Chapter 9-11

Which situations are examples of the nurse directing rather than delegating? Select all that apply. 1. A nurse manager asks a staff nurse to participate in a standing hospital committee. 2. A staff nurse asks the assistant to sit with the roommate of a client who has just died. 3. During a code blue situation, a nurse tells another nurse to start an IV. 4. A nurse tells an assistant to move a client into the hallway during severe weather. 5. A nurse reminds assistants of standard protocol for evacuation in case of fire.

*Answer: 2, 3, 4* *Explanation:* 1. This is delegation. 2. This situation is a crisis, so this is direction. 3. This is a crisis situation, so this is direction. 4. This is a crisis situation, so this is direction. 5. Because this crisis is not occurring, this is delegation.

At the beginning of a brainstorming session, the manager lists the rules to be followed. Which rule should be included and enforced? 1. Do not suggest any solution that is prohibitively expensive. 2. Suggest only ideas that the group has not already tried. 3. Do not critique any ideas presented. 4. Limit the session to the first 15 ideas.

*Answer: 3* *Explanation:* 1. Although all organizations are governed by a budget, what is "prohibitive" to one committee member may not be so to another. All solutions should be presented. 2. Sometimes an "old" solution is workable. 3. Brainstorming is for idea generation only. Idea critique will follow in another session. 4. The idea of brainstorming is to generate many ideas quickly. It would be better to limit the time than to limit the number of ideas.

In which situation should the nurse be most concerned that communication was distorted? 1. The nurse obtains an admission history from the parents of an adopted child. 2. The nurse gives discharge instructions to a couple in their early 80s. 3. The nurse manager hires a new nurse originally from the Philippines. 4. The emergency nurse receives a confused client who was transferred in an ambulance.

*Answer: 4* *Explanation:* 1. Just because this child is adopted does not mean that the admission history will not be correct or that communication with the child or parents will be impaired. 2. Just because a person is older does not mean that communication is impaired. 3. Just because the person is from another country does not mean that communication will be distorted. 4. Communication will be most affected by the confusion of the client because the nurse cannot be sure of anything the client said or that the client understood anything the nurse tried to communicate.

A serious disagreement has arisen between two staff nurses. The unit manager elects not to make a decision regarding the disagreement until more evidence is collected. Which part of the nursing process does this manager's critical thinking reflect? 1. Assessment 2. Diagnosis 3. Planning 4. Evaluation

*Answer: 2* *Explanation:* 1. Assessment is collecting the evidence. 2. Suspending judgment is equivalent to the diagnosis step. 3. Planning would occur when information is collected and analyzed and a course of action is being determined. 4. Deciding which hypothesis is correct is evaluation.

Which example represents a qualifier that may interfere with the message being communicated? 1. "Please notify me when this task is complete." 2. "Are you satisfied with the care you are receiving?" 3. "I hate to bother you with this, but we have a problem." 4. "How can I help you solve your issues with this physician?"

*Answer: 3* *Explanation:* 1. This is a direct command or request and does not contain a qualifier. 2. This is a valid inquiry that does not include a qualifier. 3. Qualifiers are often used as "entry statements" into important discussions, but they can interfere with the message being communicated. This qualifier ("I hate to bother you") sets up the receiver of the message to feel bothered. Qualifiers also reveal a lack of confidence in the sender. 4. This is a valid inquiry and does not include a qualifier.

The nurse manager has determined that two staff nurses need to be hired. Which factor is most critical as the nurse manager prepares to submit the request to administration? 1. Timing of the request 2. Negative inquiry 3. Compromise 4. Persistence

*Answer: 1* *Explanation:* 1. The nurse manager should plan to meet with administration when there is sufficient time and the supervisor seems receptive. 2. Negative inquiry is used after a request has been denied. 3. Compromise occurs after a request has been denied. 4. Persistence and repetition are used after a request has been denied.

A nurse manager approaches the nursing supervisor with a request for approval to incorporate 12-hour shifts into scheduling. The supervisor denies the request, stating this staffing pattern was used previously with poor outcomes. Which responses by the nurse manager may positively influence the supervisor? Select all that apply. 1. "I agree it was not effective years ago, but other units have now had success with it." 2. "What were your specific concerns about the 12-hour shifts?" 3. "I think it is unfair to refuse my unit this opportunity based on the past." 4. "Why are you always so opposed to change on my unit?" 5. "If we don't offer alternative staffing patterns, we aren't going to be able to attract new hires."

*Answer: 1, 2* *Explanation:* 1. This is an example of using "fogging," or agreeing with part of what is said. This technique may make the supervisor rethink the decision by offering some new information. 2. Asking about previous concerns is a type of negative inquiry. It helps the nurse manager understand the supervisor's position, but also requires the supervisor to rethink the issue. 3. Telling the supervisor it is unfair is the same as calling the supervisor unfair and is confrontational. 4. This approach is confrontational. 5. Threats, even veiled threats, are confrontational and should not be used.

In order to delegate, what must be present? Select all that apply. 1. Accountability for the assignment on the part of the delegate 2. Accountability for the assignment on the part of the delegator 3. Authority by the delegator to assign the task to the delegate 4. Responsibility for task completion on the part of the delegator 5. Authority of the delegate to accomplish the task as assigned

*Answer: 1, 2, 3, 5* *Explanation:* 1. The delegator and delegate share accountability to accomplish the task. 2. The delegator and delegate share accountability to accomplish the task. 3. The delegator must have the authority to assign the task. 4. The delegate takes on the responsibility for completion of the task. 5. Effective delegation transfers authority to the delegate to empower the delegate for success.

What is the most important reason that excellent communication skills are essential for nurses? 1. Nurses must communicate with all disciplines. 2. All nursing activities occur in relationships. 3. Interpersonal skills get the work done. 4. Good communication ensures no problems occur.

*Answer: 2* *Explanation:* 1. Although nurses do communicate with all disciplines, the correct reason is broader. 2. Nursing activities occur in relationships, making communication skills essential. 3. Excellent communication skills can get the work done more quickly and effectively, but the correct reason is broader. 4. Excellent communication skills do not keep problems from occurring.

Which situation indicates that the nurse needs additional training on effective delegation? 1. The charge nurse tells the unlicensed assistant to help prepare rooms for new clients. 2. The office nurse calls in orders for admission on a client following a surgical complication. 3. A rehabilitation nurse asks a physical therapy assistant to assist a client with ambulation around the facility. 4. A home health nurse calls the office and asks another nurse to make the visit to her next client.

*Answer: 2* *Explanation:* 1. The charge nurse can delegate the responsibility of preparing rooms to the unlicensed assistant. 2. Unless the office nurse is an advanced practice nurse, the office nurse cannot call in orders not signed off by a physician or nurse practitioner. This opens the organization up to problems with liability. 3. The physical therapy assistant is part of the rehabilitation nurse's team and can legally accept direction from that nurse. 4. A home health nurse might be delayed at a visit and need another nurse to visit the next client. It would be inappropriate for the nurse to ask an unlicensed assistant to make the visit.

The nurse has a concern regarding the quality of care being provided in the hospital. What should the nurse consider first before communicating this concern? 1. The medium of the message 2. The relationship between the nurse and the receiver of the message 3. The timing of the message 4. What to include in the message

*Answer: 2* *Explanation:* 1. The medium of the message is not the first consideration. 2. The first consideration is the relationship with the receiver of the message. This will guide the remainder of the choices the nurse will make. 3. Timing is essential, but it is not the first consideration. 4. In this situation, the nurse likely has numerous points to express. It might not be the best plan to include them all in the initial conversation.

A newly promoted nurse manager would like staff to solve problems without relying on preconceived ideas. How should the manager role-model this ability? 1. When disagreements occur on the unit, the manager privately asks the dissenters to be silent about the issue at meetings. 2. Tell staff members that they must present one opinion regarding the solutions they desire. 3. Demonstrate a genuine desire to find our why there is dissention. 4. Develop "tunnel vision" when it comes to problems on the unit.

*Answer: 3* *Explanation:* 1. Managers should not assume that only one opinion can be voiced and that others will be silent. 2. Managers should not assume that only one opinion can be voiced. 3. Good managers start out with a commitment to find out why others disagree. 4. Tunnel vision makes it difficult to see things from another perspective and will not encourage staff to avoid preconceived ideas.

The nurse manager has scheduled a series of meetings with employees to solve a unit problem. The manager purposefully created a two-week gap in the meetings to allow which portion of the creative process to occur? 1. Farsight 2. Verification 3. Preparation 4. Incubation

*Answer: 4* *Explanation:* 1. Farsight is not part of this process. 2. Verification is evaluation of the solution's effectiveness. 3. Preparation is planning time. 4. The time lapsed before a decision is made is the "incubation" time.

