leadership

In spite of the important role that hospitals play in American healthcare, there is growing importance of community-based healthcare and community-based nursing. Which of the following statements best conveys a central aspect of the philosophy of community care? A) The client is in charge of his or her health and healthcare in the community. B) Nurses maximize their scope of practice in noninstitutional settings. C) Community settings allow for the greatest number and variety of treatment options. D) The nurse becomes the key member of the healthcare team in a community setting.

Ans: A Feedback: A central premise of community healthcare is the fact that patients/clients are in charge. The move toward community care is not motivated by an increased role for nurses. There are a greater number of treatment options in hospitals than in the community, but this fact does not negate the importance of community care.

A nurse has identified glaring inefficiencies in the way that care is organized on a medical unit. Which of the following tasks will this nurse perform if he or she is to act as a change agent? A) Informing others about the need for change B) Ensuring that others comply with any change that is implemented C) Establishing punishments and rewards to foster compliance with change D) Evaluating the long-term outcomes associated with change

Ans: A Feedback: A change agent is the person who seeks to create change and is responsible for facilitating the change process with others. Having gathered data, identified the problem, and decided that change is needed, the change agent sets about making others aware of the need for change. A change agent is not necessarily involved with evaluating a change or ensuring compliance.

Which of the following statements accurately reflects the general use of the grievance process by nurses? A) Grievances usually are related to interpretations of a contract or to policies and procedures. B) Although either the management or an employee can file grievances, in most instances it is management that initiates the case. C) A grievance involves informal talk between the management and the employee until the issue is resolved. D) Employees may have grievances about the contract negotiation process itself.

Ans: A Feedback: A grievance is a circumstance or action believed to be in violation of a contract (or of policies of an institution if a contract is not in place). Grievances usually are related to interpretations of a contract or policies and procedures and they are usually initiated by employees. Although resolution may begin with an informal talk, this proceeds to a formal process if resolution is not achieved.

After identifying a job posting in his or her field of specialty, a diabetes nurse has submitted a letter of application and a rsum. What is the primary function of a letter of application? A) To introduce the applicant to the employer in a personal way B) To state why the nurse left his most recent position C) To demonstrate the nurses work ethic D) To summarize the content of the rsum in a succinct way

Ans: A Feedback: A letter of application provides the opportunity for a nurse to reveal a bit of his or her personality and connects his or her experience to the positions requirements. The purpose is not primarily to summarize the rsum or demonstrate a work ethic. It is inappropriate to state reasons for leaving previous positions in a cover letter.

Contracts are essential to the maintenance of high quality care in healthcare institutions. As well, they are necessary to protect the interests of nurses who provide this care. Which of the following issues is most likely to be addressed in a contract for nurses? A) The process that should be followed when distributing overtime work B) The obligation of nurses to participate in nursing research C) The details of the organizational structure of a hospital D) The relationships among nurses, physicians and members of other health disciplines

Ans: A Feedback: Contracts commonly address such issues as overtime work. Relationships between care providers, participation in research, and organizational structure of a hospital are issues that are normally outside the purview of a nursing contract.

A client with a long-standing diagnosis of chronic obstructive pulmonary disease (COPD) has been enrolled in a disease management program. Which of the following activities will be prioritized in this program? A) Providing comprehensive and evidence-based care of the clients COPD B) Creating collaborative relationships between the client and the care team C) Ensuring that the client qualifies for Medicare and Medicaid D) Liaising between the client and his health maintenance organization (HMO)

Ans: A Feedback: Disease management focuses on providing the best evidence-based care for an individual with a specific chronic illness. This does not necessitate enrollment in an HMO, Medicare, or Medicaid. Collaborative relationships facilitate effective disease management but this is a means to the end of positive health outcomes rather than an end in itself.

A nurse who provides care in a busy ambulatory clinic knows that there are numerous occupational hazards associated with the provision of nursing care. What is the employers responsibility in minimizing the nurses risk of experiencing an injury or infection? A) The employer must provide all the necessary supplies and equipment to prevent injuries and infections. B) The employer must ensure that staffing levels are maintained at a level specified by the state board of nursing. C) The employer must have dedicated occupational health officers present at all times. D) The employer must release nurses from tasks that may present a threat to their health.

Ans: A Feedback: Employers must be held accountable for providing the supplies and environment to make work settings safe. All risks cannot normally be eliminated and dedicated occupational health staff may or may not be available or necessary. Safe staffing levels are important, but these do not necessarily mitigate the risk of workplace injuries and infections.

