Ch 22 Questions
A senior student nurse has been elected class president. What type of power will the student have in this position? a) absolute power b) implied power c) explicit power d) assumed power
explicit power Leadership is the ability to direct or motivate others to achieve set goals. An elected class leader has explicit power
A nurse leader is working with a client with hypertension who needs to learn about a low-sodium diet. The nurse recognizes the client is in the unfreezing stage of Lewin's Change theory with which client statement? a) ?I am developing a daily meal plan for a low-sodium diet.? b) ?I understand why I need to eat a low-sodium diet.? c) ?I don?t see a problem with what I normally eat.? d) ?I have selected my daily menu with low-sodium foods.?
I understand why I need to eat a low-sodium diet.? Lewin's Change theory involves three phases which include unfreezing, moving, and freezing. With the unfreezing stage, the person recognizes the need for change. The client who understands why a low-sodium diet is needed with hypertension recognizes that this is a necessary change for their health status. If there is not a problem recognized, as with continuing a normal diet, the person is not ready for change. The person who is planning a meal is in the moving phase, which is the initiation of change after planning. The person who has already made the change with their daily menu is in the refreezing stage, where change has been effectively made.
The registered nurse (RN) has received orders to perform an unsafe practice on a client. The RN voices concern with the physician who gave the order, but the physician refuses to change the order. Whom should the nurse consult next regarding the order? a) The licensed practice nurse (LPN) b) The nurse manager c) The charge nurse d) The client
The charge nurse The RN should follow the proper channels for communication and consult the next direct supervisor. The next direct supervisor would be the charge nurse and then the nurse manager. The client and the LPN should not be consulted.
A nurse who is newly hired to manage a busy pediatric office is encouraged to use a transactional leadership style when dealing with subordinates. Which activities best exemplify the use of this type of leadership? Select all that apply. a. The manager institutes a reward program for employees meeting goals and work deadlines. b. The manager encourages the other nurses to participate in health care reform by joining nursing organizations. c. The manager promotes compliance by reminding subordinates that they have a good salary and working conditions. d. The manager makes sure all the employees are kept abreast of new developments in pediatric nursing. e. The manager works with subordinates to accomplish all the nursing tasks and goals for the day. f. The manager allows the other nurses to set their own schedules and perform nursing care as they see fit.
a, c. Transactional leadership style is based on a task-and-reward orientation. Team members agree to a satisfactory salary and working conditions in exchange for commitment and compliance to their leader. Leaders using transformational leadership style encourage nurses to participate in health care reform. Keeping abreast of new developments in nursing care is a characteristic of quantum leadership. The group and leader work together to accomplish mutually set goals and outcomes with the democratic leadership style, and the laissez-faire style encourages independent activity by group members, such as setting their own schedules and work activities.
A nurse is using time management techniques when planning activities for patients. Which nursing action reflects effective time management? a.The nurse asks patients what is their priority to accomplish each day. b. The nurse includes a "nice to do" for every "need to do" task on the list. c. The nurse "front loads" the schedule with "must do" priorities. d. The nurse avoids helping other nurses if scheduling does not permit it.
a. In order to manage time, the nurse should establish goals and priorities for each day and include the patient in prioritizing tasks, identify what needs to be accomplished each day, differentiating "need to do" from "nice to do" tasks, establish a time line and allocate priorities to hours in the workday to recognize any falling behind and correct the problem before the day is lost, and use teamwork appropriately to enhance the schedule.
Two nurses are having a disagreement over who will take the next admission to the unit. The nurse manager asks one of the nurses to take the admission and explains that this will be considered a personal favor. Which style of conflict resolution did the nurse manager display? a) Competing b) Accomodating c) Avoiding d) Collaborating
b) Accomodating The nurse manager is displaying a conflict resolution style of accommodating by asking one of the nurses to accept the assignment of the admission. If the nurse manager had ignored the situation, this would have been the avoiding style of conflict resolution. With a competing style, the nurse manager would have told the nurse to accept the admission, rather than asking the nurse. If collaborating is the conflict resolution style used, the nurse manager would have discussed the situation with both nurses in order to achieve a solution to this conflict.