When the nurse manager orders supplies for the unit, which communication mode is best? 1. Telephone 2. Email 3. In person 4. Voice mail

*Answer: 2* *Explanation:* 1. Telephoning an order leaves room for misinterpretation or inaccuracy in recording what was ordered. 2. To avoid misunderstanding what supplies are needed, a written request is the most appropriate choice. It avoids misunderstanding because the items can be checked off a list. 3. A verbal order in person may still result in double orders because there is no written record of what was ordered. 4. Voice mail may result in a mistake because there is no written record of what was ordered.

During an evaluation conference, the nurse manager observes nonverbal messages, including nodding in agreement and smiling. These behaviors are examples of which aspect of communication? 1. Metacommunication 2. Intrasender conflict 3. Fogging 4. Intersender conflict

*Answer: 1* *Explanation:* 1. Metacommunications are nonverbal messages conveyed by body language and environmental factors. 2. Intrasender conflict occurs when there is a difficulty in the interpretation of an intended message due to disparity between verbal and nonverbal communication. 3. Fogging is a communication technique in which one partially agrees with what was said. 4. Intersender conflict occurs when there is a difficulty in the interpretation of an intended message due to disparity between different sources.

Which situation requires an adaptive decision? 1. The nurse manager discovers that two clients require the use of a new piece of equipment and that the one the hospital has is the only one in the state. 2. The nurse has made a medication error on an experimental medication. 3. The nursing student makes an error when changing a client dressing. 4. The nurse manager scheduled too many nurses for the client census on the night shift, and all of the nurses scheduled have already been asked to take a low-census unpaid day off this month.

*Answer: 1* *Explanation:* 1. Adaptive decisions must be made when the situation is unusual and there is no clear-cut policy for decision making. 2. Making a medication error is not an unusual situation, and a policy exists for handling this issue. 3. A policy exists for handling procedure errors. 4. A policy exists for handling staffing errors.

A nurse says, "I am always worried that I will be liable if someone I delegate a task to does something that hurts the client." What is the manager's best response to this concern? 1. "You have lots of liability in your position as an RN." 2. "The hospital will support you as long as you follow your job description." 3. "You are at greater liability if you try to do everything yourself." 4. "As long as you follow the five rights of delegation, your liability is minimal."

*Answer: 4* *Explanation:* 1. The RN does have liability associated with job responsibilities, but if delegation is done correctly, liability is minimized. This response is not supportive of the RN's need to delegate. 2. Hospital support is never a given when liability situations occur. This is not a response that would be supportive of the nurse's need to delegate. 3. This is not necessarily an accurate statement. 4. The five rights of delegation outline accepted measures to take when delegating tasks. If these rights are followed, the nurse has fulfilled job responsibilities. The delegate is responsible for his or her own care.

The nursing supervisor would like to delegate an information-gathering task. All the people listed have the ability to perform the task. In general, whom should the supervisor ask to do this work? 1. A nurse manager 2. A staff nurse 3. A licensed practical nurse 4. An unlicensed nursing assistant

*Answer: 4* *Explanation:* 1. The rule of thumb is to ask the lowest person in the hierarchy who has the requisite capabilities. 2. The rule of thumb is to ask the lowest person in the hierarchy who has the requisite capabilities. 3. The rule of thumb is to ask the lowest person in the hierarchy who has the requisite capabilities. 4. The rule of thumb is to ask the lowest person in the hierarchy who has the requisite capabilities.

In the morning care conference, the nurse instructs the assistant to feed breakfast to the clients in beds 2234, 2230, and 2241. The assistant indicates understanding of the assignment and repeats the bed numbers back to the nurse. What is the nurse's next step? 1. Check with the assistant to see how the assignment is going during the time breakfast is served. 2. Check the client's breakfast trays before they are returned to dietary. 3. Check with the clients to see if they had breakfast. 4. At the end of the shift, ask the assistant how the clients ate.

*Answer: 1* *Explanation:* 1. Checking with the assistant while the tasks are being done is the best plan. If there is a misunderstanding or problem, this is the best time for the nurse to intervene. 2. Simply seeing an empty breakfast tray does not guarantee that the instructions were carried out correctly. 3. Checking with the clients does not allow for the nurse to amend the instruction or correct the actions being taken. 4. Waiting until the end of the shift does not allow the nurse to amend the instruction or correct actions being taken.

The hospital chief operating officer holds monthly focus groups with the purpose of gaining ideas and insights from nursing administration and staff nurses. Which type of communication does this indicate? 1. Lateral communication 2. Downward communication 3. Diagonal communication 4. Grapevine communication

*Answer: 3* *Explanation:* 1. Lateral communication involves discussion among individuals at the same hierarchical level (e.g., all nurse supervisors). 2. Downward communication involves direction given by management to the staff. 3. Diagonal communication involves dialogue among individuals at different hierarchical levels (e.g., staff nurses to chief executive officer of nursing). 4. Grapevine communication is an informal channel among individuals at all hierarchical levels and has the potential to generate misinformation.

An inexperienced speaker is practicing delivering a speech. Which statement indicates a lack of understanding about how easily communication is distorted? 1. "I know I can better connect with my audience with good eye contact." 2. "If I repeat a complicated section in another way, comprehension is improved." 3. "If I know the background of the audience, it can help with tailoring the content." 4. "The topic is not complicated, so I don't have to worry about misunderstanding."

*Answer: 4* *Explanation:* 1. Eye contact can assist in keeping the message clear. 2. Repeating the message can assist in keeping the message clear. 3. Tailoring the message can assist in keeping it clear. 4. It does not matter how uncomplicated the topic is; misunderstandings and distortions can still occur.

The nurse is using critical thinking skills to decide which of several options is the best. Which question is most important for the nurse to take into consideration? 1. Are there different situational effects or contexts to be considered? 2. How has the problem usually been handled? 3. What is the easiest and least expensive alternative? 4. Can the problem be solved using the nursing process?

*Answer: 1* *Explanation:* 1. Critical thinking involves choosing the best alternative from among several, depending on the situation in which the problem occurred. This is the context of the problem. 2. Handling the problem the way it is usually handled may be easy but would not involve critical thinking. 3. Choosing the easiest or least expensive alternative may be easy but would not involve critical thinking. 4. The nursing process should be used in critical thinking, but the changing situation is the more defining and specific characteristic of critical thinking.

An employee is sabotaging the work of a newly oriented charge nurse, and the charge nurse has not been successful in addressing the problem. When the nurse manager addresses the issue, which is the most appropriate statement? 1. "I know it must be frustrating working with a new charge nurse, but how can we make this situation better?" 2. "This is not professional behavior, and you need to stop it or you will lose your job the next time I hear about it." 3. "I know the charge nurse is new to the role, but you should get used to it or there will be more changes." 4. "I know the new charge nurse is difficult to work with, but please help make the job easier to do."

*Answer: 1* *Explanation:* 1. Acknowledging the person's frustration validates his or her feelings, and asking for input helps make him or her part of the solution. 2. This statement is confrontational and is unlikely to result in a positive response from the employee. 3. Threatening the employee, no matter how veiled the threat, is confrontational and is unlikely to result in a positive response. 4. Patronizing remarks are condescending and are not likely to result in a positive employee response.

The nurse manager is challenged to find an innovative way to adequately staff the unit and provide quality nursing care. Which ability would be most useful to the nurse in this situation? 1. Creativity 2. Problem solving 3. Brainstorming 4. Decision making

*Answer: 1* *Explanation:* 1. Creativity is a part of the critical-thinking process that fosters the development and implementation of new approaches to different situations. 2. Problem solving implies there is a problem that needs a solution. 3. Brainstorming generates diverse ideas with many superficial solutions. 4. Decision making identifies one effective strategy that is not necessarily innovative.

The nurse has attended a "how to" refresher course on successful delegation. Which statement indicates successful learning has taken place? 1. "I knew that effective delegation made my job easier, but I never thought about how it could benefit the hospital." 2. "The clients on our unit come and go so frequently that delegation is of little benefit." 3. "I just don't understand why people think delegation is difficult; all you have to do is tell other people what to do." 4. "Now I know that effective delegation means telling my nursing staff when they need to have their regular work done."

*Answer: 1* *Explanation:* 1. Delegation can benefit every level of the organization. 2. Delegation can be successfully used in any unit. 3. Delegation does not consist of just telling other people what to do. 4. The "regular work" of the staff is done by assignment, not delegation. Delegation is more than just telling staff when to have work done.

The staff nurse is unsure of the correct protocol for calling in sick to work. The nursing supervisor told the nurse to call the nursing office; however, the nurse manager told the nurse to call the unit. This issue is likely the result of which distorted communication? 1. Intersender conflict 2. Intrasender conflict 3. Metacommunication 4. Downward communication

*Answer: 1* *Explanation:* 1. Intersender conflict occurs when a person receives two conflicting messages from different sources. 2. Intrasender conflict occurs when a verbal message differs from the nonverbal message; the recipient has difficulty interpreting the intended meaning. 3. Metacommunication is the combination of oral messages with nonverbal messages. 4. Downward communication occurs from manager to staff and is often directive.