A nurse who works in a rural hospital has become frustrated and disillusioned at the steady increases in nurse to patient ratios at the same time that patient acuity has increased. When planning to address this issue with the hospitals leadership, the nurse should cite which of the following statements about increased nurse to patient ratios? A) Increased nurse to patient ratios are associated with a decline in patient outcomes. B) Reality shock is more common and severe when there are increased nurse to patient ratios. C) An increased nurse to patient ratio increases the incidence of disruptive behavior in hospital settings. D) Discrimination and stress increase when there is an increase in nurse to patient ratios.

Ans: A Feedback: Increased nurse to patient ratios have been shown to result in decreased patient outcomes. There are other deleterious effects on nurses, including reality shock and stress, but patient outcomes should be the primary consideration.

A registered nurse is responsible for overseeing the care that is provided in a long-term care facility. The skills mix at the facility includes the registered nurse, a practical nurse, and several unlicensed assistive personnel (UAP). Which of the following statements is true of the delegation that the RN performs? A) The RN is accountable for the care that the other members of the team provide. B) The RN may only delegate tasks that are outside of her own scope of practice. C) The RN can delegate tasks that are outside the PNs or UAPs scope of practice if she first provides adequate teaching. D) Once a task is delegated, the person who performs the tasks is solely responsible for the outcomes.

Ans: A Feedback: It is critical to remember that although you have asked someone else to carry out a nursing task, you are still accountable for the care that is given. A person cannot be delegated a tasks that is outside his or her scope of practice, regardless of whether teaching is provided. A person cannot delegate a task that is outside of his or her own scope of practice.

A nursing student finds that she has difficulty with procrastination. Which of the following is a recommended guideline to help this student manage her time? A) Start working on a project for 10 minutes, and quit if tired or bored. B) Schedule 2 or 3 days a week in which to concentrate her tasks. C) Avoid spending the time it takes to make to-do lists. D) Schedule down-time first and work second.

Ans: A Feedback: Kanarek (1996) provides five suggestions for dealing with procrastination. First, she suggests that you start working on a project for 10 minutes and quit if tired or bored. Work times should be prioritized carefully and spread out over time. The creation of lists is a useful tool.

The nurse manager of a busy medical unit prioritizes effective communication with the employees of the unit. In recent years, an increasing amount of this communication has involved e-mails and text messages. When using these communication media, the nurse should A) take action to ensure that patient confidentiality is maintained. B) cc upper management and human resources with all e-mails. C) avoid using a smartphone on the unit whenever possible. D) follow up e-mails with a paper copy of important messages.

Ans: A Feedback: Patient privacy can be difficult to ensure when communicating electronically. As a result, nurse leaders must take measures to protect confidentiality. Electronic messages do not always need be followed up with paper copies and it is unnecessary to cc superiors on all communications. Smartphones are an effective communication tool, provided they are used in an appropriate manner.

A goal of community nursing is to provide primary prevention from disease. Which of the following nursing actions reflect this goal? A) A nurse creates a pamphlet discussing heart-healthy foods and distributes it in the neighborhood community center. B) A nurse starts an intravenous line on a dehydrated baby who has been brought to the emergency department. C) A nurse performs range-of-motion exercises for a patient in traction. D) A nurse repositions an elderly patient confined to a wheelchair to avoid the formation of pressure ulcers.

Ans: A Feedback: Primary prevention involves the efforts to prevent disease from ever occurring. Primary prevention can be aimed at stopping the cause of disease. Generalized efforts to educate people regarding healthy diets are aimed at this type of primary prevention. Tertiary prevention focuses on preventing long-term disability and restoring functional capacity, as exemplified by repositioning an immobile patient, rehydrating a patient, or assisting with exercises.

A nurse has responded to a patients call light for the fourth time in the past hour only to be berated by the patient for taking so long to come to the bedside. Rather than responding in a confrontational tone the nurse has paused to think of the best response to the patients statements. In doing so, the nurse has exhibited A) self-regulation. B) sympathy. C) manipulation. D) self-strategy.

Ans: A Feedback: Self-regulation refers to the ability to control inappropriate impulses and to think before acting or speaking. Research on mindfulness training indicates it is a positive strategy for managing emotionally charged situations. The nurse has not acted in a manipulative way. Sympathy involves feeling sorrow for another persons pain, a dynamic that is not evident in this interaction.

