planning phase in a new job. Which action shows this? (Select all that apply.) a. Developing goals that reflect the mission and vision of the organization b. Defining strategies to meet the mission and vision of the organization c. Providing direction for staff to perform the work of the organization d. Retaining accountability for all work completed by the staff e. Planning for contingencies which may interfere with the work of the organization

A, B, E In the planning phase, the nurse manager will develop goals, define strategies, and plan for contingencies that may interfere with the work. The next phase of management is providing direction to staff and retaining accountability for all work completed by the staff. PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ: Management versus leadership. TOP: Differentiate between management and leadership MSC: NCLEX®: Not applicable

5. A nurse notices that a coworker has been taking longer lunch breaks. The nurse is frustrated by this and wants to use assertive communicate techniques to effectively handle the situation. Which statement(s) would be the most beneficial? (Select all that apply.) a. "I feel frustrated about the length of your breaks because I am really busy with my patient assignment today." b. "You need to stop taking such long lunch breaks while the rest of us pick up your slack!" c. "I am willing to compromise so that we can both get the breaks and help that we need." d. "I am having a hard time keeping up with both of our assignments today." e. "You are putting my nursing license in jeopardy."

A, C, D To effectively communicate, the nurse should use "I" statements and compromise with her coworker. Statements that would be the most beneficial include "I feel frustrated about the length of your breaks because I am really busy with my patient assignment today," "I am willing to compromise so that we can both get the breaks and help that we need," and "I am having a hard time keeping up with both of our assignments today." PTS: 1 DIF: Cognitive Level: Analysis REF: p. 279 OBJ:Describe an assertive communication style. TOP: Assertive styles of communication MSC: NCLEX®: Safe and effective care environment

7. The nurse manager understands the causes of performance weaknesses when making which of the following statements? (Select all that apply.) a. "The employee does not know what is expected." b. "The employee is getting adequate feedback." c. "The employee requires additional education." d. "The employee lacks motivation." e. "The employee needs additional supervision."

A, C, D, E There are several causes of performance weaknesses, including not knowing what the expectations are, not getting adequate feedback, not having enough education to perform the job, lack of motivation, and requiring additional supervision. PTS: 1 DIF: Cognitive Level: Application REF: p. 315 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate's performance. TOP: The right circumstances MSC: NCLEX®: Safe and effective care environment

7. What actions can a nurse implement into daily practice to reduce conflict? (Select all that apply.) a. Deal with issues and not personalities. b. Worry about themselves and no one else. c. Communicate openly. d. Listen actively. e. Sort out issues.

A, C, D, E To reduce conflict, nurses can implement the following actions into their daily practice: deal with issues and not personalities, communicate openly, listen actively, and sort out issues. PTS: 1 DIF: Cognitive Level: Application REF: pp. 288-290 OBJ: Discuss five methods to resolve conflict. TOP: Conflict resolution MSC: NCLEX®: Safe and effective care environment

8. A nurse manager is discussing the "five rights of clinical delegation?" Which statement indicates understanding? (Select all that apply.) a. "The nurse should determine if the task can safely be delegated." b. "The nurse should determine if this is a task that will fit into schedule." c. "The nurse should delegate the task to the right person." d. "The nurse should determine whether this is a task that would enhance learning." e. "The nurse should provide feedback to the delegate."

A, C, E To safely delegate, the nurse manager should determine the following: The right task—determining whether the task can be delegated The right circumstance—according to the NCSBN, the appropriate client setting, available resources, and consideration of other relevant factors The right person—matching the task to the right (qualified) person The right direction and communication—clear expectations of what needs to be done The right supervision and evaluation—acknowledgment that the person understands the information and is capable of completing the task and giving them feedback and evaluation PTS: 1 DIF: Cognitive Level: Application REF: p. 308 OBJ: Delegate tasks successfully based on outcomes. TOP: Definition of delegation MSC: NCLEX®: Safe and effective care environment—management of care

12. Which of the following scenarios shows an ethical conflict? a. A nurse who consistently speaks poorly of another nurse for always being "grumpy" b. A nurse who has a hard time respecting 'no codes' on young patients c. A nurse who refuses to run a systems check on the glucometers because "it's night shift's duty" d. A nurse who forgets to alert family members to a change in visiting hours

B A nurse who has a hard time respecting "no codes" on young patients is experiencing an ethical conflict. A nurse who speaks poorly of another nurse has a personality conflict. A nurse who refuses to run controls on a glucometer has a role conflict. A nurse who forgets to alert family members to a change in visiting hours has a communication conflict. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 287 OBJ: Identify common factors that lead to conflict. TOP: Conflict MSC: NCLEX®: Safe and effective care environment

18. To optimally use the level of preparation of the LPN, which task should the nurse delegate to the LPN? a. Transporting a patient to the laboratory b. Assisting with a thoracentesis c. Restocking and counting the sterile supplies d. Passing afternoon nutrition supplements and waters

B Although the LPN/LVN could be delegated appropriately to do all of these tasks, assisting with procedures (e.g., the thoracentesis) would make best use of the LPN's emergency department educational preparation. The other activities would be appropriate to delegate to a nursing assistant. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 309-311 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate's performance. TOP:Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care

5. There is a temporary agency registered nurse assigned to the nursing unit. You have no knowledge of this nurse's skills, and you want to assign the nurse to a patient who has a fresh tracheostomy. How should you handle this situation? a. Assign the nurse to the patient with the tracheostomy and hope for the best. b. Ask the nurse about his or her competency to care for the patient with the tracheostomy. c. Assign the patient to another nurse and use the temporary agency nurse to do simple care tasks. d. Call the agency and ask for a nurse skilled in the care of a patient with a tracheostomy.

B Float and temporary nurses should be asked about their competency at the beginning of a shift or assignment. Never assume that an individual knows something; be sure and ask. Delegation of an activity should always be followed by an anticipated response from that nurse as to whether or not he or she feels capable of performing the task. It is important to determine the competency of the nurse as well as to make sure the nurse indicates he or she is competent to carry out the delegated activity. It would be appropriate to check on this nurse frequently to evaluate their delivery of care or to offer assistance. It would be okay to call the agency and verify the nurse's skilled competencies, but talking with the nurse would still be the first action. PTS: 1 DIF: Cognitive Level: Application REF: p. 314 OBJ: Select the right person for the task. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care

1. Which action shows the cyclical phase of forming? a. A group dissolving b. Individuals coming together with a common bond c. Developing mutual goals d. A group completing tasks together

B Forming is the beginning development of a group with well-defined reasons and common directions. In the storming phase, the nurse begins to act out the roles they normally portrays in the presence of peers. Norming occurs during the development of mutual goals and guidelines that help to redefine the nurse's behavioral roles in the group. During the performing phase, everyone knows one another, is able to work together, and trusts one another. PTS: 1 DIF: Cognitive Level: Application REF: p. 269 OBJ: Identify different types of groups and group process. TOP: Group process MSC: NCLEX®: Not applicable

13. The nurse is reviewing I-SBAR-R with a coworker at the end of the shift. Which statement indicates that they are discussing the Situation component? a. The nurse states the patient's name using two identifiers. b. The nurse states that the patient was hospitalized for a broken tibia and that surgery is scheduled for later today. c. The oncoming nurse acknowledges the info that has been received. d. The nurse states an opinion on what is happening with the patient.