The person who has just been promoted to nurse manager is male. If this nurse communicates in a way that is considered typical for men, what can the staff expect? 1. He will focus more on the issue than on personal experience. 2. He will strive to reach consensus within the group. 3. He will strive to avoid conflict within the group. 4. He will prefer to ask questions rather than make statements.

*Answer: 1* *Explanation:* 1. Men have been socialized to remain focused on the issue and avoid self-disclosure about personal experiences. 2. Men can tolerate disagreement within the group. 3. Men may be more apt to tolerate conflict than women are. 4. Women are more apt to ask questions to seek input.

Which statement represents a situation is which delegation is ineffective or inappropriate? 1. The RN asks the LPN to assist with admissions by assessing the clients as they get to their rooms. 2. The RN delegates administration of oral medications for a group of clients to the LPN. 3. The LPN directs the unlicensed assistant to report vital sign changes on a postoperative client to the RN. 4. The nurse manager asks the RN to act as chairperson for today's unit council meeting because the charge nurse went home sick.

*Answer: 1* *Explanation:* 1. The RN is the only caregiver legally responsible for assessing clients. Thus, the RN cannot delegate this to the LPN, and this is an example of overdelegation. 2. It is within the LPN's scope of practice to administer oral medications. 3. The LPN can delegate tasks to the unlicensed assistant. Reporting vital sign changes to the RN is within the scope of an unlicensed assistant. 4. The nurse manager can delegate to the RN. An RN is a logical substitute for the charge nurse in this situation.

The staff nurse job description states that the nurse is responsible for attending hospital committee meetings as assigned. The nurse manager asking the staff member to attend a risk management meeting is an example of which concept? 1. Work assignment 2. Overdelegation 3. Ineffective delegation 4. Transfer of authority

*Answer: 1* *Explanation:* 1. This assignment reflects duties listed in the nurse's job description, so asking the nurse to attend a meeting is work assignment. 2. Overdelegation occurs when the delegator loses control over a situation by giving too much authority to the delegate. 3. Ineffective delegation occurs when authority and responsibility are given but the steps of effective delegation are not followed. 4. Assignments are a bureaucratic function and no transfer of authority occurs.

A nurse manager is aware that there is a strong "grapevine" communication system on the unit. The manager elects to use this grapevine to distribute information about an upcoming change in unit policy. In making this decision, the manager should consider which possibilities? Select all that apply. 1. The information may be rapidly disseminated. 2. The information may be altered as it moves across the grapevine. 3. Most people try to spread information accurately. 4. Most people do not pay any attention to the grapevine. 5. Professional nurses do not participate in grapevine communication.

*Answer: 1, 2* *Explanation:* 1. Grapevine communication is often rapid and complete. 2. Grapevine communication is often altered as is goes from person to person. 3. The grapevine is very prone to distortion-sometimes significant distortion. 4. Most people do believe or at least attend to the grapevine. 5. Grapevine communication crosses all levels of professionalism.

Which directions given by the nurse to the assistant are most likely to be understood and completed correctly? Select all that apply. 1. "Here are your directions for this morning. Please give the clients in rooms 2156, 2158, and 2159 total bed baths." 2. "Go to the diet kitchen and get a cup of apple juice for the client in room 2112." 3. "Ambulate the clients on the south wing." 4. "Do you think you'll have time to do shampoos today?" 5. "It might be a good idea to get the client in room 2110 up in the chair this morning. Or maybe it would be better to wait until this afternoon."

*Answer: 1, 2* *Explanation:* 1. Saying "Here are your directions" alerts the assistant that an important statement is going to be made. The instructions are clear and concise. 2. This is a clear and concise set of instructions. 3. This direction is not clear. Does the nurse want the clients whose rooms are on the south wing ambulated? Or does the nurse want all ambulation to occur on the south wing today? 4. This instruction is ambiguous. If the nurse would like for certain clients to have their hair shampooed today, the nurse should indicate that more clearly. 5. The nurse should be clear regarding what should be done before instruction is provided.

Part of the facility's performance evaluation is based on the nurse's strength in the three types of decisions. During a nurse manager's performance evaluation, the supervisor says, "You are very good at adaptive decisions, but you need to be more precise in routine decisions. When the situation calls for really innovative decisions, you do not seem sure of yourself." How should the manager interpret this information? Select all that apply. 1. "I am not following the policies and rules well." 2. "I should review the procedure manual." 3. "I'm good at using my previous experiences to guide my decisions." 4. "I am strongest in making decisions when the problems are very unusual or unclear." 5. "I make good decisions when the situation is novel."

*Answer: 1, 2, 3* *Explanation:* 1. Routine decisions are based on policies and rules. 2. Routine decisions are based on procedures. 3. Adaptive decisions are often modifications of well-known problems or solutions. 4. Solving unusual or unclear problems requires innovative decision making. 5. Novel situations require innovative decision-making abilities.

Which statements by a nurse in the emergency department are examples of groupthink? Select all that apply. 1. "We've already talked about this enough. We need to present a united front on this issue." 2. "The medical unit nurses won't like this decision because it is too much work." 3. "Let's all vote yes on this so we can get back to work." 4. "We need to consider the workload of the intensive care unit nurses." 5. "Does anyone else have any ideas to discuss?"

*Answer: 1, 2, 3* *Explanation:* 1. Suppression of dissent and new ideas occurs with groupthink. 2. Stereotyping outsiders is a symptom of groupthink. 3. There is a strong tendency in groupthink to seek concurrence. 4. Considering the opinion of others is not a symptom of groupthink. 5. Leadership controls the discussion and numbers of topics to be discussed in groupthink.

A disagreement has arisen between two staff nurses. Both have discussed the situation with the manager. The manager feels that that problem is likely self-solving. How should the manager approach this situation? Select all that apply. 1. Allow some time to pass to see if the situation resolves. 2. Support both nurses as they work through this issue. 3. Provide any resources the nurses may need to help solve the problem. 4. Intervene if the problem begins to impact client care. 5. Ignore the situation.

*Answer: 1, 2, 3, 4* *Explanation:* 1. Many situations resolve themselves with time. 2. Support from the manager is important and may lead to self-solving of the problem. 3. Depending on the problem, the nurses may need information, time off, or problem-solving practice. 4. The manager should intervene if client care begins to suffer. 5. The manager must manage this situation.

During the first staff meeting, a newly promoted nurse manager says, "I would like a commitment from all the nurses to review and improve the way delegation is done on the unit." Why would the manager be interested in delegation? Select all that apply. 1. Effective delegation allows the manager to focus more time on management tasks. 2. Efficiency is increased by effective delegation. 3. If the manager has more time to focus on managerial duties, there is more chance of career advancement. 4. The nurse manager thinks unlicensed assistive personnel (UAPs) provide better bedside care than nurses do. 5. The manager is interested in developing the entire staff to its maximum potential.

*Answer: 1, 2, 3, 5* *Explanation:* 1. The manager may be able to delegate some tasks to nurses if the nurses are not overloaded with client care that could be completed by UAPs. 2. If delegation is done effectively, unit efficiency is increased. 3. If the manager can get more done because delegation is effective, there is a greater chance for career advancement. 4. There is no evidence that this is the case. 5. Development is stifled when the staff members are doing the wrong tasks.

Which situations would cause concern about liability with regard to delegation? Select all that apply. 1. The nurse asks the LPN to change a central line dressing. 2. The nursing supervisor asks the nurse for details about a client's history. 3. The nursing assistant asks a nurse to check the status of a client on the team. 4. The supervisor asks the charge nurse to give a nurse a difficult assignment. 5. The charge nurse asks a staff nurse's opinion on the client's surgical incision.

*Answer: 1, 2, 4* *Explanation:* 1. The LPN cannot usually work with central lines and cannot legally change the dressing for the RN. 2. Confidential information cannot be shared with individuals not directly involved in the client's care. Under normal circumstances, the nursing supervisor would not need information about a client's history. 3. It is acceptable for a nursing assistant to ask the nurse to check on a client. 4. Requesting that a nurse be given a difficult assignment is leaving the organization open to liability issues. 5. It is common and acceptable for nurses to ask other nurses for consultation on client care.

Which situations are examples of ineffective delegation? Select all that apply. 1. After delegating committee attendance to a staff nurse, the nurse manager also attends the meetings. 2. The unit clerk asks the nurse manager to "listen for the phones" so the clerk can go to the hospital's celebration of hospital week. 3. The nurse manager asks the staff nurse to collect information about a new type of hospital bed being considered for purchase. 4. The staff nurse asks the UAP to provide simple discharge instructions to a client. 5. The staff nurse often bathes clients because "I like to give bed baths."

*Answer: 1, 2, 4, 5* *Explanation:* 1. The purpose of delegating attendance to a staff nurse is so the manager will not need to attend the meeting. When the manager does attend, the staff nurse's position is diminished. This is an example of underdelegation. 2. When someone of lower rank, in this case the unit clerk, delegates a task to someone of higher rank, in this case the nurse manager, a situation of reverse delegation has occurred. This is ineffective delegation. 3. The nurse manager has asked someone of lower rank to complete a task that is within that person's capabilities. This is effective delegation. 4. Provision of education requires nursing knowledge and judgment and cannot be delegated to a UAP. This is an example of over-delegation. 5. Bathing clients can be delegated to staff of lower rank. If the nurse is giving the bath for assessment purposes, this lack of delegation would be appropriate. If the nurse is not delegating baths because "I like to give bed baths," the lack of delegation is inappropriate.

