Clinical Management Exam 1

As the manager, you have been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperatively that is being operationalized throughout your organization. Which of the following illustrates effective leadership?

A RN who is already familiar with the new approach volunteers to take the lead in mentoring and teaching others how to implement it.

The hospital administration is discussing the possibility of closing hospital beds in your unit because of a nursing shortage and the increased amount of overtime required to care for patients. As the leader on the unit, which of the following examples best demonstrates your transformational leadership style?

A group of your staff members goes to the administration to propose closing of a different unit.

As the RN charge nurse on the night shift in a small long-term care facility, youve found that there is little turnover among your LPN and nursing assistant (NA) staff members, but they are not very motivated to go beyond their job descriptions in their work. Which of the following strategies might motivate the staff and lead to greater job satisfaction?

Allow the LPNs and NAs greater decision-making power within the scope of their positions in the institution.

A grievance brought by a staff nurse against the unit manager requires mediation. At the first mediation session, the staff nurse repeatedly calls the unit managers actions unfair, and the unit manager continues to reiterate the reasons for her actions. What would be the best course of action at this time?

Ask each party to examine her own motives and issues in the conflict.

Nancy is a staff nurse who works on a rehabilitation unit. Nancy tells you that the assistants are experiencing difficulty with the new lift and wonders what your thoughts are on organizing an in-service training. Nancy is exhibiting which trait of a follower?

Assumes responsibility for identifying a safety concern and concedes authority for solution to you

A new RN staff member asks you about the difference between QA and QI. You explain the difference by giving an example of QI.

At a staff meeting last year, two of our staff commented on the number of recent falls and asked, What can we do about it?

The new head nurse on G Unit has been the subject of a great deal of discussion and complaining during breaks. She is a competent nurse of tremendous integrity with approximately 30 years experience. Her predominant method of problem solving and communication is through meetings, which can go over the allotted time. The staff may:

Be presenting different generational values and attitudes than the head nurse.

Your institution has identified a recent rise in postsurgical infection rates. As part of your QI analysis, you are interested in determining how your infection rates compare with those of institutions of similar size and patient demographics. This is known as:

Benchmarking.

A nurse managers responsibility for financial management involves making budgetary decisions. Budgets that allow the nurse manager to allocate resources at the unit level allow:

Budgetary decision making at the point-of-service (POS).

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery. According to quality improvement (QI), to correct the problem, the educator, in consultation with the patient care manager, would initially do which of the following?

Call a meeting of all staff to discuss this issue.

The hospital administrator approves a case management position for a new rehabilitation unit to help reduce costs. In developing the job description, the nurse manager understands that a key element of case management is:

Coordination of resources for effective outcomes.

A manager who is concerned with ensuring that patients on her surgical unit have the necessary information to make informed choices is:

Demonstrating respect for patient rights.

A nurse manager has worked rapidly to bring the staff to accept changes in the units mission, so that downsizing can be avoided. This nurse manager is using quantum leadership by:

Determining accurately the direction of change in the institution.

As a senior executive, you are keen to develop your hospital as a learning organization. Part of your purpose in translating this vision into practice is to (select all that apply):

Develop leaders Maintain and/or improve quality of care Stay abreast of new knowledge and evidence.

Nurses on Unit 17 complain that their manager frequently checks up on them and encourages little involvement in decision making and yet, during performance reviews, praises them for their outstanding performance. Nurses on Unit 18 indicate that their experience is different from that of nurses on Unit 17. The manager on Unit 18 encourages active involvement in decision making and provides authentic, growth-promoting feedback. The practices on Units 17 and 18 reflect.

Differences in the managers expectations of their role.

A nurse manager is discussing with unit staff the repeated lack of staff compliance in documenting exercise activity for postcardiac surgery clients. The units licensed practical/vocational nurses are responsible for ensuring that clients carry out the prescribed exercise regimen and that the activity is documented. Using Druckers five basic functions of a manager, identify appropriate functions for the nurse manager to use when addressing this situation (select all that apply):

Divide the necessary activities into manageable tasks, so clients adhere to the exercise regimen Establish objectives and goals for each area and decide who is accountable for them. Engage in activities that motivate the team, and communicate effectively with the responsible staff members Analyze, appraise, and interpret the performance of responsible staff, and communicate these findings to staff management.