A charge nurse in a busy hospital manages a skilled nursing unit using an autocratic style of leadership. Which leadership tasks best represent this style of leadership? Select all that apply. a.The charge nurse polls the other nurses for input on nursing protocols. b.The charge nurse dictates break schedules for the other nurses. c.The charge nurse schedules a mandatory in-service on new equipment. d.The charge nurse allows the other nurses to divide up nursing tasks. e.The charge nurse delegates nursing responsibilities to the staff. f.The charge nurse encourages the nurses to work independently.
b, c, e. Autocratic leadership involves the leader assuming control over the decisions and activities of the group, such as dictating schedules and work responsibilities, and scheduling mandatory in-services. Democratic leadership is characterized by a sense of equality among the leader and other participants, with decisions and activities being shared—polling the other nurses is an example. In laissez-faire leadership, the leader relinquishes power to the group and encourages independent activity by group members. Examples of laissez-faire leadership style are allowing the nurses to divide up the tasks and encouraging them to work independently.
A nurse manager is attempting to update a physician's office from paper to electronic health records (EHR) by using the eight-step process for planned change. Place the following actions in the order in which they should be initiated: a. The nurse devises a plan to switch to electronic health records. b. The nurse records the time spent on written records vs. electronic health records. c. The nurse seeks approval from management for new computers d. The nurse analyzes all options for converting to electronic health records. e. The nurse installs new computers and provides an in-service for the staff. f. The nurse explores possible barriers to changing to electronic health records. g. The nurse follows up with the staff to check compliance with the new system. h. The nurse evaluates the effects of changing to electronic health records.
b, f, d, c, a, e, h, g. Planned change involves the following steps: (1) recognize symptoms that indicate a change is needed and collect data, (2) identify a problem to be solved through change, (3) determine and analyze alternative solutions, (4) select a course of action from possible solutions, (5) plan for making the change, (6) implement the change, (7) evaluate the change, and (8) stabilize the change.
A nurse manager who is attempting to institute the SBAR process to communicate with physicians and transfer patient information to other nurses is meeting staff resistance to the change. Which action would be most effective in approaching this resistance? a. Containing the anxiety in a small group and moving forward with the initiative b. Explaining the change and listing the advantages to the individual and the organization c. Reprimanding those who oppose the new initiative and praising those who willingly accept the change d. Introducing the change quickly and involving the staff in the implementation of the change
b. Change is ubiquitous, as is resistance to change. The manager should explain the proposed change to all affected, list the advantages of the proposed change for all parties, introduce the change gradually, and involve everyone affected by the change in the design and implementation of the process. The manager should not use the reward/punishment style to overcome resistance to change.
A new nurse manager at a small hospital is interested in achieving Magnet® status. Which action would best help the hospital to achieve this goal? a. Centralizing the decision-making process b. Promoting self-governance at the unit level c. Deterring professional autonomy to promote teamwork d. Promoting evidence-based practice over innovative nursing practice
b. Magnet hospitals use a decentralized decision-making process, self-governance at the unit level, and respect for and acknowledgment of professional autonomy. In magnet hospitals, 14 characteristics, the Forces of Magnetism, have been recognized that identify quality patient care, excellent nursing care, and innovations in professional nursing practice.
Derrick is the nurse manager for the psychiatric unit. There are major conflicts between the day and night shift staff. Derrick suggests that each shift put aside their differences for a time and determine a common major goal. Which of the following conflict resolution styles does Derrick display? a) Smoothing b) Avoiding c) Collaborating d) Competing
c) Collaborating With collaborating there is a joint effort to resolve the conflict with a win-win solution. All parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. With avoiding there is awareness of the conflict situation but the parties involved decide to either ignore the conflict or avoid/postpone its resolution. Competing is an approach that results in a win for one party at the expense of the other. Smoothing is an effort to complement the other party and focus on agreement rather than disagreement thus reducing the emotion in the conflict. The original conflict is rarely resolved with this technique
The new nursing graduate is having difficulty managing time required to care for a group of complex clients. Medications are several hours behind schedule and several nursing procedures have not be performed. What is the first step that the nurse needs to take to resolve the time management issue? a) Establish a timeline to get the nursing interventions completed. b) Evaluate the potential to successfully complete the nursing interventions. c) Identify which nursing interventions are priority. d) Identify which nursing interventions can be delegated to other members of the health care team.
c) Identify which nursing interventions are priority. Follow the steps in improving time management: establishing goals and priorities takes precedent; next is the ability to complete the goals. Then, decide which goals can be delegated to other personnel. Next, establish a timeline to complete goals that cannot be delegated, and finally, evaluate the success of completing the goals.