Currently, clients on a unit are bathed in the morning between 8:00 a.m. and 11:00 a.m. The nursing staff is contemplating changing that routine to bathing clients in the evening between 7:00 p.m. and 9:00 p.m. Which statement reflects an underlying assumption that might affect the staff's ability to think critically about this change? Select all that apply. 1. "The day shift just wants to shift work onto the evening shift." 2. "Everyone likes to bathe right before bed." 3. "I read a research article that reported that clients sleep better if they have been bathed right before bedtime." 4. "The physician staff will be upset if we change our morning routine." 5. "If we let them change this, they will want to make lots of other changes, too."

*Answer: 1, 2, 4, 5* *Explanation:* 1. This is an underlying assumption about why this change is being considered. 2. This speaker assumes that everyone likes to bathe right before bed, not taking into consideration that some like to bathe in the morning. 3. A research article report is not an assumption but based on evidence. 4. This is an assumption that might well be erroneous. 5. This is an assumption.

A healthcare organization has provided intensive education to staff regarding benefits and correct methods of delegation. Why has the organization spent the time and money to sponsor these sessions? Select all that apply. 1. Good delegation helps to reduce overtime. 2. Absences decrease when delegation is used correctly. 3. Delegation is required by state boards of nursing. 4. Patient satisfaction scores increase when care is efficient and effective. 5. Good delegation increases productivity.

*Answer: 1, 2, 4, 5* *Explanation:* 1. When delegation is appropriate, work gets done in a timely manner and overtime decreases. 2. Delegation helps get work done efficiently and effectively. Absences tend to decrease in this environment. 3. Delegation is permitted by state boards of nursing, but it is not required. 4. Delegation results in care that is efficient and effective. Efficient and effective care results in increased patient satisfaction. 5. Delegation results in each part of the team working at their designated skill level. Nurses are not doing tasks that could be done by assistants. This results in increased productivity.

A nurse manager is committed to establishing an environment that supports critical thinking and creativity. What strategies would help in this effort? Select all that apply. 1. Provide opportunities for staff to interact with nurses from outside the facility. 2. Give the nurses freedom to design their work environment. 3. Create a spreadsheet for nurses to complete describing their creative efforts. 4. Assign each nurse 15 minutes during a staff meeting to talk about his or her creative efforts. 5. Be receptive to ideas even if they seem strange at the beginning.

*Answer: 1, 2, 5* *Explanation:* 1. Exposure to new ideas and a fresh environment outside the facility increases creativity. 2. Freedom is necessary to support the creative process. 3. Filling in a spreadsheet is a bureaucratic, regimented strategy that will not foster creativity. 4. Making creativity an assignment is a sure way to stifle it. 5. Being receptive to new ideas encourages creativity.

Which statements would be important for the charge nurse to make when delegating a responsibility? Select all that apply. 1. "I think it would be important to our organization if you represent the unit on the policy and procedure committee." 2. "I have assigned you to be the unit's representative because I don't have enough time to go." 3. "I think your attendance at the task force meeting will be a good reflection on our unit." 4. "I chose you to attend the meeting because it seems as though you have the lightest assignment." 5. "I would like you to be the unit's representative on the client education task force committee."

*Answer: 1, 3* *Explanation:* 1. Key behaviors in delegating tasks are describing the task and providing the delegate with the benefit gained for the task. 2. Delegating should be done for the right reasons and not to dump tasks for purely personal reasons. 3. Key behaviors in delegating tasks are describing the task as well as the benefits to be gained. 4. The delegate should be assigned because the task meets the delegate's abilities. 5. The delegator should make the delegate aware of the reason for and the benefits gained from the delegation.

The nurse manager has asked that another staff nurse position be funded for the unit. The supervisor denies the request. Which statements by the manager are examples of negative assertion? Select all that apply. 1. "I know I haven't been too careful in keeping personnel costs low, but we are really going to need another position." 2. "I don't see why another position cannot be funded. We have met our budget each year for the last 3 years." 3. "I realize that my staff is not always positive about organizational changes, but having this extra staff member might reduce some of their stress." 4. "I can understand what you said about budget being tight, but we still need the position." 5. "Do you not understand how hard my nurses are working?"

*Answer: 1, 3* *Explanation:* 1. Negative assertion occurs when the speaker accepts some of the blame for the situation. 2. This is an example of negative inquiry. 3. Negative assertion is accepting some of the blame. 4. This is an example of fogging. 5. This is a confrontational statement and should be avoided.

Which statement describes the primary difference between group and individual decision making, besides the number of individuals involved? Select all that apply. 1. A decision made by a group is often better than a decision made by one person. 2. A decision made by an individual results in greater commitment. 3. Groups can provide more input into the process. 4. A decision made by a group can create a greater obligation to achieve results. 5. Routine decisions are more often made by individuals.

*Answer: 1, 3, 4, 5* *Explanation:* 1. Decisions made by groups are often better than those made by individuals because there is more input into the process. 2. There is no evidence to support that a decision made by an individual results in greater commitment. 3. Decisions made by groups are often better than those made by individuals because there is more input into the process. 4. The peer pressure of a group can create a greater commitment or feeling of obligation to achieve results. 5. Routine decisions are often made by individuals, with no group input necessary.

A nurse often has difficulty explaining and getting a clear message through to the receiver. Which communication skills will help the nurse to improve communication. Select all that apply. 1. Check timing 2. Expect respect 3. Consider relationship to receiver 4. Find an interpreter 5. Reply appropriately

*Answer: 1, 3, 5* *Explanation:* 1. Check timing is a communication skill that will help the nurse to improve communication. 2. Expect respect is not a communication skill that will help the nurse to improve communication. 3. Consider relationship to receiver is a communication skill that will help the nurse to improve communication. 4. Find an interpreter is not a communication skill that will help the nurse to improve communication. 5. Reply appropriately is a communication skill that will help the nurse to improve communication.

Which statements exemplify the attributes of critical thinking essential to nurses? Select all that apply. 1. "I am always curious about why we do things the way we do." 2. "I think we need to hurry up and make a decision." 3. "Can you help me understand your perspective a little better?" 4. "I don't think that your concern is necessarily pertinent to this issue." 5. "I don't think I can make that decision until I have more information."

*Answer: 1, 3, 5* *Explanation:* 1. Curiosity and a willingness to examine underlying assumptions are characteristic of a critical thinker. 2. A critical thinker is not in a hurry to make a decision but waits until all the facts are known and can be considered. 3. The critical thinker considers the possible alternative perspectives. 4. The critical thinker does not discount the concerns of others who have knowledge of the issue. 5. The critical thinker collects and analyzes the facts before considering any decision.

The RN plans to delegate responsibility of client care to a certified nursing assistant (CNA). Select all that apply. 1. Assist a client to shower. 2. Start an IV. 3. Administer oral medications. 4. Take vital signs. 5. Discontinue an IV.

*Answer: 1, 4* *Explanation:* 1. The CNA is permitted to help clients with activities of daily living. 2. The CNA is not permitted to start IVs. 3. The CNA is not permitted to administer oral medications. 4. The CNA is permitted to collect vital signs. 5. The CNA is not permitted to discontinue IV's. The tip of the catheter must be assessed by the RN.

An RN prepares for the day and makes a list of what should be delegated to the LPN. Which tasks should the nurse delegate to the LPN? 1. Assess a surgical incision. 2. Turn and reposition the client with a decubitus ulcer every two hours. 3. Dressing change and assessment of newly debrided wound. 4. Assessment two new admissions. 5. Administer all oral medications to clients on the unit.

*Answer: 2, 5* *Explanation:* 1. Assessment is a responsibility for the RN. 2. The LPN is permitted to turn and reposition the patient with an ulcer. 3. Although the LPN is permitted to change dressings, the RN is responsible for assessment. 4. Assessment is a responsibility for the RN. 5. The LPN is permitted to administer oral medications.

The nurse manager works at a rural hospital and is in charge of a medical unit. Another nurse manager is in charge of the adjacent surgical unit. Equipment is shared between the two units. The surgical unit manager frequently confronts and intimidates the manager of the medical unit regarding the use of the equipment. Which strategies could the manager of the medical unit use to generate feelings of personal power? Select all that apply. 1. Body language 2. Power plays 3. Arguing 4. Word choices 5. Listening

*Answer: 1, 4, 5* *Explanation:* 1. Body language is a strategy used to generate feeling of personal power. 2. Power play is not a strategy used to generate feeling of personal power. 3. Arguing is not a strategy used to generate feeling of personal power. 4. Word choice is a strategy used to generate feeling of personal power. 5. Listening is a strategy used to generate feeling of personal power.