B In the Situation component of I-SBAR-R, the nurse states what is going on with the patient. In this situation, the patient was hospitalized with a broken tibia, and surgery is planned for later today. The Identification component involves stating the patient's name, the Assessment component involves the nurse discussing what the nurse thinks is happening with the patient, and the Read-Back or Response component involves that the oncoming nurse repeating what the nurse has heard from the nurse who is reporting at the end of the shift. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 244 OBJ: Utilize a standardized hand-off communication tool (I-SBAR-R) for receiving and giving change-of shift-report. TOP: Communication and patient safety MSC: NCLEX®: Safe and effective care environment

3. A nurse is assigned to care for five patients. The nurse is concerned about the ability to care for this many patients. The nurse needs to a. delegate one of the patients to someone else. b. prioritize the needs of the patients and determine the sickest patient. c. procrastinate and hope that someone will offer assistance. d. do the easiest patients first to allow more time for sicker patients.

B It is important to determine the least stable patient when planning care for multiple patients. Plan and complete the care for the patient who requires multiple treatments or complex nursing care. This patient is most likely to experience physiological problems if the nurse does not address his or her needs. The others are cared for in the priority order determined by their stability and needs. Procrastination and caring for the easiest patient first are not reflective of assessing patient needs and administering patient care management effectively. PTS: 1 DIF: Cognitive Level: Application REF: p. 249 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting. | Identify time-management strategies for increasing high-payoff, high-priority activities. TOP:Time management in clinical MSC: NCLEX®: Safe and effective care environment—management of care

9. Which of the following actions by the nurse leader is most likely to lead to an effective meeting? a. Creating an atmosphere in which people say very little b. Sending out an agenda ahead of time c. Creating well-designed overhead transparencies d. Completing all the tasks of the group

B It is the leader's responsibility to send out an agenda ahead of time and to indicate any preparations members need to make or materials they need to bring. It is important to have a meeting atmosphere where people feel as though they can respond and ask questions in a cooperative and collaborative setting. It is not necessary to have well-designed handouts for the meeting or for the leader to complete all the tasks of the group because this would indicate a lack of participation from the group members. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 273-274 OBJ: Identify effective ways of communication with other health care workers. TOP: Effective communication MSC: NCLEX®: Not applicable

5. Which statement best describes effective leadership by the nurse manager? a. Directs a staff nurse to modify his or her communication skills b. Fosters behavior changes in one staff member that have positive effects on the nurse manager and his or her peers c. Encourages behavior changes through the annual evaluation process d. Uses the group process to determine what behavior is distressing to staff

B Leadership in groups is democratic; the members feel positive about their participation and the outcomes of the group process. The other options are not examples of effective leadership. This person should be flexible enough to adapt to the changing roles of nursing staff. The nurse manager/leader should be willing and able to share power with the same people that he or she will supervise. It is important to understand that the most effective leadership style for one situation is not necessarily the most effective for another. Research indicates that the effectiveness of the leader is influenced by the situation itself. As leadership theories continue to develop, emphasis is more on what the leader does rather than on the traits the leader possesses. Effective leadership revolves around the leader focusing a group's efforts on identifying goals and carrying out the activities needed to reach those goals, not necessarily on individual issues, such as an annual evaluation processes or working with a staff to change communication skills. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 216 OBJ: List characteristics of an effective manager and an influential leader. TOP: Nursing management MSC: NCLEX®: Not applicable

2. The instructor has suggested that the student nurse could improve organizational skills and manage time better by scheduling selected nursing activities in the daily assignment. Which activity should be scheduled? a. Suctioning the tracheostomy tube of a patient b. Administering medications c. Assessing patient knowledge of colostomy care d. Assisting a patient with personal hygiene

B Medications are the most time sensitive issues in nursing care delivery. Scheduling is predetermined by the physician's order. Assessment of a patient's understanding of colostomy care can be done at any time. Personal hygiene needs can be met around non-time-sensitive issues (medications, treatments) in managing the patient care. Suctioning a tracheostomy should be performed when the patient needs it; it is not scheduled. PTS: 1 DIF: Cognitive Level: Application REF: p. 249 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting. TOP:Time management in clinical MSC: NCLEX®: Safe and effective care environment—management of care

15. Staff nurse 1: "You're stomping around and glaring at me. I'm wondering what's going on." Staff nurse 2: "I'm sick of you always going to lunch first. You don't care about anyone but yourself." What assessment can best be made about this exchange? a. Staff nurse 1's remark is challenging and obstructive. b. Staff nurse 1's remark invites clarification of the meaning of the specific behaviors of staff nurse 2. c. Staff nurse 2's remark will facilitate effective problem solving. d. Staff nurse 2's remark will keep anger at a minimum and give incentive for meeting the other's needs.

B Nurse 1 was assertive in her approach by giving direct descriptive feedback reflecting nurse 2's actions with a question seeking information to explain nurse 2's actions. Asking about what is going on allows nurse 2 to make some comment about what is bothering her. Nurse 2's comment does not promote effective problem solving as it is judgmental (You don't care about anyone but yourself.). PTS: 1 DIF: Cognitive Level: Analysis REF: p. 279 OBJ: Apply effective communication skills in common nursing activities. TOP: Effective communication MSC: NCLEX®: Not applicable

19. The nurse understands that having a stand-up meeting versus the traditional (sitting at a conference table) meeting takes less time to come to a decision based on which of the following ideas? a. Contingency-style leadership b. Evidence-based management protocols and interventions c. Autocratic management style d. Presence of a clinical nurse leader (CNL)

B Nurses are expected to practice using evidence-based protocols and interventions for clinical decision making, and managers are expected to use those management practices that are not simply based on conventional wisdom but on demonstrated outcomes. Evidence indicates that stand-up meetings took 34% less time to make decisions (Pfeffer & Sutton, 2006). Using this model could save an organization many hours a year that can be put to another productive use or could be eliminated from the payroll. However, very few organizations use this model for meetings even in the face of the clear evidence of the impact it would have on the organization. The CNL is a highly prepared individual in the clinical setting whose role is to positively impact patient safety issues by identifying and managing risk while meeting standards of quality clinical care. Autocratic management style is authoritative. Contingency leadership style is a style of leading that is flexible to adapt to the situation. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 225 OBJ:Discuss the value of using evidence-based management actions. TOP: Nursing management MSC: NCLEX®: Not applicable

16. The nurse wants to anticipate patient needs in order to increase patient satisfaction and decrease the use of call bells in the assigned section. What actions can be taken to achieve this? a. Tell patients to turn on their call bells if they need something. b. Perform hourly rounding on each patient. c. Check on the patient every 2 to 3 hours. d. Check on the patient only when medication needs to be administered.