Electronic health records (EHRs) are being instituted at Pleasant Valley Hospital. Some of the staff on Unit 4 complain to the manager that acquiring the technologic skills required is too time consuming. They question its value in patient care. The manager responds that:

EHRs will increase effectiveness of care by enhancing coordination and improving patient outcomes.

An example of an effective patient outcome statement is:

Eighty percent of all patients admitted to the Emergency Department will be seen by a nurse practitioner within 3 hours of presentation in the Emergency Department.

John is interested in leadership positions within his nursing organization. Al-though he has been on the same unit for 10 years, he has attended two workshops during that time and has steadfastly refused opportunities to engage in leadership development opportunities or other learning offered as part of the hospitals succession planning strategy. He says that he is interested in a leadership role primarily because it will give him a more stable work schedule and will enable him to spend more time with his family. In coaching John, it would be important to:

Encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in life-work balance.

As a nurse manager, you embrace the usefulness of resources such as Smart Bed. This behavior is important to:

Encouragement of staff utilization of technology.

A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of the older adult patient. Using complexity principles, what would be the best approach to take in making this change?

Engage involved staff at all levels in the decision-making process.

A dispute arises between an RN staff member and an LPN over a patient issue. The tension between the two begins to affect other staff members, who are drawn into the conflict; eventually, the team becomes polarized toward either the RN or the LPN. This situation might have been prevented through:

Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves.

The manager of a surgical area has a vision for the future that requires the addition of RN assistants or unlicensed persons to feed, bathe, and walk patients. The RNs on the staff have always practiced in a primary nursingdelivery system and are very resistant to this idea. The best initial strategy in this situation would include:

Exploring the values and feelings of the RN group in relationship to this change.

The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility. While making rounds on the units, the staff development coordinator overhears RN staff complaining that they feel it is insulting to be required to participate in a competency program. Which behavior by the staff development coordinator is most appropriate in this situation?

Facilitate a meeting so nurses can articulate their values and concerns about a competency program.

Hospital ABCD is a Magnet hospital. This designation has been applied to Hospital ABCD because it:

Facilitates active staff participation in decision making related to quality nursing care.

A nurse manager is experiencing considerable conflict among staff members because of weekend staffing coverage. During a called staff meeting, the nurse manager asks the disgruntled staff to meet as a group and determine the best staffing practices. In doing this, the nurse manager is using the concept of collaboration to:

Focus all energies of staff members on a best possible strategy.

Examples of sentinel events include (select all that apply):

Forceps left in an abdominal cavity Patient fall, with injury Administration of morphine overdos Death of patient related to postpartum hemorrhage.

As a nurse manager, you identify that a shift in nursing care models might increase patient and staff satisfaction and avoid downsizing. Administration is reluctant to adopt this approach because downsizing is seen as critical to reduction of costs. To leverage your ideas, you:

Identify influential members of your nurse manager group with similar ideas and request an opportunity to meet with administration to discuss options.

A new graduate is asked to serve on the hospitals quality improvement (QI) committee. The nurse understands that the first step in quality improvement is to:

Identify the standard.

As the nurse manager who wants to increase motivation by providing motivating factors, which action would you select?

Implement a model of shared governance.

A nurse is explaining the pediatric units quality improvement (QI) program to a newly employed nurse. Which of the following would the nurse include as the primary purpose of QI programs?

Improvement in patient outcomes

Which of the following nurses is MOST likely to inspire others to do their best?

Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious.

You walk into Mr. Smiths room and find him yelling at the LPN, Miss Jones. He is obviously very upset and after you speak with him regarding his behavior, you determine that he has not slept for three nights because of unrelieved pain levels. The LPN is very upset with Mr. Smith and calls him an ugly, old man. You acknowledge her feelings and concerns and then suggest that Mr. Smiths behavior was aggressive but is related to lack of sleep and to pain. You say to Miss Jones, Can you both, together with Mr. Smith, determine triggers for the pain and effective approaches to controlling his pain? This approach demonstrates:

Leadership behavior.