The nurse manager needs to cover vacation shifts and must decide whether to use agency nurses or the PRN nursing pool. The manager must decide between the two choices. Decision making includes which steps? Select all that apply. 1. Seek alternatives. 2. Make a decision. 3. Define the problem. 4. Weigh the criteria. 5. Troubleshoot.

*Answer: 1, 4, 5* *Explanation:* 1. Seeking alternative is one of the steps in the decision-making process. 2. Making a decision is not one of the steps in the decision-making process. 3. Defining the problem is not one of the steps in the decision-making process. 4. Weighing the criteria is one of the steps in the decision-making process. 5. Troubleshooting is one of the steps in the decision-making process.

A nurse manager's supervisor reports that many staff members have complained about the manager's rigidity. What situations reflect this rigidity? Select all that apply. 1. The manager has historically used trial and error as a decision-making strategy. 2. The manager takes unnecessary risks when staffing the unit. 3. The manager is not concerned when staff members arrive late to work. 4. The manager uses old ways of thinking to solve the day-to-day issues of the unit. 5. The manager does not consider the advice of the assistant manager when making a decision.

*Answer: 1, 4,5* *Explanation:* 1. A history of ineffective trial-and-error solutions to problems tends to make the manager rigid. 2. Generally, fear of risk taking is characteristic of a rigid management style. 3. Rigidity in personality often translates to rigidity in management style. A rigid manager would be upset if staff members routinely came to work late. 4. Using old ways of thinking to solve new problems is characteristic of rigid management. 5. Rigid managers typically prefer to make decisions independently.

A nurse working in a rehabilitation center notices that clients frequently asking for something to drink. Which response indicates the use of creativity in finding a solution to this problem? 1. Calling local beverage distributors to inquire about service pricing 2. Asking all employees to write down their ideas about a solution 3. Determining what type of drinks most clients might want 4. Encouraging clients to bring a drink from home

*Answer: 2* *Explanation:* 1. Calling a local beverage distributor is a "classic" way to address this problem and does not engage the creativity of the staff. 2. Asking others to think about different options opens up the possibilities beyond one individual's ideas. This is part of the preparation stage of creativity. 3. Finding out the drink preferences of the clients is part of the standard information gathering stage of providing drinks and does not reflect creativity. 4. Simply encouraging clients to bring a drink from home is not a creative approach to solving this problem.

Which statement indicates understanding how a nurse could improve personal decision-making skills? 1. "We should gather a group together to make important unit decisions to ensure fairness." 2. "I should practice making decisions by developing potential solutions and then choosing one." 3. "We can make a decision and then ask for input from others to make sure it was the right choice." 4. "I know I will never be able to improve my decision-making skills because I am not a strong person."

*Answer: 2* *Explanation:* 1. Depending on a group is not likely to help the nurse improve personal decision-making skills. 2. Practicing making decisions will increase the nurse's experience, comfort, and overall skill. 3. Including a "we" in this process is not as likely to improve the nurse's personal decision-making skills as making an individual decision. Asking for input to make certain the choice was correct indicates lack of certainty. 4. Decision-making skills can be learned regardless of one's perceived personal strength.

The nurse manager gave the unit secretary complete responsibility for the unit's staffing, including finding replacements for call-ins and disciplining nurses with excessive call-ins. This is an example of which type of delegation? 1. Effective delegation 2. Overdelegation 3. Reverse delegation 4. Underdelegation

*Answer: 2* *Explanation:* 1. Effective delegation is the process by which responsibility and authority for performing a task is transferred to another person. It is critical that the task is one that can be delegated. 2. Overdelegation occurs when the delegator loses control over a situation by providing the delegate with too much authority or responsibility. Discipline of an employee is a responsibility of the manager that cannot be delegated because of the confidentiality and controversy associated with it. 3. Reverse delegation occurs when a person with a lower rank (unit secretary) delegates to someone with authority (nurse manager). 4. Underdelegation occurs when full authority and responsibility are not transferred in a situation where delegation would otherwise be appropriate.

A nursing task force has been created to determine whether a new model of differentiated practice would be more effective than the current model. The task force analyzes data as a basis to examine alternatives. Which activity does this represent? 1. Group problem solving 2. Critical thinking 3. Groupthink 4. Satisficing

*Answer: 2* *Explanation:* 1. Group problem solving implies that a problem exists, which is not the case in this situation. The task force is comparing two models of practice, not solving a problem. 2. Critical thinking is a higher-level cognitive process that involves the examination of assumptions, interpretation and analysis of arguments, and the development of a conclusion that can be justified. 3. Groupthink is a negative phenomenon that occurs in highly cohesive groups that become isolated. There is no evidence that groupthink has occurred in this situation. 4. Satisficing is a type of decision-making strategy that identifies a strategy that is minimally acceptable. There is no evidence that satisficing has occurred in this situation.

The nurse manager is counseling a male nurse about several recent incidents in which female nurses complained that he was abrupt and condescending. What advice should the manager give this nurse? 1. "Make sure that anything you say is clear and concise." 2. "Don't feel as if you are responsible for fixing every problem." 3. "Avoid using phrases such as 'sort of' when talking to females." 4. "Don't personalize everything."

*Answer: 2* *Explanation:* 1. Males tend to communicate clearly and concisely, especially in professional relationships. 2. There are many gender differences in communication. Males tend to take responsibility and feel the need to "fix" things. 3. Using phrases such as "sort of" is a more common trait of female conversation than of male conversation. 4. Women tend to personalize, whereas men are more focused on the issues.

A nurse believes that milk is part of the healthy adult's diet. The nurse frequently offers milk to adults as a between-meal beverage. This action is based on which concept? 1. Evidence 2. An underlying assumption 3. An alternative perspective 4. An inquiring attitude

*Answer: 2* *Explanation:* 1. Scientific evidence shows that milk is not tolerated by all adults. This action is not based in science. 2. The nurse's assumption is that milk is good for adults. 3. The nurse has not considered the alternative perspective that milk is not tolerated by some adults. 4. An inquiring attitude would lead the nurse to investigate research about adult tolerance to milk.

The nurse manager should be most careful not to hold preconceived beliefs when listening to which person? 1. The hospital administrator discussing next year's budget 2. A staff nurse the manager has worked with for 25 years 3. A newly licensed nurse who is hesitant to address the manager 4. A physician discussing prognosis with the client and family

*Answer: 2* *Explanation:* 1. The manager will probably pay close attention to the hospital administrator because of the position. 2. When there is a long-term relationship, the listener sometimes thinks they know what the other person is going to say. Careful listening is necessary in these situations. 3. The manager would be attuned to someone who is new to the organization and who might be hesitant to speak. This is not a common situation in which the manager would have preconceived beliefs. 4. The nurse manager will likely to listen very closely to this conversation without preconceived beliefs.

A nurse asks an unlicensed assistant to help with discharging clients because so many are going home at one time. The nurse states, "Can you help get these clients ready to go home by helping them pack?" Which option best describes the statement with regard to effective delegation? 1. The delegation is ineffective because the nurse has no responsibility to pack the client's belongings. 2. Delegation would have been more effective had the nurse been more specific about which clients and when it should be completed. 3. The delegation is ineffective because the nurse has no authority to ask the unlicensed assistant to help with client discharge. 4. Delegation could have more effective had the nurse gone with the assistant to ensure the assistant did the packing as requested.

*Answer: 2* *Explanation:* 1. The nurse has ultimate responsibility to ensure that the client is ready for discharge, which includes packing the client's belongings as necessary. 2. Effective delegation occurs when the delegator gives specific information to the delegate about the requested task. The nurse request in the stem was not specific enough. 3. The nurse has the authority to delegate this task to the unlicensed assistant. 4. There is no need for the nurse to go with the assistant to oversee the packing process.

The nurse prepares the medication ordered for the client. The nurse asks the nurse assistant to give the medication when the client receives breakfast and to report on the task at its completion. The nurse assistant agrees. Which component of the steps of delegation was violated by this request? 1. Defining the task 2. Deciding on the delegate 3. Determining the task 4. Reaching agreement

*Answer: 2* *Explanation:* 1. The task was defined but is inappropriate. 2. The violation occurred at the step of deciding on a delegate. Nurse assistants cannot administer medications. 3. The task was determined but is inappropriate. 4. The nurse and nurse assistant reached agreement, but the delegation was inappropriate.

2) A nurse plans to seek employment in an acute-care setting after graduation. Which form of communication would be most effective in applying for a position? 1. Send an email to the nurse manager, requesting a job interview. 2. Send a written letter and résumé in the mail. 3. Call the nurse manager to ask if any jobs are open. 4. Drop into the nurse manager's office to discuss employment options.

*Answer: 2* *Explanation:* 1. This approach is too informal. 2. Applying for a job requires a high level of formality. A written cover letter and résumé are expected by most organizations offering employment opportunities. This submission would be done by email only if that is the organization's specific request. 3. This approach is too informal. 4. "Dropping in" to the manager's office is not professional. Any meetings generally occur at the request of the potential employer and would occur after the résumé and cover letter are sent.