B Performing hourly rounding encourages the nurse to anticipate the patient's needs, thereby increasing patient satisfaction and decreasing call bell usage. Although checking on the patients every 2 to 3 hours is appropriate, it is not the best answer because hourly rounding provides increased patient satisfaction and reduction of call bells. The nurse needs to check more frequently on the patient rather than wait until the nurse sees the patient when medications are administered. PTS: 1 DIF: Cognitive Level: Application REF: p. 250 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting. TOP:Managing time in the clinical setting MSC: NCLEX®: Safe and effective care environment

1. During clinical experience, the student nurse is assigned a patient scheduled to undergo numerous treatments. The student decides it is not possible to complete all the needed treatments in the time scheduled for this clinical day. The student nurse consults with the clinical instructor to a. delegate. c. procrastinate. b. prioritize. d. do the easiest treatment first.

B Plan your care of a patient who requires multiple treatments or complex nursing care by determining the priority of the patient's problems or needs so that you can provide care to the patient's highest priority needs first. Delegation would not be the most logical or appropriate choice as the student is not working over anyone. It is not always wise to do the easiest treatment first because difficult treatments may have unexpected outcomes that may challenge time management. Procrastination is never a good approach in managing patient care. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 249 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting. TOP:Nursing time management in clinical MSC: NCLEX®: Safe and effective care environment—management of care

10. The nurse needs to discuss a problem with the nursing assistant. The nursing assistant has left several rooms cluttered with trash and not cleaned appropriately. Which comment by the nurse would be the best way to approach the problem? a. "I checked on the four rooms you were assigned, and they are really a mess." b. "Have you had a problem completing your work assignment today?" c. "All four of the patient rooms assigned to you today are messy with a lot of trash in them." d. "Family members have been really upset today. Why have you not cleaned up the rooms assigned to you?"

B Providing an open-ended question to determine if there was some difficulty with an assignment is an appropriate method to assess this situation. When correcting or telling a person that they did something wrong, it is best to start by giving that person an opportunity to provide some input into the situation. This can be accomplished by asking the nursing assistant if there were any problems completing the assignment today. Asking "why" type questions can put the person on defensive and does not allow the CNA to provide an explanation of why the rooms were cluttered. Telling the CNA that the rooms were cluttered and messy does not address the issue of how it occurred. PTS: 1 DIF: Cognitive Level: Application REF: pp. 321-322 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate's performance. TOP:Providing feedback MSC: NCLEX®: Safe and effective care environment—management of care

10. Considering the following terms used to label different styles of handling anger—the Sherman tank, the sniper, the constant complainer, and the clam. Which of the following comments would you expect a Sherman tank to make? a. "That sure sounded like a put-down to me." b. "How dare you accuse me of not putting away the linen!" c. "So, you think you know everything, eh?" d. "Why do we always have to rotate shifts?"

B Sherman tanks attack individuals and have a strong need to prove to themselves and to others that their view of a situation is right. Their comments are abusive and abrupt and can be intimidating. Snipers take "potshots" at others and are not as openly aggressive as Sherman tanks. Constant complainers do just that—they complain but offer no solution. Clams also behave like their name—they clam up and refuse to respond when you need an answer or want to talk. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 292 OBJ: Discuss solutions and alternatives in dealing with anger. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care '

7. What would be the best example of supervision? a. Assigning nursing care for a group of five patients to a nurse b. Following up with a CNA on the assigned task of ambulation and feeding of two patients c. Assigning a urinary catheterization and collection of sterile culture to an LPN d. Scheduling the LPN to administer medications on the unit for the afternoon

B Supervision is the provision of guidance, direction, and follow-up for the accomplishment of an assigned task. The nurse would follow up with the CNA to determine whether the tasks were completed and whether any problems occurred. Assigning nursing care for a group of patients or a specific procedure are examples of delegation, as is scheduling an LPN to administer medications. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 305 OBJ: Define the operational terms delegation, supervision, and accountability. TOP:Definition of supervision MSC: NCLEX®: Safe and effective care environment—management of care

13. Which statement by the staff nurse shows adequate understanding of the nurse manager role? The nurse manager: a. "is given information and power through an official position." b. "coordinates group activities toward a common goal." c. "is responsible for developing goals to be accomplished." d. "selects and assumes a role among a group of peers."

B The manager coordinates the activities of the group to maintain balance and direction. There are generally four functions the manager performs: planning (what is to be done), organizing (how it is to be done), directing (who is to do it), and controlling (when and how it is done). Good leaders carefully balance job-centered and employee-centered behaviors to meet both staff and patient needs effectively and often have information and power through an official position. A good leader works toward developing goals and has a sense of purpose and direction. A good leader must also be aware of how her or his behavior impacts the workplace. Emotions, moods, and patterns of behavior displayed by the leader will create a lasting impression on the behavior of the team involved. A team member is a person who assumes a role among a group of peers. PTS: 1 DIF: Cognitive Level: Application REF: p. 208 OBJ: List characteristics of an effective manager and an influential leader. TOP: Nursing management MSC: NCLEX®: Not applicable

24. The nurse manager identifies which of the following as the most critical step in problem solving? a. Brainstorm all possible solutions. c. Evaluate possible solutions. b. Identify the problem. d. Choose a solution.

B The most critical step in the problem solving process is to identify the problem. Brainstorming solutions, evaluating possible solutions, and choosing a solution occur after the problem has been identified. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 224 OBJ: Apply problem-solving strategies to clinical management situations. TOP: Management problem solving MSC: NCLEX®: Not applicable

17. Which of the following statements indicate the nurses understanding of accountability in the delegation process? a. "I am solely accountable for the actions of the delagetee." b. "I am accountable for assessing the delegatee's competency before delegation." c. "The delegate is responsible for telling them if they are competent." d. "The manager is responsible for providing feedback to the delegate."

B The nurse is accountable for assessing the delegatee's competency before delegation and providing feedback after the task has been completed. The delegate is solely responsible for his or her actions, not the nurse. PTS: 1 DIF: Cognitive Level: Application REF: p. 307 OBJ: Define the operational terms delegation, supervision, and accountability. TOP: Accountability MSC: NCLEX®: Safe and effective care environment

14. A nurse has received report on assigned patients and is prioritizing their care. Which of the following patients should the nurse assess first? a. A female patient who is complaining of a headache b. A patient who has just returned from surgery and has saturated his dressing c. A patient with a femur fracture that is requesting pain medications d. A male patient who needs to use the bathroom

B The nurse should assess patients using Maslow's hierarchy of needs or the ABCD system. In the situation, the patient who has saturated his postoperative dressing should be seen first because an issue with the circulatory system makes the patient a priority over the others. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 249-250 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting. TOP:Managing time in the clinical setting MSC: NCLEX®: Safe and effective care environment

19. The charge nurse is assigning patients for care. There are two nurses, a LPN, and a certified nursing assistant (CNA). The charge nurse would assign which of the following patients to the LPN? a. An older adult who is receiving IV chemotherapy through a central line and will need a dressing change b. An adult patient diagnosed with insulin-dependent diabetes who will need dressing changes on several stasis ulcers on the lower extremities c. An adult patient with a right fractured femur and right arm in a cast who needs to urinate d. An older patient with terminal cancer who will be transferred to hospice

B The patient with diabetes will need stasis ulcer care, which is within the scope of practice of the LPN. The patient receiving chemotherapy through a central line would be assigned to the nurse. The nursing assistant would help the female patient with the fractures with the bedpan. The nurse should facilitate the transfer of the hospice patient. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 309-311 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate's performance. TOP:Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care

15. A nurse is reviewing delegation with a graduate nurse. The nurse knows that the teaching has been successful when the graduate nurse states which of the following? a. "The nurse can delegate assessments to the nurse assistants." b. "The nurse must create the care plan based on assessment findings." c. "The nursing assistants cannot perform bed baths on postsurgical patients." d. "The LPN can perform discharge teaching."