To retain supervisory staff members, the director of nursing develops a mentoring program. The best person to be a mentor for a new supervisor in a leadership position is someone who has:

Leadership experience and time to spend communicating with the new supervisor about his or her experiences.

During a discussion of concern about approaches used with aggressive patients in the Emergency Department, several staff members express concern for their safety. As a leader, the nurse manager should:

Look directly at speakers and acknowledge their comments.

The adage leaders are born and not made reflects which of the following ideas around leadership?

Management can be taught; leadership depends on abilities.

The outcome statement Patients will experience a ten percent reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding is:

Measurable and nursing-sensitive.

The nurse manager plays a unique role in institutional management in that the nurse manager:

Models professional nursing behavior.

A nursing-led classification system that has led to greater reliability and standardization in data utilized for QI processes is:

NANDA

In determining the relationship between injury-producing falls and proposed preventive measures as part of the QI process, a QI team might turn to which of the following for confirmatory evidence?

NDNQI

In developing an orientation program, the hospital educator breaks essential organizational information down into chunks, which she develops as online modules. This is an application of which of Druckers functions of management?

Organization of activities into manageable tasks

As a nurse manager, you know that the satisfaction of patients is critical in making QI decisions. You propose to circulate a questionnaire to discharged patients, asking about their experiences on your unit. Your supervisor cautions you to also consider other sources of data for decisions because:

Patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff.

The senior executive praises John for the positive patient evaluations that his unit has received. As an effective leader, John:

Points out the contributions of his staff to the outcomes and shares the praise with his staff.

Patient perceptions are useful in:

Providing one source of data for QI initiatives.

The successful integration of informatics into healthcare settings is key to:

Quality decision making related to management of resources and patient care.

As a nurse manager on a urology unit, you note that there has been a marked increase in medication errors on the unit. Which of the following actions would be consistent with the National Database of Nursing Quality Indicators (NDNQI) measures?

Recent changes in staffing mixes are examined to determine if the timing of changes coincides with the increase in errors.

A nurse manager wants to decrease the number of medication errors that occur in her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a total quality management philosophy by:

Recommending that a multidisciplinary team should assess the root cause of errors in medication.

A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who begins to complain loudly about the quality of care his mother is receiving. His behavior is so disruptive that it is overheard by staff, physicians, and other visitors. The family member rejects any attempt to intervene therapeutically to resolve the issue. He leaves the unit abruptly, and the nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner?

Reflect to gain insight into how the situation could be handled differently in the future.

The nurse manager in the Emergency Department needs to implement new staffing patterns. As a transformational leader, the nurse manager should:

Reinforce how this change will respond to the ideas and solutions generated by staff members.

The nurse gives an inaccurate dose of medication to a patient. After assessment of the patient, the nurse completes an incident report. The nurse notifies the nursing supervisor of the medication error and calls the physician to report the occurrence. The nurse who administered the inaccurate medication understands that:

Risk management programs are not designed to assign blame.

As the clinical director of 24 employees, you have been asked to explain to staff members why they are not getting a raise this year, even though they have been working short-handed for many months and patient satisfaction scores have never been higher. Because you believe yourself to be a transformational leader, you will approach this problem by:

Showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future.

The style of leadership that Kari is exhibiting is likely to:

Stifle innovative thinking about ways to move out of financial jeopardy.

Becky graduated five years ago and is keenly interested in pursuing leadership opportunities. She has been active in learning about leadership through workshops and Internet research and recently began a graduate degree program with a focus on nursing administration. She has excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and sometimes aggressive behavior tends to alienate other staff members on the unit. In coaching Becky, you:

Suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation.

Healthcare organization X is committed to improving patient outcomes and, as part of the QI process, examines its executive structure and organizational design. This approach recognizes:

That structure influences nurse burnout and participation in quality improvement initiatives.

A nurse executive is hired to restore a units productivity, which has decreased as the result of low staff morale. The nurse executive utilizes which of the following leadership principles?