A nurse manager in a long-term care facility threatens to fire subordinates who refuse to work overtime when needed. This manager is displaying what type of power? a. Expert power b. Referent power c. Coercive power d. Informational power
c. Managers exerting coercive power use punishment to force someone to comply or do something that individual does not want to do. Leaders using expert power are able to influence and convince subordinates to trust them and work toward meeting goals. Referent power occurs when one person receives approval or personal acceptance from another person. Informational power uses information to persuade others or provides rational arguments for the acceptance of information
An RN on a surgical unit is behind schedule administering medications. Which of the RN's other tasks can be safely delegated to a UAP? a. The assessment of a patient who has just arrived on the unit b. Teaching a patient with newly diagnosed diabetes about foot care c. Documentation of a patient's I & O on the flow chart d. Helping a patient who has recently undergone surgery out of bed for the first time
c. Nursing care that should never be delegated to a UAP includes the initial nursing assessment for a patient, patient teaching that requires an assessment, and any nursing intervention that requires professional nursing knowledge and judgment.
A nurse manager helps staff nurses who are resistant to change with use of a new medication administration system by doing which of the following actions? a) Discuss potential decrease in medication errors with the new system. b) Implement change quickly to the new system on the unit. c) Ensure a long, detailed explanation of use of the new system to all staff. d) Describe the evaluation process with use of the new system. e) Encourage feedback by the nursing staff with use of the new system.
d) Describe the evaluation process with use of the new system. a) Discuss potential decrease in medication errors with the new system. e) Encourage feedback by the nursing staff with use of the new system. In order to effectively implement a change on the nursing unit with nurses who are resistant, a nurse manager can have the staff be involved in the process by giving feedback, and understanding how the change can be evaluated. The nurses should also understand why this is important so that they will be ready for change; in this case, a decrease in medication errors would be an important reason for nurses to want to adopt a new medication system. Ensuring that the system is explained in simple, concise terms rather than complex and detailed terms, will help overcome resistance, as well as implementing change in stages or more slowly, rather than quickly.
A nurse is asked to act as a mentor to a new nurse. Which nursing action is related to this process? a. The nurse mentor accepts payment to introduce the new nurse to his or her responsibilities. b. The nurse mentor hires the new nurse and assigns duties related to the position. c. The nurse mentor makes it possible for the new nurse to participate in professional organizations. d. The nurse mentor advises and assists the new nurse to adjust to the work environment of a busy emergency department.
d. Mentorship is a relationship in which an experienced person (the mentor) advises and assists a less experienced person (protégé). This is an effective way of easing a new nurse into leadership responsibilities. The preceptor (experienced nurse) is selected (and generally paid) to introduce an employee to new responsibilities through teaching and guidance. The nurse mentor does not hire or schedule new nurses. Nurses do not need mentors to join professional organizations.
A nurse manager of a busy cardiac unit observes disagreements between the RNs and the LPNs related to schedules and nursing responsibilities. At a staff meeting, the manager compliments all the nurses on a job well done and points out that expected goals and outcomes for the month have been met. The nurse concludes the meeting without addressing the disagreements between the two groups of nurses. Which of the following conflict resolution strategies is being employed by this manager? a. Collaborating b. Competing c. Compromising d. Smoothing
d. The manager who resolves conflict by smoothing compliments the other party and focuses on agreement rather than disagreement, thus reducing the emotion in the conflict. The original conflict is rarely resolved with this technique. Collaborating is a joint effort to resolve the conflict with a win-win solution. All parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. Competing results in a win for one party at the expense of the other group. Compromising occurs when both parties relinquish something of equal value.