B The teaching has been successful when the graduate nurse states: "The nurse must create the care plan based on assessment findings." The nurse is solely responsible for this action. The nurse cannot delegate assessments to the nursing assistants; this must be completed by the nurse. Performing discharge teaching is a requirement of the nurse, not the LPN. Nursing assistants can perform bed baths on postsurgical patients. PTS: 1 DIF: Cognitive Level: Evaluation REF: pp. 309-310 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: The right task MSC: NCLEX®: Safe and effective care environment

6. A staff nurse who has worked on the unit for 6 months voices the following concerns to another nurse: "The clinical nurse leader of the unit often follows me into the supply room and stands blocking the doorway and chats. The nurse leader makes opportunities to mention my good looks, muscular physique, or strength in the context of daily work, saying things like: 'You're so handsome; no wonder your patients like you.' The nurse leader frequently touches me on the arm, the shoulder, chest, or the hair, and if I'm sitting, touches my leg. Yesterday, the nurse leader patted my arm and said, 'You know, if we were dating, I might be able to give you lighter assignments.' I don't want to date the nurse leader. I just want to be left alone! What should I do?" What is the best reply? a. "Don't be quite so honorable. Go on a date and see if you get better assignments." b. "Confront the nurse leader with a description of the behavior and state that you want the behavior to stop." c. "Go directly to the human relations office at the agency and tell them what you just told me." d. "Contact your lawyer and get advice ASAP in case the nurse leader decides to turn the tables and accuse you of advances."

B There are two ways to deal with sexual harassment in the workplace: informally by confrontation and formally through a grievance procedure, keeping a record of all confrontations and statements in writing. The best first step is to confront the person directly. Then, if there is no stopping of the behavior, go to the human relations office and explain the situation. At this point, there is no need to contact a lawyer because the human relations office can handle the sexual harassment issue. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 300 OBJ: Identify situations of sexual harassment in the workplace and discuss possible solutions. TOP:Conflict management MSC: NCLEX®: Safe and effective care environment—management of care

7. To resolve a scheduling conflict, a nurse manager is using employment seniority. The nurse manager interprets this as a. a win-win strategy. c. a lose-lose strategy. b. a win-lose strategy. d. a compromise.

B This is an example of a win-lose strategy, which underpins competition as the method of resolving the conflict. The person with the more seniority wins, and the one with the lesser seniority loses the scheduling issue. Compromise or bargaining is a modified win-lose strategy. In this instance, there is no compromise as the nurse manager uses seniority to resolve the conflict. Avoidance is a lose-lose strategy for conflict resolution, which is unassertive and uncooperative. Win-win strategies involve collaboration and problem solving, which lead to cooperation and objectivity. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 289 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care

6. Which of the following statements by the nurse about unresolved conflict is true? (Select all that apply.) a. "Conflict makes nursing staff more productive." b. "Conflict reduces productivity among staff." c. "Conflicts wastes time." d. "Conflict waste energy." e. "Conflict increases teamwork."

B, C, D Unresolved conflict reduces productivity, decreases teamwork, and wastes time and energy. Nursing staff are not more productive with unresolved conflict, and this type of conflict does not increase team work. PTS: 1 DIF: Cognitive Level: Application REF: p. 288 OBJ: Discuss five methods to resolve conflict. TOP: Conflict resolution MSC: NCLEX®: Safe and effective care environment

3. What is important for the nurse manager to understand about resolving conflict in the workplace? (Select all that apply.) a. Realize that most new graduates use competition as a form of conflict response. b. Effective role socialization reduces negative conflict behaviors among nursing staff. c. Use of collaboration to solve conflict issues is an important strategy to encourage. d. Thinking like a nurse promotes role socialization and reduces conflict. e. Nurse managers need to create working environments that facilitate professional practice. f. High self-esteem fosters entitlement-type behavior that promotes conflict.

B, C, D, E New graduates use compromise and avoidance as primary means of conflict resolution based on current research. High self-esteem is often found in empowering workplace environments where successful positive conflict resolution occurs. Effective role socialization, positive professional practice environments, using collaboration, and thinking like a nurse are noted in effective conflict resolution situations. PTS: 1 DIF: Cognitive Level: Application REF: pp. 288-290 OBJ: Identify common factors that lead to conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care

4. What are some positive results that can come from conflict? (Select all that apply.) a. Disturbing issues are brought out, which may lead to more serious conflict. b. Groups cohesiveness may increase as individuals resolve issues. c. Results of conflict can be constructive. d. Groups can learn from each other. e. Talking about issues can avert serious conflict.

B, C, D, E Positive aspects of conflict include group cohesiveness may increase as individuals resolve issues, results of conflict can be constructive, and groups can learn from each other and talking about issues can avert serious conflict. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 288-289 OBJ: Identify common factors that lead to conflict. TOP: Conflict MSC: NCLEX®: Safe and effective care environment

1. Which of the following statements made by the charge nurse indicates appropriate delegation? (Select all that apply.) a. The LPN can delegate dressing changes to the nursing assistant. b. The LPN can administer a DPT immunization to a child. c. The LPN can add a dose of Bleomycin to an existing IV infusion. d. The nursing assistant can transfer a paraplegic patient from a wheelchair to the bed using a lift, as long as the nursing assistant has received training and demonstrated competency. e. The nursing assistant can assess vital signs on a patient 15 minutes after the transfusion has been started.

B, D Only nurses can delegate to other personnel. LPNs can administer routine medications, such as immunization, but not chemotherapy drugs (Bleomycin). A nursing assistant can transfer patients, provide basic hygiene measures, and assess vital signs. (The patient has been receiving blood, so the nurse needs to monitor the first 50 mL that is given because this is when a transfusion reaction is most likely to occur.) PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 309-311 OBJ:Select the right person for the task.TOP:Providing feedback MSC: NCLEX®: Safe and effective care environment—management of care

4. Which of the following statements about listening indicate the nurse's adequate understanding? (Select all that apply.) a. "Listening is the hearing of words." b. "Listening requires most of our communication time." c. "We pay most attention to our listening skills." d. "People remember 1/3 of the messages that they have heard." e. "Listening requires a lot of energy."