There is general agreement on a postsurgical unit that the admission assessment template that is used is lengthy, unwieldy, and includes many parameters that are not relevant to the care of the patient population on the unit. Which of following aspects of amending the assessment template best exemplifies the concept of shared governance? A) Managers and nurses cooperatively make a change and share accountability for the outcomes. B) The unit manager consults with nurses and members of other disciplines prior to changing the document. C) The decision-making process reflects the chain of command that exists at the hospital. D) Nurses collectively present the change in practice to the manager, who is then accountable for the outcomes of the change.

Ans: A Feedback: Shared governance encompasses a collaborative model of decision-making and shared accountability for the outcomes of these decisions. It does not involve nurses announcing an independent change to management or management being solely accountable for the decisions of others. Shared governance is not necessarily linked to the chain of command in an organization.

What is the basic tenet of shared governance? A) It allows nursing staff and management to be involved in decision-making. B) It establishes the control of the institution over the actions of the nursing staff. C) It allows the administrative decision area to be controlled by management. D) It supports the traditional role of the supervisor as one who hires, evaluates, promotes, and fires.

Ans: A Feedback: Shared governance may be viewed as a system in which nurses have organizational autonomy as reflected in control over their practice, and have input into decision relating to patient care. It is a professional practice model in which both the nursing staff and the nursing management are involved in decision-making, as opposed to the administrative decision area being controlled by management. In this way, it is an alternative to traditional supervision models and hierarchies.

In response to her recent job application, a nurse has been contacted by a member of the hospitals human resources (HR) department in order to schedule an interview. The nurse should A) bring several copies of her rsum to the interview. B) ask the HR representative how she should dress for the interview. C) do research so that she can avoid asking questions during the interview. D) ask the interviewers about their work history and areas of career interest.

Ans: A Feedback: Take several copies of your rsum with you to the interview. You may want to refer to it, or you may find it appropriate to leave a copy with someone. It is best to dress formally rather than asking for direction in this matter. It is appropriate to ask questions during an interview, but these should not focus on the work of the interviewers.

Which of the following statements accurately reflects the nurses responsibility for patient outcomes in todays workplace? A) Tasks can be delegated, but accountability cannot be delegated. B) In todays environment, authority is more often given to management. C) Most nurses who are accountable have the authority to affect the situation or effect change. D) Nurses are protected against legal action being taken in cases of malpractice in the hospital setting.

Ans: A Feedback: Tasks can be delegated, but accountability cannot; nurses who delegate tasks to assistive personnel continue to be accountable for that care. Many nurses experience frustration because they must be accountable for activities without the authority to affect the situation or create change. Authority is often shared in contemporary care settings. Nurses are legally responsible for the care they provide and are vulnerable to malpractice suits.

Despite being seen as a safe environment where victims of violence are treated, hospitals are the site of a large number of assaults. Which of the following care environments is associated with the greatest risk of physical violence? A) Psychiatric mental health B) Geriatrics and gerontology C) Critical care and acute medicine D) Labor and delivery

Ans: A Feedback: The majority of client assaults occur in psychiatric mental health settings.

Which organization developed the most definitive statements on the competencies needed by the newly licensed practical nurse (PN) and the RN? A) National Council of State Boards of Nursing (NCSBN) B) American Association of Nurses (ANA) C) National League for Nursing (NLN) D) American Association of Colleges of Nursing

Ans: A Feedback: The most definitive statements on the competencies needed by the newly licensed practical nurse (PN) and the RN have been developed by the NCSBN based on its job analysis studies, which serve as the basis for the NCLEX-RN and NCLEX-PN.

There is an increasing trend for nursing care to move from the hospital setting into the community. Nurses who are to provide excellent care in a community setting should prioritize which of the following? A) Integrating culture and family into the planning and delivery of care B) Becoming more assertive in client education and the planning of client care C) Encouraging clients to limit their interactions with physicians D) Teaching clients to replace biomedical interventions with complementary therapies

Ans: A Feedback: The move to community care heightens the importance of family-centered, culturally-competent nursing. Community nursing does not necessarily require that a nurse become more assertive with client. It would be simplistic, and in most cases inappropriate, to guide clients to replace biomedical interventions or avoid doctors.