A newly licensed nurse working on a unit committee challenges every detail of a proposal the committee is developing. How should other committee members interpret this behavior? 1. This nurse is too inexperienced to realize the behavior is inappropriate. 2. This nurse is learning to be creative. 3. This nurse believes that new nurses are more knowledgeable than those who have worked several years. 4. This nurse misunderstands the work of the committee.

*Answer: 2* *Explanation:* 1. This behavior is not inappropriate. 2. Challenging details is a part of the preparation portion of learning to be creative. 3. There is no indication that this is the belief of this nurse. 4. There is no indication that this nurse does not understand the work of the committee.

A problem has arisen on a unit with primarily Generation X nursing staff. Which strategies should the nurse manager employ to get staff input into solving this problem? Select all that apply. 1. Schedule a staff meeting for discussion of the problem and its possible solutions. 2. Post a notice on the bulletin board explaining the issue. 3. Ask nurses individually for input. 4. Develop a possible solution and share it with nurses in a formal meeting. 5. Ask for input in text message and promise to respond to texts immediately.

*Answer: 2, 3* *Explanation:* 1. Generation X members do not like group problem solving and decision making. This is more the style of Baby Boomers. 2. Generation X members would be more likely to read the information, formulate an opinion, and share it with the manager. They like decisions to be made without unnecessary discussion. 3. Generation X members do not like unnecessary discussion, so asking for input individually would be a good strategy. 4. Traditionalists are more likely to respond to a suggestion from someone higher in the chain of command. They also tend to be more formal. 5. Generation Y is more likely to want immediate feedback from emails or text messages.

A nurse manager who is retiring is helping the new manager learn about the position. As part of this education, the current manager has the new manager make all decisions that can be made under certainty. What conditions will these decisions have in common? Select all that apply. 1. There is risk associated with the decision. 2. The alternatives are known. 3. The conditions of each alternative are clear. 4. Possible consequences of alternatives are not known. 5. The decision is complex and dynamic.

*Answer: 2, 3* *Explanation:* 1. With decisions made under certainty, there is little if any risk. 2. When a decision is made under certainty, the possible alternatives are known. 3. When a decision is made under certainty, the conditions surrounding possible alternatives are clear. 4. If possible consequences of alternatives are not known, the decision is being made under conditions of uncertainty. 5. Complex and dynamic decisions are those made under uncertainty.

The nursing supervisor is assessing a unit that has received several written complaints. The nurse manager seems overwhelmed and stressed trying to address many client situations. The charge nurse is trying to help everyone at once. Based on this assessment, what might this supervisor conclude? Select all that apply. 1. The nurse manager is inexperienced and needs time to adjust. 2. The unit culture may foster distrust and poor communication among staff. 3. Client complaints are usually an indicator of a larger unit problem. 4. Nurses on the unit are in need of additional training and skills. 5. The unit is short staffed.

*Answer: 2, 3, 4* *Explanation:* 1. There is nothing in this scenario to suggest that the nurse manager is inexperienced. 2. The unit clearly is having problems getting client responsibilities completed in a timely manner, resulting in stress and complaints. Reasons behind this might include distrust, poor communication, and a lack of delegation training. 3. When multiple client complaints are lodged against one unit, there is generally an overall problem with some aspect of the unit. 4. A lack of delegation training may result in chaos and client complaints. 5. There is no indication that the unit is short staffed.

The nursing supervisor is planning an education session on collaborative communication between nurses and physicians. Which topics should be on this agenda? Select all that apply. 1. Interdisciplinary respect 2. Understanding the role of the physician 3. Understanding the role of the nurse 4. Communication across disciplines 5. Active listening skills

*Answer: 2, 3, 4, 5* *Explanation:* 1. This topic is diffuse and hard to understand. More precise topics should be used. 2. Understanding roles is essential to collaboration. It must include both roles. 3. Understanding roles is essential to collaboration. It must include both roles. 4. Communication is the key to collaboration. 5. Listening is an essential part of communication.

A nurse on a mission trip needs a urinary catheter for an infant. The nurse only has a pediatric feeding tube and must think creatively. The nurse knows the creative process includes which stages? Select all that apply. 1. Communication 2. Incubation 3. Verification 4. Innovation 5. Insight

*Answer: 2, 3, 5* *Explanation:* 1. Communication is not included in the stages of the creative process. 2. Incubation is included in the stages of the creative process. 3. Verification is included in the stages of the creative process. 4. Innovation is not included in the stages of the creative process. 5. Insight is included in the stages of the creative process.

A nurse manager is delegating a new, complex task to the unit secretary. Which strategies should the manager use? Select all that apply. 1. Begin the instruction with a statement such as "It would be good if you could help me with this project." 2. Make eye contact with the secretary when explaining the task. 3. Talk to the secretary in person rather than by telephone or in an email. 4. Introduce the generalities of the task with a promise that details such as a time line will follow shortly. 5. Discuss the importance of the task to the organization.

*Answer: 2, 3, 5* *Explanation:* 1. The manager should use a more direct "I" statement such as, "I need for you to take the lead on this project." 2. Eye contact helps to ensure that the secretary is attending to the information presented. 3. Face-to-face communication will be necessary for explanation and questions. 4. It is important to have all the critical information available so that the delegate can make a logical decision about the task. 5. It is important to let the delegate know the importance of the task.

Although the postoperative assessment of a client reveals no abnormalities, the nurse believes the client's condition is deteriorating and orders frequent vital signs. This intervention was made on the basis of which type of problem solving? Select all that apply. 1. Experimentation 2. Intuition 3. Satisficing 4. Past experience 5. Trial-and-error method

*Answer: 2, 4* *Explanation:* 1. Experimentation involves testing a theory to produce a prediction. 2. Intuition and past experiences enable the expert nurse to make clinical judgments based on wisdom, sensitivity to the client, and a "gut feeling" that a change in the client is imminent. 3. Satisficing involves choosing a solution to meet minimum standards of care. 4. Intuition and past experience enable the expert nurse to make clinical judgments based on wisdom, sensitivity to the client, and a "gut feeling" that a change in the client is imminent. 5. The trial-and-error method is not based on prior experience; rather, one approach after another is tried until the problem is solved.

The nurse supervisor would like to delegate accreditation preparation activities to the nurse manager. The manager is unsure of what is expected and has no experience with accreditation. How should the manager respond? Select all that apply. 1. "I'll be glad to work on this task." 2. "I will need some education on the accreditation process before I can accept this task." 3. "I don't have time to add that to my work." 4. "Please tell me more about what this assignment entails." 5. "I'm not interested in working on this project."

*Answer: 2, 4* *Explanation:* 1. The manager should not accept a task until it is clear. 2. The manager should be clear about not having the required skill set but should indicate willingness to take the job if education is provided. 3. The problem is that the manager is not confident of his or her skills, not that time is unavailable. 4. The manager should clarify the task before accepting or refusing it. 5. Working on accreditation would help this nurse manager in career advancement.

Which situation represents an obstacle to delegation? 1. Most of the nursing staff deliver highly skilled care. 2. The entire organization has a team-centered culture. 3. There is a budget shortfall for the current fiscal year. 4. Each employee knows and executes job responsibilities.

*Answer: 3* *Explanation:* 1. A staff that includes many competent nurses enables the nurse manager to delegate and still have other nurses to rely on to deliver quality nursing care. 2. Democratic leadership styles facilitate delegation and provide good role models. 3. Resources such as qualified nurses, finances, and educational resources may be limited, which are obstacles to delegation. 4. Environmental factors such as a norm of crisis management as a result of poor job descriptions and unclear chains of command are unsupportive to delegation.

The nurse manager needs to delegate specific tasks to the charge nurse of the unit. Which action is an appropriate use of delegation? 1. Instructing the charge nurse to assume a client team 2. Asking the charge nurse to discipline a nurse on the unit 3. Having the charge nurse lead a nursing quality assurance task force 4. Evaluating all unlicensed personnel assigned to the unit

*Answer: 3* *Explanation:* 1. Because assuming a client assignment is included in the charge nurse's job description, this is assignment, not delegation. 2. Disciplining a nurse on the unit is the responsibility of the manager. Discipline should not be delegated. 3. Delegation is the mutual transfer of responsibility and authority that occurs on the basis of competence and trust. The nurse manager can delegate both the responsibility of leading this task force and the authority to make decisions regarding this role. Both must be delegated for the delegation to be successful. 4. The process of evaluation is the responsibility of the manager, and this authority cannot be transferred to a delegate.

Which statement made by the nurse manager is an example of the first step of delegation? 1. "I must choose a person with good time management skills to be the delegate for this task." 2. "I plan to evaluate the outcomes of your work in 6 months." 3. "I am going to delegate the responsibility for creating the vacation schedule." 4. "I have some additional information that will help you in this task."