B, D, E The nurse has an adequate understanding of listening when the nurse states: "Listening is not just the hearing of words," "Listening requires most of our communication time," "We pay least attention to our listening skills," "People remember 1/3 of the messages that they have heard" and "Listening requires a lot of energy." PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 265-266 OBJ: Apply effective communication skills in common nursing activities. TOP:Components of effective communication MSC: NCLEX®: Safe and effective care environment

2. The Delegation Decision Tree, which was prepared and adopted by ANA and NCSBN, has specific steps. Identify the steps in this Decision Tree. (Select all that apply.) a. Monitoring b. Surveillance and supervision c. Readback and response d. Assessment and planning e. Evaluation f. Communication

B, D, E, F There are four steps to the ANA and NCSBN Delegation Decision Tree. They are in order as follows: Step 1: Assessment and planning. Step 2: Communication: Must be a two-way process involving the nurse who assesses the nursing assistive personnel's understanding of the delegated task and the nursing assistive person who asks questions regarding the delegation and seeks clarification of expectations if needed. Step 3: Surveillance and supervision: The purpose of surveillance and monitoring is related to nurse's responsibility for patient care within the context of a patient population. The nurse supervises the delegation by monitoring the performance of the task or function and assures compliance with standards of practice, policies, and procedures. Frequency, level, and nature of monitoring vary with needs of patient and experience of assistant. Step 4: Evaluation and feedback: Evaluation is often the forgotten step in delegation and should include a determination if the delegation was successful and discussion of parameters to determine the effectiveness of the delegation. (ANA & NCSBN, 2006, pp. 7-9) PTS: 1 DIF: Cognitive Level: Application REF: p. 306 OBJ: Delegate tasks successfully based on outcomes and define the operational terms delegation, supervision, and accountability. TOP: Delegation decision tree MSC: NCLEX®: Safe and effective care environment—management of care

11. The nurse interprets assertive behavior as a. apologetic. c. direct. b. coercive. d. self-denying.

C A person exhibiting assertive behavior would express his or her true feelings in an honest, direct manner. An assertive person's behavior respects others and is not coercive or self-denying or self-depreciating in any manner. Assertive persons accept compliments and criticism and are not excessively apologetic but have self-respect for their thoughts and actions. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 279 OBJ: Describe an assertive communication style. TOP: Effective communication MSC: NCLEX®: Not applicable

15. A nurse is frustrated about being scheduled on a holiday that had been requested off, but a new nurse with less seniority was given the holiday off. Which action by the nurse shows accommodation? a. The nurse works out a schedule change with the new nurse. b. The nurse doesn't bring the issue to the attention of the new nurse but feels angry and frustrated. c. The nurse works the holiday while the new nurse has the day off. d. The nurse requests to have the day before the holiday off.

C Accommodation occurs when the nurse decides to work the holiday while the new nurse has the holiday off. Collaboration occurs when the nurses work out a schedule change. Avoidance occurs when the nurse doesn't bring the issue to the attention of the new nurse but feels angry and frustrated. Compromise occurs when the nurse requests to have the day before the holiday off. PTS: 1 DIF: Cognitive Level: Application REF: p. 290 OBJ: Discuss five methods to resolve conflict. TOP: Conflict resolution MSC: NCLEX®: Safe and effective care environment

9. A nurse is interested in moving into a management position. Which action would assist with accomplishing this? a. Use of reward power c. Use of expert power b. Use of coercive power d. Use of legitimate power

C An expert refers to someone who is knowledgeable, experienced, and respected in his or her area of nursing. This type of expert power would assist the nurse to advance to higher positions in nursing. Reward power is closely linked with legitimate power in that it comes about because the individual has the power to provide or withhold rewards. Legitimate power is power connected to a position of authority. Coercive power is power derived from fear of consequences. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222 OBJ: Differentiate between power and authority. TOP: Nursing management MSC: NCLEX®: Not applicable

12. The nurse manager tells the patient that he must eat his breakfast before getting out of bed. What type of power is the nurse manager using? a. Legitimate power c. Coercive power b. Expert power d. Referent power

C Coercive power is power derived from fear of consequences. Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others. Reward power is closely linked with legitimate power in that it comes about because the individual has the power to provide or withhold rewards. Legitimate power is power connected to a position of authority. Referent power is power that a person has because others closely identify with that person's personal characteristics; the person is liked and admired by others. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 222 OBJ: Differentiate between power and authority. TOP: Nursing management MSC: NCLEX®: Not applicable

7. A nurse is using the decision-making process. Which action should be taken first? a. Evaluate the outcome. c. Set the objective. b. Identify and evaluate options. d. Implement the options.

C Decision making requires the definition of a clear objective to guide the process. The nurse must set the objective before proceeding to the other steps in the decision-making process. The second step is to identify and evaluate alternate decisions. The third step is to make the decision and implement, and the last step is to evaluate the outcome. PTS: 1 DIF: Cognitive Level: Application REF: p. 226 OBJ: Use the decision-making process in clinical situations. TOP: Nursing management MSC: NCLEX®: Not applicable

2. What action would be an appropriate first step for the nurse to take toward becoming an effective manager? a. Learn how to effect and direct the change process. b. Assess individuals' sources of power. c. Develop communication and interpersonal skills. d. Implement effective nursing care plans.

C Effective managers have a balanced mix of management skills and leadership qualities. There are generally four functions the manager performs: planning (what is to be done), organizing (how it is to be done), directing (who is to do it), and controlling (when and how it is done). To be effective in performing these functions, a manager must develop communication and interpersonal skills. PTS: 1 DIF: Cognitive Level: Application REF: p. 212 OBJ: List characteristics of an effective manager and an influential leader. TOP:Nursing management MSC: NCLEX®: Safe and effective care environment—management of care

1. Which task could a staff nurse delegate to a certified nursing assistant (CNA)? a. Evaluating a patient's response to pain b. Making rounds with a physician c. Feeding a stroke patient who has minimal dysphagia d. Assessing a patient's central venous line site

C Feeding a stroke patient who has minimal dysphagia is an appropriate delegation of a nursing intervention to a CNA. The majority of state boards have addressed the issue of delegation and have developed rules that offer specific guidelines regarding who can do what. The scope of practice for each level of care provider usually includes a description of the tasks that may be performed at that level. The nurse cannot delegate the task of assessing the patient or making rounds with the physician to the CNA. Nursing interventions such as assessment and evaluation of pain, management of central line sites, or performing tracheotomy or colostomy care are within the scope of professional nursing, as is making rounds with a physician. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 309-310 OBJ: Select the right person for the task. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care

16. A nurse wants to implement a change in the work environment. Which of the following actions would be the most important thing to do? a. Ask for suggestions from peers working in other institutions. b. Explain to coworkers how a different plan would work better. c. Seek input from coworkers from the beginning. d. Incorporate all suggestions into the plan before implementing.