The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment.

While explaining the importance of developing leadership skills among nurses to a group of first-year nursing students, Natalie, a nursing unit manager, emphasizes that:

The public depends on nurses to assume leadership in moving consumer advocacy concerns forward.

The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader?

The staff nurse who persuades other staff members to practice by making evidence-based decisions

In working with Cheryl, her mentor suggests that it is really important for Cheryl to engage in self-appraisal and to know her strengths. This observation is based on an understanding that:

There is little external motivation and affirmation in leadership.

A nurse executive who considers herself a Baby Boomer will have the challenge of convincing the emerging workforce of the necessity of committee meetings. One of the primary reasons that the Baby Boom generation appears to have so many meetings in the work environment is that:

They find that the journey to the solution is as important as the solution itself.

While interviewing for a nurse manager position, Ann is asked to give an example of a situation in which she demonstrated leadership. Which of the following examples exemplifies leadership?

Through research and investigation of best practice and practice-based evidence, she proposed a change in the management of incontinence in elderly patients.

Hospital Magnet decides against creating a separate department to lead and monitor quality activities because:

Total organizational involvement is critical to QI.

After a newly hired director of nursing has reviewed the hospitals strategic plans, she develops a timeline for achieving those plans. The new leader is:

Translating a global document into realistic plans for nursing.

At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. It would now be best to:

Turn the dispute over to the director of nursing.

A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled but must often care for his wife, who is undergoing treatment for breast cancer. According to Maslows need hierarchy theory, what would be the best approach to satisfying the needs of this nurse, other staff, and patients?

Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wifes treatments.

You overhear a newly graduated RN telling one of your colleagues that leadership and management belong to the unit manager and not to her. As a nursing colleague, you respond by demonstrating understanding that the perception of the new graduate:

Would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals.

During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is:

a leadership tag

Recruiting among the emerging workforce (18- to 35-year-olds) is a challenge for healthcare agencies. Marketing brochures should address the leadership and vision of the healthcare agency. Which of the following workplace environments will attract applicants in the emerging workforce?

a nurturing and receptive environment

The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are angry and ask for a meeting to discuss the change. After hearing their concerns related to reduction in professional autonomy and care quality, you:

acknowledge the loss

Sarah wonders about the direction that you have given regarding management of incontinent, confused patients. She brings you evidence that she has found regarding incontinence interventions and asks you if she and you could talk about the guidance that you have given after you have had an opportunity to read the articles she has given you. This is an example of (select all that apply):

assertiveness followership

Which of the following is not important in a positive work environment, as defined by the AONE?

challenge and striving for excellence

A method commonly used in Quality Assurance to monitor adherence to established standards is:

chart audit

As a leader on a rehab unit, you encourage all staff members to see themselves as having a role in decision making and quality care. You see your role as involving particular responsibilities in decision making but not as a hierarchal role. This view of decision making and leadership is consistent with:

complexity theory

Joan, the nursing unit manager, finds it difficult to work with Thomas, a new graduate. Thomas has many ideas, and his manner of presenting them irks Joan. After reflection and discussion with others, Joan recognizes that she also feels threatened by his behavior. She comes to understand that Thomas is trying to establish his own role on the unit, is not trying to challenge her, and needs guidance, coaching, and affirmation. Joan is demonstrating:

deepening self awareness

You recently acquired a position as a unit manager. During your time on the unit, you have formed a strong social network among your staff, have promoted the development of relationships between your staff and workers in other areas of the organization, and have formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, you are engaging which principle?

development of networks

In planning a new wing, the nurse manager complies with the workplace safety requirements of the Occupational Safety & Health Administration (OSHA). Which of the following groups is considered to be at high risk for violence in the workplace?

emergency department staff

After assessing an older adult patient in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. The nurse managers decision and actions are based on:

experience

Through the QI process, the need to transform and change the admissions process across administrative and patient care units is identified. In this particular situation, what method of data organization will be most effective?