*Answer: 3* *Explanation:* 1. Choosing the person to delegate to can only be accomplished after the task to be delegated is identified and defined. 2. Information regarding the task, such as when it will be evaluated, is given to the delegate as part of the delegation process. This cannot be done until the task is defined and the delegate is chosen. 3. The first step of the process is to identify and define the task that will be delegated. 4. Additional information can only be offered when the delegate has been chosen, and the delegate can be chosen only after the task has been identified.

The nurse asks the nurse manager if he can go home early because the census is low. When the request is denied, the nurse states, "I don't understand why I can't leave early. I will use vacation time, and this will help minimize personnel costs for the shift." This statement is an example of which technique of influencing the supervisor? 1. Fogging 2. Negative assertion 3. Negative inquiry 4. Compromise

*Answer: 3* *Explanation:* 1. Fogging is a technique used when the person is in partial agreement with what was said. 2. Negative assertion involves some acceptance of blame for what was said. 3. Negative inquiry is a statement of "I don't understand." Negative inquiry is an effective technique, provided the person to whom it is directed does not become defensive or distraught. 4. Compromise implies that an agreement has occurred between the nurse manager and the nurse.

Which is the most important reason that practicing and mastering effective delegation skills is essential for nurses? 1. Higher job satisfaction 2. Greater confidence in skills 3. Higher client satisfaction 4. Increased time for other tasks

*Answer: 3* *Explanation:* 1. Higher job satisfaction occurs when delegation skills are improved, but this is not the most important outcome. 2. Effective delegation may result in greater confidence in skills, but this is not the most important outcome. 3. When effective delegation takes place in an organization, everyone benefits. This leads to higher client satisfaction, which is the ultimate goal of nursing care and nursing management. 4. If delegation skills improve, the delegator should have increased time for other endeavors. This is not the most important outcome of increasing delegation skills.

Which situation is an example of reverse delegation? 1. The nurse manager asks the staff nurse to attend an in-service on a new product. 2. The nursing supervisor asks the nurse manager to attend a meeting with the physicians. 3. The licensed practical nurse asks the nurse manager to administer insulin to a client. 4. The staff nurse asks the licensed practical nurse to record intake and output in his client's charts.

*Answer: 3* *Explanation:* 1. It is appropriate for a person with more authority (nurse manager) to delegate a task to someone with a lower rank (staff nurse). 2. It is appropriate for a person with more authority (nursing supervisor) to delegate a task to someone with a lower rank (nurse manager). 3. Reverse delegation occurs when someone with a lower rank (licensed practical nurse) delegates a task to someone with more authority (nurse manager). 4. It is appropriate for a person with more authority (staff nurse) to delegate a task to someone with a lower rank (licensed practical nurse).

The nursing group has been charged with the task of solving a patient care problem on the unit. Which step should this group take first in this process? 1. Investigate what has already been tried to solve the issue. 2. Brainstorm about potential solutions. 3. Gather information to define the problem. 4. Categorize information in order of reliability.

*Answer: 3* *Explanation:* 1. Once the problem has been identified, the group would then look at solutions that have already been tried. 2. Brainstorming is used to develop solutions after information about the problem is analyzed. 3. Problem solving begins with collecting the facts, which provides clues to the scope and solution of the problem. 4. Information cannot be sorted into an orderly arrangement until it has been collected.

A staff nurse asks the nurse manager, "What assignment are you delegating to me today? I would like to begin to organize my day before shift report begins." What is the error inherent in this statement? 1. There is no way for the nurse to know how to organize until the assignment is clear. 2. The nurse manager would not make assignments. 3. The nurse manager is not delegating but rather making daily assignments. 4. Assignment occurs after shift report.

*Answer: 3* *Explanation:* 1. Organization takes many forms and is different for every nurse. Some nurses may use the time prior to shift report to organize. 2. Depending on the structure of the unit, assignments may be made by the charge nurse or the nurse manager. 3. Assignment is a bureaucratic function that reflects job descriptions and client or organizational needs. Daily work allotment from nurse manager to staff nurse is an assignment, not delegation. 4. Team assignments occur prior to shift report. In some institutions, all nurses working on the unit listen to shift report on all clients. In other institutions, the nurse receives report only on the assigned team.

Which action by the nurse manager is a demonstration of satisficing? 1. The nurse manager works with the staffing schedule until all requested days off are honored. 2. The nurse manager reposts a job opening because no applicants were a good fit for the current unit staff. 3. The nurse manager agrees with a proposed budget that does not provide badly needed new client beds. 4. The nurse manager insists on firing a nurse who is chronically late to work.

*Answer: 3* *Explanation:* 1. Satisficing would not involve extra effort to honor requested days off. 2. If the nurse manager was satisficing, someone would be hired, even if the fit was not good. 3. This is an example of satisficing. An example of not satisficing would be the nurse manager not agreeing with the budget until funding for the beds was provided. 4. A nurse manager who is satisficing would provide continued counseling, work with the nurse, make excuses, and retain the nurse on staff.

The nursing faculty would like to incorporate problem-based learning into the curriculum. Which action is essential? 1. Obtain funding for a simulation mannequin. 2. Write standardized scripts for volunteers who will portray clients. 3. Add more information to existing care plans as the study unfolds. 4. Assign client care debate topics to teams of three or four students.

*Answer: 3* *Explanation:* 1. Simulation mannequins are not essential for problem-based learning. 2. It is not essential to have a person who portrays a client in order to conduct problem-based learning. 3. Problem-based learning exists when students are exposed to "what comes next" in a case study. Additional information is revealed as the case study progresses. 4. Debates are a way to encourage innovation but are not essential for problem-based learning.

The nurse manager has instituted a policy of sending information to the staff in emails. Many misunderstandings have occurred since this policy was implemented. What technique should the manager use to reduce this miscommunication? 1. Use text messaging instead of email. 2. Require a return email from everyone reading the information. 3. Be certain that emails go only to the intended recipients. 4. Send all emails with a message line that says "Important."

*Answer: 3* *Explanation:* 1. Text messaging can make the problem worse because it implies the need to respond quickly. 2. Having everyone send a return email will set the nurse manager up for an onslaught of messages that really are not important. 3. Email communication is fraught with difficulties. The best of these options is to be certain that emails go only to the intended recipients. The use of "reply to all" or distribution lists is convenient, but it can result in sending the email to people that it does not affect. When this happens, people begin to ignore email. 4. Sending the message line "Important" with each email is much like crying wolf, and recipients will soon realize that the term Important is meaningless.

For the nurse to effectively and legally delegate, which document must be consulted and followed to reduce the likelihood of liability? 1. The American Nurses Association Bylaws 2. The National Council of State Boards of Nursing 3. The regulations of the state nurse practice acts 4. The rules of the governing specialty organization

*Answer: 3* *Explanation:* 1. The ANA Bylaws do not set out legal rules or regulations for delegation. 2. NCSBN does not set the legal rules and regulations of delegation. 3. Nurses in each state are governed by their own state's nurse practice act, and these regulations must be consulted and followed. 4. Specialty organizations do not set the legal rules and regulations of delegation.

What action is necessary by a delegate accepting delegation? 1. Accept all aspects of the task delegated. 2. Assume the delegator will serve as a mentor. 3. Clarify the time line and expectations. 4. Realize the delegate and delegator share responsibility.

*Answer: 3* *Explanation:* 1. The delegate has the option to negotiate for those aspects of a task the individual feels can be accomplished. 2. The delegator may have no intention of mentoring the delegate. 3. It is important for the delegate to make sure the time line and expectations are clearly defined, and he or she may opt to outline the specifications in writing. 4. Accepting delegation means accepting full responsibility for the outcomes and the benefits or liabilities associated with a task.

The nurse manager generally uses a stepwise method to arrive at decisions that are logical and that serve to maximize the achievement of the desired objective. Which decision-making model does this manager use? 1. Political decision-making model 2. Experimentation process 3. Rational decision-making model 4. Trial-and-error method

*Answer: 3* *Explanation:* 1. The premise of the political decision-making model is that decisions align with the interests of powerful stakeholders such as hospital boards and regulatory bodies. 2. Experimentation involves the use of a pilot project to test the effectiveness of a solution. 3. The rational decision-making model is a series of steps that managers take to make logical, rational choices that maximize the achievement of successful outcomes. 4. The trial-and-error method is used by inexperienced managers and involves the application of one solution after another to improve a problem.

After several near-incidents during procedures, the nurse manager is increasingly concerned about how nursing staff members communicate with physician staff. Which advice from the manager would be most beneficial to the nursing staff? 1. "Don't forget, you are just as good as they are." 2. "Physicians just don't listen as well as nurses." 3. "Let's review the steps of the procedures that we know are the biggest problems." 4. "I'm going to listen to the physicians, but I think most of the problem is with the physicians, not the nurses."

*Answer: 3* *Explanation:* 1. This statement sets up an "us against them" mentality. This mindset does not support respect for the physicians and could make communication more difficult. 2. This statement sets up an "us against them" mentality. This mindset does not support communication. 3. The nurse manager should ensure that the nursing staff is competent in the procedures that are causing problems by reviewing the steps of the procedures with them. 4. The preconceived notion that the problems are the fault of the physicians would make open and honest communication more difficult.