C Seeing the input from coworkers from the beginning is an important component of initiating change in the work environment. In the unfreezing phase, all of the factors that may cause resistance to change are considered. Others who may be affected by the change are sought out to determine whether they recognize that a change is needed and to determine their interest in participating in the process. It will be important to determine whether the environment of the institution is receptive to change and then convince others to work with the group initiating the change. PTS: 1 DIF: Cognitive Level: Application REF: p. 229 OBJ:Discuss the change process.TOP:Nursing management MSC: NCLEX®: Not applicable

9. Which of the following represents appropriate feedback for an assignment to an LPN? a. "Did you understand the assignment that you received in the staff report?" b. "Have you completed the urinary catheterization and care of the new patient?" c. "The patient in Room 430 looks much better, and you did a good job of making the patient comfortable." d. "I know you are busy; however, you need to get caught up with your pain medications."

C Telling the LPN that they did a good job of making a patient comfortable is appropriate feedback on an assignment. Feedback is a process of informing someone of how well or how poorly a delegated task was performed. Asking understanding of an assignment or whether a procedure was performed is not giving feedback but determining if what is supposed to be done is understand or whether the task (urinary catheterization) has been completed. The pain medications may have been delegated; however, if this task was delegated, the feedback does not tell the LPN what her or she is doing right or wrong. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 316-317 OBJ: Provide reciprocal feedback for the effective evaluation of the delegate's performance. TOP:Providing feedback MSC: NCLEX®: Safe and effective care environment—management of care

11. Which of the following task can the nurse safely delegate to the nursing assistant? a. Assessing the patients who are being discharge later today b. Give discharge instructions to a patient c. Help a patient select food according to their diet d. Educating the patient on what foods to eat for his diet plan

C The nurse can safely delegate the job of helping the patient select food according to his diet. The nurse is responsible for assessing patients, giving discharge instructions, and educating the patient on what foods to eat for his diet plan. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 316 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: What does delegation mean? MSC: NCLEX®: Safe and effective care environment

18. A female nurse is experiencing sexual harassment in the workplace by a male nurse. Which action should this nurse take to stop the sexual harassment? a. Ignore the comments made by the male nurse. b. Laugh about the comments. c. Tell the male nurse to stop. d. Begin to sexually harass the male nurse.

C The nurse should take the most direct route and tell the male nurse to stop. Ignoring the comments, laughing at them, or sexually harassing the male nurse will not stop the harassment. PTS: 1 DIF: Cognitive Level: Application REF: pp. 300-302 OBJ: Identify situations of sexual harassment in the workplace and discuss possible solutions. TOP:Sexual harassment in the workplace MSC: NCLEX®: Safe and effective care environment MULTIPLE RESPONSE

10. What would be a good assignment for an experienced nursing assistant? a. Help teach patients newly diagnosed with diabetes to give themselves injections. b. Report on the quality and quantity of urine on a continuous bladder irrigation. c. Obtain a clean-catch urine specimen from a patient. d. Chart a diet for a patient with an eating disorder.

C The nursing assistant can be assigned activities that involve standard, unchanging procedures such as helping to obtain a clean-catch urine specimen from a patient. Charting, teaching, and assessing are not assigned to the nursing assistant. PTS: 1 DIF: Cognitive Level: Application REF: p. 252 OBJ: Identify criteria for supervising and evaluating care provided by others. TOP: Supervision MSC: NCLEX®: Safe and effective care environment—management of care

20. The nurse is making assignments for the team. There are 2 LPNs and a nursing assistant on the team. Which of the following assignments would the nurse choose for themself? a. A patient who had a cerebrovascular accident (CVA) with left-sided paralysis who will need help with bathing b. A patient with a chest tube who is ambulating in the hall c. A patient receiving chemotherapy for bone cancer d. A patient receiving tube feedings with a J-tube

C The patient with the highest acuity would be the patient receiving chemotherapy for bone cancer. The nurse would be managing delivery of chemotherapy drugs and pain control with narcotics as ordered. The other patients are within the scope of care for the LVN and the nursing assistant. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 311 OBJ:Select the right person for the task.TOP:Selecting right person MSC: NCLEX®: Safe and effective care environment—management of care

15. A nurse has been assigned the following patients. Which patient is a priority to assess first? a. A patient with abdominal pain b. A patient who has been NPO all morning and wants to eat c. A patient with pneumonia and O2 saturation of 88% d. A patient complaining of ear pain

C Using Maslow's hierarchy of needs or the ABCD system, the nurse should see the patient with pneumonia and low O2 saturation first. Issues involving the airway are a priority, and these patients must be seen first. Next, the nurse should see the patient with abdominal pain followed by the patient with ear pain and then the patient who is NPO and wants to eat. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 249-250 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting. TOP:Managing time in the clinical setting MSC: NCLEX®: Safe and effective care environment

5. A nurse is caring for an older adult patient when conflict regarding treatment arises between the family and the health care provider. What can the nurse do to resolve this conflict? (Select all that apply.) a. Defend the health care provider's treatment and try to explain it to the family. b. Try to convince the family that the health care provider knows what is best for the patient. c. Allow the family to participate in the decision-making process for their loved one. d. Encourage the family to speak directly to the health care provider regarding treatments. e. Clarify the health care provider's order with the family.

C, D, E The nurse should avoid defending the health care provider's treatment and convincing the family that the health care provider knows what is best. Instead the nurse should allow the family to participate in the decision-making process, encourage the family to speak directly to the health care provider regarding treatments, and clarify orders with the family. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 288-290 OBJ: Identify common factors that lead to conflict. TOP: Conflict MSC: NCLEX®: Safe and effective care environment

11. The nurse calls a physician to come to the unit to assess a patient. Which of the following is the most effective telephone communication by the nurse? a. "This is the 4100 unit troublemaker again. You probably ought to come to the unit to see Mr. Samuels. His condition doesn't seem right." b. "This is Ann Allen on 4100. I don't quite know what to think about Mr. Samuels. I think his condition is deteriorating, and I'd like to have you see him." c. "Sorry to bother you. This may not be important, but I'm not completely comfortable with Mr. Samuel's response to care. His blood pressure has dropped, and his pulse is elevated." d. "This is Sheila Ryan on 4100 calling regarding your patient, Mr. Samuels. His BP has dropped from 130/90 at 8 am to 100/70 at 10 am. His pulse has risen from 80 to 100, and he seems restless. He received his 8 am Cardizem."