flowchart

A family is keeping vigil at a critically ill patients bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with people in such situations. In response to this situation, you approach the unit manager to apprise her of your concerns that the family dynamics of the patient involved may lead to staff-family and patient-family conflicts. You suggest that the physician may need to discuss the treatment plan with the family. The unit manager advises that he will arrange this discussion. If, after the meeting with family members, this is identified as a desired approach, you support the managers decision. Your actions indicate that you are acting in what role?

follower

The nurse manager is anticipating changes on the unit because of managed care. It is up to the manager to sell the staff on this care concept. A goal of managed care that the staff must understand is that managed care is:

grounded in business theory

A nursing unit is interested in refining its self-medication processes. In beginning this process, the team is interested in how frequently errors occur with different patients. To assist with visualizing this question, which organizational tool is most appropriate?

histogram

With the rise of violence in the psychiatric department, the nurse manager decides that she should work with the risk manager in violence prevention. The nurse manager should:

hold staff accountable for safe practices

The nurse manager is concerned about the negative ratings her unit has received on patient satisfaction surveys. The first step in addressing this issue from the point of view of quality improvement is to:

identify a clinical activity for review

The chief executive officer asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit. The nurse manager explains that nursing research has validated which statement about a low nurse-to-patient ratio? It:

improves patient outcomes

Susan, a new graduate on the dialysis unit, appears to take Karis remarks very seriously and works even harder, often volunteering for extra assignments. She also is often in Karis office, advising of successes with her patients and of the extra effort that she is committing. This behavior suggests that Susan:

knows how to play the game

You pull staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions. Staff members are becoming distanced from the family. After inviting the concerns of staff, you explain that the organization values patient-centered care and that evidence supports that acting as an advocate and a listener is helpful to families. You ask the staff for ideas as to strategies that are effectively patient-centered in these situations. In this situation, you are taking on which role?

leadership

Budgeting and protection of revenues is a function of:

management

Chart audits have revealed significant omissions of data that could have legal and funding guidelines ramifications. As the unit manager, you meet with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. This is an example of:

management

A family is keeping vigil at a critically ill patients bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with people in such situations. What role are you assuming through this action?

manager

A group of managers is meeting to discuss ideas related to the successful implementation of evidence-based practice on their units. Susan has been asked by the director of care to assume leadership of these discussion groups. After two such sessions, Susan expresses disappointment to her mentor that the group seems disinterested in her ideas and that they are listening to Ken, who has much less experience with leadership. In discussing this with Susan, the mentor understands that leadership:

must be earned

At Hospital Ajax, there has been a 20% increase in instruments and sponges being left in patients during surgery and surgeries on the wrong limbs. These are known as:

never events

Before beginning a continuous quality improvement project, a nurse should determine the minimal safety level of care by referring to the:

nursing care standards

The Sunny Long-Term Care Facility has experienced numerous difficulties with staff relationships, despite its success in maintaining financial viability and judicious use of resources. Staff members complain that the primary concerns of the facility include applying policy, saving money, and ensuring that lawsuits are avoided. There is little trust in, and involvement of, staff members. This facility may be:

overly managed and not well led

Role theory has its underpinnings in management theory. Management theories influence managers leadership styles. Which of the following theories would a nurse manager be most likely to follow when redesigning the staffing schedule?

quantum

A nurse manager in a hospital is deeply concerned that senior administration makes decisions about budgetary directions that affect staffing and other resources without sharing the rationale for changes or demonstrating concern as to how these changes may affect patients or staff. She says she does not feel respected and is emotionally tired as a result. This situation represents:

quantum leadership

The nurse manager, as the leader of the units customer (client) first initiative, has asked the staff nurses to develop and administer a survey to every client before discharge. In asking the staff nurses to accomplish this task, the nurse manager is demonstrating:

shared leadership

According to the complexity theory, which of the following should be the focus of measurement?

staff morale and budgets

Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style?

transactional

As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas. You are employing _____ leadership.

transformational

Nurses in the CCU are unhappy and frustrated with their nurse manager. They complain that nothing is ever good enough for him. These statements suggest that the nurse managers goals may be:

unrealistic

After being interviewed for the unit manager position, the staff nurse reflects on the interview process. The staff nurse is aware that leadership begins:

within