A newly licensed nurse is concerned about the legal aspects of delegation. What is the most important question for the nurse to consider prior to delegating a task? 1. Do other nurses in the facility delegate similar tasks? 2. How long has the assistant worked at the facility? 3. Does this task involve nursing judgment? 4. How busy is the delegate?

*Answer: 3* *Explanation:* 1. Whether or not other nurses delegate similar tasks is not as important as another question. 2. Experience is important, but is not the most important question. 3. The nurse should not delegate tasks that involve nursing assessment or judgment. 4. The nurse should consider if the delegate has sufficient time to complete the task, but this is not the most important consideration.

Which statement by the formal leader of a nursing unit reflects the personality required to energize the staff and promote creativity? Select all that apply. 1. "I would like to change the format we use for shift report, but I'm afraid it would upset staff members who have been here a long time." 2. "This is the decision I have made, and there is no room for discussion." 3. "I would like to thank everyone for your hard work and dedication while we have been short staffed." 4. "I am certain that our new assignment system is going to make the workload more equitable." 5. "I know this week has been rough. I feel a little like sandpaper myself."

*Answer: 3, 4, 5* *Explanation:* 1. Basing decisions on placating staff indicates the leader is insecure and does not energize staff or promote creativity. 2. The leader who does not value input from staff will not promote creativity. 3. The leader who recognizes the staff's efforts and sacrifices is more likely to energize the staff. 4. Optimism is crucial to energizing staff and promoting creativity. 5. Humor is a good method to help energize staff and promote creativity.

A nurse has made several "near errors" in client care in the last 2 months. The nurse manager says, "These are simple errors. You just aren't listening." How could the nurse improve listening skills in this situation? Select all that apply. 1. The nurse should try to think ahead about what the person talking is going to say. 2. The nurse should hold eye contact with the speaker at all times. 3. When listening to instructions, the nurse should ask anyone who interrupts to wait a moment. 4. The nurse should get sufficient time away from work to rest. 5. The nurse should be careful not to prejudge what the speaker is going to say.

*Answer: 3, 4, 5* *Explanation:* 1. Thinking ahead in the conversation interferes with the ability to listen and comprehend. 2. Eye contact does not mean the nurse is listening. 3. When many people are talking at one time, it is difficult to listen and comprehend. 4. Being tired and stressed from too much time at work can cause energy to flag, resulting in difficulty listening. 5. Preconceived beliefs about what the speaker is going to say makes it more likely that the nurse is not going to listen effectively.

The nurse is always intimidated when asking a physician to clarify orders. Which statements should the nurse use to help counteract this feeling? Select all that apply. 1. "I'm sorry, doctor, but I need for you to repeat the dosage on that medication order." 2. "Doctor, what was the dosage on that medication you ordered, and do you want the client up in a chair today?" 3. "How often did you want the furosemide given?" 4. "Uh, can you tell me if you need for this client to be NPO today?" 5. "Doctor, what rate did you want for the IV?"

*Answer: 3, 5* *Explanation:* 1. Saying "I'm sorry" discounts the message. 2. The nurse should focus on one point at a time. 3. This is a direct statement. 4. This statement is weak. Avoid "uh" and "um." 5. This is a direct statement, and it starts with a "name" that gets the physician's attention.

The novice nurse manager is hesitant to delegate tasks to competent, experienced staff nurses. Fear of which factor is most likely to explain this hesitancy? 1. Overburdening others 2. Decreased personal satisfaction 3. Increased liability 4. Competition and criticism

*Answer: 4* *Explanation:* 1. Even the novice nurse manager should realize that delegating is part of the role. 2. Fear of decreased personal satisfaction should be diminished by the increased opportunity to explore new challenges and gain other skills and experiences. 3. The novice nurse manager would not fear increased liability if delegating to competent, more experienced nurses. 4. The novice nurse manager may be insecure and fear that another staff member could perform the task more effectively. Fear exists that a successful delegate could threaten the nurse manager's credibility as a leader.

The staff nurse would like to improve personal communication with peers, patients, and the medical staff. Which strategy would be most effective for this nurse? 1. Plan to be more assertive in all communication. 2. Work to manage fear of conflict. 3. First learn to delegate clearly to others. 4. Attend the hospital-based communication training.

*Answer: 4* *Explanation:* 1. Although being more assertive in communication could help this nurse, this is not the most complete option. 2. Working to manage fear of conflict is not the most complete option. 3. Learning to delegate clearly would help the nurse learn to communicate better, but this is not the most effective strategy. 4. Attending training on communication would be the best plan for this nurse. The strategies described in the other options would likely be included in this training.

The nursing supervisor states, "I really don't have the time to delegate this task to a nurse manager. I can do it faster!" What is the most likely basis for this statement? 1. The nursing supervisor does not have time to delegate. 2. The nursing supervisor's job description needs to be redefined. 3. The nursing supervisor feels that he or she can do the job faster. 4. The nursing supervisor is concerned that staff is ill-prepared to assume additional responsibilities.

*Answer: 4* *Explanation:* 1. It is the responsibility of the supervisor to develop the staff. Failing to delegate is the time waster. 2. An effective manager's role is to develop staff in which such roles are delegated. 3. The fact that the nurse supervisor could do the job faster does not help to facilitate staff development. 4. Even though it may appear that these statements are straightforward and that the supervisor is just trying to save time, statements such as this often suggest a lack of trust and confidence in the abilities of the staff.

The nurse manager is calculating the cost of offering two bonus incentives to nursing staff for covering call-ins for sickness. After reviewing the statistics, the manager finds that option A is more cost-effective than option B but decides to implement option B because it seems safer. Which option best describes the basis of this decision? 1. Probability 2. Probability analysis 3. Objective probability 4. Subjective probability

*Answer: 4* *Explanation:* 1. Probability is the likelihood, expressed as a percentage, that an event will or will not occur. 2. Probability analysis is a method of calculating expected risk; this is the method the nurse used to compare the two options. 3. Objective probability is the likelihood that an event will or will not occur, based on facts and reliable information. 4. Even though option A is more cost-effective, the manager believes option B to be in the best interest of the unit. Subjective probability is the likelihood that an event will or will not occur based on personal judgment and beliefs.

The nurse manager is concerned about a family member's complaint regarding the professional behavior of a nurse on the unit. Which is the most effective method to address this issue? 1. Post a memo to the nursing staff about expected professional behavior. 2. Send an email to the nursing staff about expected professional behavior. 3. Address the complaint with the individual nurse in a telephone conversation. 4. Discuss the complaint with the individual nurse face-to-face.

*Answer: 4* *Explanation:* 1. The purpose of a memo is to convey general information to a group; it has a low level of personal intimacy. 2. The purpose of email is to broadcast information to large groups; it has a low level of personal intimacy. 3. A telephone conversation is less intimate than face-to-face communication, and the individual's response cannot be seen. 4. More important or difficult issues should be communicated face-to-face to the nurse involved so that the individual's response can be seen and questions can be answered appropriately.

The nurse has been concentrating on improving personal communication skills. Which option represents the final step in this nurse's work to improve communication? 1. Think about the goals of the communication. 2. Develop an appropriate and thoughtful response. 3. Decide how to say what you want conveyed. 4. Ensure the communication is understood.

*Answer: 4* *Explanation:* 1. Thinking about the goals is assessment. 2. Developing an appropriate response is an implementation. 3. Deciding how to say what you want conveyed or how to deliver your response is an implementation or plan. 4. Ensuring all parties understand the communication is the last step as it involves evaluation.

A group of nurses has been convened to solve a problem. As the first step in this process, the group leader asks for a definition of the problem to be solved. Which statement reflects the best problem statement? 1. Emergency department nurses do not make professional client handoff reports. 2. Long-term care facility nurses lack the education to make complete assessments prior to client transfers. 3. Housekeepers are getting sloppy about cleaning rooms. 4. Unit clerks have made 10 transcription errors in the last 6 months.

*Answer: 4* *Explanation:* 1. This is a judgment statement. 2. This is a judgment statement. 3. "Getting sloppy" is a judgment statement. 4. A good problem statement reflects the facts without judgment as to cause.

The nurse has determined that in order to provide the highest quality care it is important to become more creative. What is the most effective way for the nurse to increase creativity? 1. Watch others implement creative solutions. 2. Work with a group to implement a creative solution. 3. Evaluate the effectiveness of creative solutions. 4. Practice the steps of the process as often as possible.

*Answer: 4* *Explanation:* 1. Watching others implement creative solutions would be helpful in improving the nurse's creativity, but it is not the best of these choices. 2. Working with a group to implement a creative solution would be helpful in improving the nurse's creativity, but it is not the best of these choices. 3. Evaluating the effectiveness of creative solutions would be helpful in improving the nurse's creativity, but it is not the best of these choices. 4. The most effective of these methods would be practicing the steps. Creativity is a skill that can be learned and improved through practice, just like technical skills.