D A detailed, objective response is effective when communicating not only in person but also by telephone. Try organizing your conversation in the I-SBAR-R communication format. The other responses are subjective in nature with no descriptive assessment data to provide to the physician. PTS: 1 DIF: Cognitive Level: Application REF: p. 247 OBJ:Analyze effective communication as it relates to patient safety. TOP: Effective communication MSC: NCLEX®: Not applicable Xx12. A nurse is working on a busy orthopedic floor and is on the phone with the floor manager when a physician comes up and gives a verbal order for pain medications on an assigned patient. The physician then leaves the unit. Which action by the nurse would be the most appropriate? a. Write down the order and administer the medication. b. Put the nurse manager on hold and ask the physician to write the order. c. Ignore the physician and continue the conversation with the nurse manager. d. Write down the order and document it as a telephone order. ANS: B The most appropriate action would be for the nurse to put the nurse manager on hold and ask the physician to write the order. The Joint Commission states that there is a big difference between verbal and telephone orders. Verbal orders should never be accepted unless there is an emergency or the physician is in a sterile environment because there is too much opportunity for a transcribing error. PTS: 1 DIF: Cognitive Level: Application REF: p. 242 OBJ:Analyze effective communication as it relates to patient safety. TOP: Communication and patient safety MSC: NCLEX®: Safe and effective care environment

9. During a staff meeting, an upset nursing assistant tells the group that the other nursing assistants are given easier patient assignments and are always given their choice of days off. What approach by the nurse manager would be effective to resolve this conflict? a. Attempt to persuade the upset nursing assistant to calm down. b. Tell the group that this type of conversation needs to be handled privately. c. Consider transferring the upset nursing assistant to another unit. d. Acknowledge the feelings of the upset nursing assistant and make a plan to meet with her.

D Acknowledging the nursing assistant's feelings is the first step in conflict resolution. This process requires dealing with issues, not personalities, by communicating openly, listening actively to the complaints, sorting out the issues, identifying key themes of the discussion, and weighing the consequences and options to resolve the conflict. Transferring the upset person avoids dealing with the conflict. PTS: 1 DIF: Cognitive Level: Application REF: p. 288 | p. 290 OBJ: Discuss five methods to resolve conflict. TOP: Conflict management MSC: NCLEX®: Safe and effective care environment—management of care

2. The nurse has just given a patient a narcotic for pain relief. Because the nurse must leave the unit for lunch and a 1-hour meeting, the task of evaluating the patient's response to the pain medication must be delegated. To whom should the nurse delegate this responsibility? a. Nursing assistant c. Licensed practical nurse b. Student nurse d. Nurse manager

D Evaluating the patient's response to pain medication is an activity within the scope of the registered professional nurse (who in this situation is the nurse manager). Many states are very specific in their description of what cannot be delegated and belongs only to the nurse's scope of practice. The licensed practical nurse can administer the pain medication. The student nurse could assist the professional nurse in the evaluation of the patient's response to the pain medication; however, the nurse leaving the unit cannot delegate this responsibility to a student. This nursing intervention is outside the scope of practice of the nursing assistant. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 311 OBJ: Select the right person for the task. TOP: Delegation in the clinical setting MSC: NCLEX®: Safe and effective care environment—management of care

13. Dr. Jones asks you to give a medication to one of the patients, and you know the patient is allergic to it. When you point this out, Dr. Jones says, "Give the medication or I'll report this to your supervisor." What is the best assertive response? a. Agree to give the medication and hope no one finds out. b. Say, "I won't give the medication, and I don't care who you talk to about it." c. Walk away and ignore Dr. Jones. d. Say, "Perhaps you and I could talk this over with my supervisor together."

D Expressing to the physician that both of you should discuss the issue with the supervisor is an assertive response. As nurses gain experience, their judgment improves, and they are able to recognize ways to communicate needs and feelings with the goal of improving the processes and procedures used in the work setting. The patient's safety always comes first, so you would not go ahead and give the medication. When you walk away and ignore the comment, you are denying the feelings and not dealing assertively with the situation. Not giving the medication and stating that you don't care who the physician talks to about the issue is a threatening, aggressive response. PTS: 1 DIF: Cognitive Level: Application REF: p. 279 OBJ: Apply effective communication skills in common nursing activities. TOP: Effective communication MSC: NCLEX®: Not applicable

17. If many complaints arise about a newly developed procedure, what is the best way to handle them? a. Discontinue the change because it is not working. b. Persuade a few friends to talk positively about it. c. Consider the complaints as indications that change is being resisted. d. Analyze the complaints and alter the plan as needed.

D In handling complaints about a new procedure, consideration should be given to bringing in a person with expert power and returning to the moving phase for analysis and adjustment of the procedure if needed. Because a complaint occurs does not mean that the change is being resisted. Until the complaint is investigated, the change should continue; it should not be discontinued until the issue is fully determined and resolved about the newly developed procedure PTS: 1 DIF: Cognitive Level: Application REF: pp. 226-227 OBJ:Discuss the change process.TOP:Nursing management MSC: NCLEX®: Not applicable

6. In considering the overall task of the team, what issues should be considered in the care of the patient? a. Nursing care plan, religious preference, and financial base b. Physician's orders, nursing actions, and religious preference c. Family needs, physician's orders, nursing diagnosis, and religious preference d. Physician's treatment plan, nursing plan of care, and needs of the patient and family

D Nurses as individuals and as team members are advocates of the patient with a focus on the best and safest delivery of quality health care. PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 275-276 OBJ:Analyze group member roles.TOP:Group process MSC: NCLEX®: Not applicable

8. The graduate nurse has an adequate understanding of effective listening when stating which of the following? a. "Limited level of vocabulary often affects listening skills," b. "Underdeveloped attention span affects listening skills." c. "External noise distractions affect listening skills." d. "Emotional reactions interfere with the actual message."

D One of the most problematic reasons for ineffective listening is that people allow their emotions to dictate what they hear or do not hear. Limited vocabulary, underdeveloped attention span, and external noise distractions are not the most problematic reason for ineffective listening. PTS: 1 DIF: Cognitive Level: Application REF: pp. 265-266 OBJ: Identify effective ways of communication with other health care workers. | Define basic components of communication. TOP: Effective communication MSC: NCLEX®: Not applicable

6. The nurse is receiving a phone order from a health care provider. How will the nurse make sure that the provider's order is received without error? a. Advise the health care provider that the order must be written on the chart within the next 24 hours. b. Ask the nurse in charge to come to the phone to take the order. c. Write the order without using any unclear or unapproved abbreviations. d. Repeat the order, write the order verbatim, and read it back to the provider.

D Repeat the order, write the order verbatim, and read it back to the provider are the steps recommended to confirm that the order was understood correctly, as well as communicated correctly. The question is in regard to the receiving of the order, not specifically how it is written. The nurse will write the phone order on the chart, and later the health care provider will co-sign the order. The charge nurse does not have to take the phone order; any licensed nurse can take the phone order. PTS: 1 DIF: Cognitive Level: Application REF: p. 239 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting. | Identify current methods of transcribing physician's orders. TOP: Communication MSC: NCLEX®: Safe and effective care environment—management of care

13. A nurse is feeling overwhelmed and has determined to delegate some of the tasks to the LPN he//she is working with. Which of the following would be most appropriate for the nurse to delegate? a. An initial assessment on a new patient b. Educational teaching on diabetes management c. Creating a care plan for a patient d. Updating the care plan for a patient who is postop day 2

D The nurse could delegate updating the care plan for a patient who is postop day 2. The nurse should not delegate an initial assessment, educational teaching, or creating a care plan for a patient. These responsibilities are not within the scope of practice for the LPN and must be completed by the nurse. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 318 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Delegation MSC: NCLEX®: Safe and effective care environment

12. Determine how the nurse's role is different from that of the LPN in assessment of the patient. a. Collects data during the health history and physical exam b. Contributes to the development of the care plan c. Assist in updating the care plan d. Uses findings from the assessment to create a care plan

D The nurse differs from the LPN in that the nurse uses assessment findings to create a care plan for the patient. The LPN focuses on collecting data during the health history and exam, contributes to the development of the care plan, and assists in updating the care plan. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 318 OBJ: Understand and apply the five rights of delegation in nursing practice. TOP: Delegation MSC: NCLEX®: Safe and effective care environment

22. A nurse manager has received a report that indicates the infection rate on the unit has gone up by 25% in the past month. The control phase of management requires that the nurse manager take action. What should the nurse manager do? a. Post the report for staff to read. b. Pull a couple of the nurses aside and discuss the issue with them. c. Send an email out to the staff with information regarding upcoming infection prevention conference. d. Provide a mandatory handwashing in-service to all staff.

D The nurse manager has a duty to implement and mandate interventions to reduce infection rates for her unit. Providing a mandatory handwashing in-service to all staff is the best way to do this and to ensure that every staff member is competent. The other options may be used in the process for the nurse manager to set up or reinforce the handwashing in-service program. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 208 OBJ:Differentiate between management and leadership. TOP: Management versus leadership MSC: NCLEX®: Safe and effective care environment

7. The nurse receives report on an assigned group of patients. Which patient would the nurse assess first? a. A patient 2 days postoperative who is complaining of pain b. An older adult patient reported to have increasing lethargy and confusion c. A newly admitted patient with a serum blood urea nitrogen (BUN) of 32 mg/dL d. A hypertensive patient complaining of severe midsternum pain

D The patient with chest pain is at greatest risk of experiencing urgent problems and needs to be evaluated immediately. This does not mean that the nurse will not address the needs of the other patients, but the safety of the hypertensive patient is at risk if the nurse does not see him first. PTS: 1 DIF: Cognitive Level: Application REF: p. 249 OBJ: Discuss strategies to manage and prioritize your time in the clinical setting. TOP:Patient management MSC: NCLEX®: Safe and effective care environment—management of care

14. What can staff nurses do to reduce conflict with patients and families? a. Allow nurses to enforce what they feel comfortable with. b. Keep treatment decisions between the patient and health care team only. c. Do not allow family to participate in patient care. d. Maintain consistency in enforcing rules and policies.

D To reduce conflict with patients and families, the nurse can maintain consistency in enforcing rules and policies. Allowing each nurse to enforce rules they are comfortable with, keeping treatment decisions between the patient and the health care team, and not allowing family to participate in care may increase conflict. PTS: 1 DIF: Cognitive Level: Application REF: pp. 288-290 OBJ: Identify common factors that lead to conflict. TOP: Conflict MSC: NCLEX®: Safe and effective care environment

8. What are potential causes of performance inadequacies? a. The person to whom the task was assigned had appropriate educational qualifications to complete the task. b. The task was assigned to a person capable of carrying out the assignment. c. The person who delegated the task confirmed the recipient's ability to perform the task. d. The person to whom the task was assigned did not understand what the task involved.

D When a person who was assigned a task and did not understand it, this would be a potential cause of a performance inadequacy. A principle of delegation, the person to whom the task is assigned, should verify that they understand and can perform the task. If the person is capable, has appropriate educational qualifications, and the nurse has confirmed that they are able to perform the task, then there should not be performance inadequacy. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 319 OBJ: Select the right person for the task. TOP: Evaluating performance MSC: NCLEX®: Safe and effective care environment—management of care

5. One of your peers, a staff nurse, is a "potshot artist." This nurse often makes you the butt of innuendo or teasing digs. You are fed up and decide to take action the next time it happens. What strategy should be considered as an effective way of dealing with a "sniper?" a. Clam up and allow the individual to fully ventilate her concern. b. Confront and tell the individual he or she is wrong. c. Coldly withdraw from the individual. d. Obtain group confirmation or denial of criticism raised by the individual.

D When confronting the sniper, it is important to involve the rest of the staff to get a group consensus of denial or confirmation. Remember to always expose the sniper's attack by saying, "That sounded like a put-down to me." Clams tend to withdraw from the individual. Confronting the individual and telling them they are wrong is how a Sherman tank would approach the situation because they have a strong need to be right. PTS: 1 DIF: Cognitive Level: Application REF: p. 294 OBJ:Discuss techniques to use in dealing with difficult people. TOP:Conflict management MSC: NCLEX®: Safe and effective care environment—management of care

17. The charge nurse is determining which activities to delegate to the nursing assistant. Which of the following would not be appropriate for the charge nurse to delegate to the nursing assistant? a. Changing soiled linen b. Taking a blood pressure on someone receiving blood c. Removing a urinary catheter d. Assessing a patient's lung sounds

D When delegating care, the charge nurse must remember that she cannot delegate nursing judgment. Therefore, in this scenario, the nurse cannot delegate the task of assessing lung sounds. This is a task that must be performed by the nurse. Taking blood pressures, removing a urinary catheter, and changing bed linens are all activities that can be delegated. PTS: 1 DIF: Cognitive Level: Application REF: pp. 251-252 OBJ: Identify criteria for supervising and delegating care provided by others. TOP: Managing others MSC: NCLEX®: Safe and effective care environment

8. Which statement by the nurse shows understanding of the primary advantage in using the group process in decision making? The process a. "increases the time spent discussing alternatives." b. "eliminates opposition to decisions by administrators." c. "allows additional time for the planning process." d. "promotes acceptance of the decision by the group."

D When the group has input in the decision-making process, there is more acceptance of the group's decision. Groups can be beneficial to the decision-making process. Groups generally offer the benefits of a broader knowledge base for defining objectives and more creativity in identifying alternatives. The effectiveness of the group decision-making process is dependent on the dynamics of the group. When a group is involved in the decision-making process, there may be additional time spent discussing alternatives, and more time may be allowed for planning; however, this is not a specific advantage. It may not necessarily eliminate opposition to the decision by administration, but when the group makes a decision, it may be easier to deal with administrative opposition. PTS: 1 DIF: Cognitive Level: Application REF: p. 212 OBJ: Identify characteristics of effective work groups. TOP: Nursing management MSC: NCLEX®: Not applicable

12. The nurse is using assertive communication skills to express self rights, when stating: a. "I shield others from my anger." c. "I am avoiding direct confrontation." b. "I do not compromise." d. "I am responsible for what I say."

D When you use an assertive communication style, you send the message that you will take responsibility for the consequences of both your words and your actions. Assertive individuals often compromise and may confront people directly about issues. Assertive individuals express anger appropriately rather than shielding others or repressing the feeling. The other statements do not express an assertive communication style. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 279 OBJ: Describe an assertive communication style. TOP: Effective communication MSC: NCLEX®: Not applicable