The expected competencies of new nursing graduates are not standardized and can vary between institutions and organizations. Most nursing and healthcare organizations, however, agree that recent graduates should be able to use the nursing process in a systematic way. Which of the following nursing activities best exemplifies this competency? A) The nurse identifies a nursing diagnosis of Impaired Skin Integrity based on an assessment and plans to reposition the patient. B) The nurse administers an ACE inhibitor to a patient with high blood pressure. C) The nurse makes a referral to occupational therapy for a patient with a neurological deficit. D) The nurse attends an inservice on pain control that is conducted by a nurse educator.

Ans: A Feedback: The nursing process includes assessment, analysis, planning, intervention, and evaluation. Identifying a nursing diagnosis on the basis of an assessment exemplifies the early stages of this process. Learning about pain management, administering a medication, and making a referral to another discipline may also exist within the framework of the nursing process, but the steps of this process are not as clearly evident in these examples.

Alex is a nurse who has been taken aside by a colleague and the colleague has described another nurse as a backstabber and battleaxe. The colleague has gone on to give Alex details of ongoing conflict between the colleague and this nurse. Which conflict management technique should Alex apply in this situation? A) Withdrawing from conflict B) Accommodating the conflict C) Negotiating D) Collaborating

Ans: A Feedback: The strategy of avoiding or withdrawing from the conflict is employed when you choose not to address the issue at hand. There are many times when this approach is appropriate. This includes situations in which the conflict clearly is not your problem or when there is little or nothing that you can do about it. This is the case when a conflict is limited to two other individuals and does not involve patient safety. Accommodating, negotiating, and collaborating are likely not appropriate responses by the nurse to this interpersonal conflict.

Nurses decide to go on strike to try to force improvement in the quality of patient care in their facility. Once the strike is resolved, what are their options for being rehired by the facility under the reinstatement privilege that is in effect in their contract? A) They will be rehired after the strike whether or not it is decided that the strike was lawful. B) They will be rehired after the strike as positions become available provided they have not engaged in unfair labor practices. C) They will be rehired to replace nurses hired during the strike who were hired to replace them. D) They will be rehired at their former job as soon as the strike is resolved.

Ans: B Feedback: A reinstatement privilege is a guarantee offered to striking employees that they will be rehired after the strike as positions become available, provided that they have not engaged in any unfair labor practices during the strike, and provided that the strike itself is lawful.

Kurt Lewins force-field theory of change is one of the most widely accepted and remains in current use today. The central concepts of this theory of change include A) the forces that govern intrinsic and extrinsic motivation. B) the relationship between driving forces and restraining forces. C) the forces of resilience and inertia in an organization. D) the relationship between the will for change and the ability to effect change.

Ans: B Feedback: According to Lewin, change requires an imbalance between the forces that call for changethe driving forces, which push the system toward change and the restraining forces that pull the system away from change. Lewin does not explicitly address the issues of motivation, inertia, resilience, and will for change.

A client asks a nurse for help in obtaining an alternative healthcare provider. Which of the following is an accurate fact regarding alternative care that the nurse should share with this client? A) Most alternative healthcare practitioners do not have education-based credentials to practice their medicine. B) Alternative providers are not usually included in the federal HIPAA legislation that mandates confidentiality in conventional healthcare settings. C) The cost of alternative therapy is never covered by insurance carriers or healthcare plans. D) It is easy to find accurate safety and efficacy data for alternative medicine on the Internet.

Ans: B Feedback: Alternative providers are not normally included in the federal Health Insurance Portability and Accountability Act of 1996 legislation that mandates confidentiality in conventional healthcare settings. Alternative practitioners do not necessarily lack credentials. Accurate online information can be difficult to find and costs for treatment may be covered by some insurance plans.

A registered nurse is responsible for organizing the care at a facility that has several UAPs. Which of the following tasks can an RN delegate to a UAP? A) Performing an ongoing assessment B) Answering call lights C) Administering medications D) Counseling clients

Ans: B Feedback: Any activity that requires knowledge and judgment that is unique to the function of an RN cannot be delegated to others. Such activities include ongoing assessment, medication administration, and counseling clients. Answering call lights is within the scope of a UAP and can thus be delegated.

A recent nursing graduate is attempting demonstrate the competencies that she learned as a nursing students and to reconcile the expectations of her new colleagues and employer with her own abilities. Which of the following tasks is the most important and most frequently performed? A) Helping patients and families navigate the healthcare environment B) Applying the principles of infection control and standard precautions C) Initiating vascular access and maintaining peripheral and/or central IV access D) Liaising with members of other health disciplines to ensure safe and continuous care

Ans: B Feedback: Apply principles of infection control (e.g., hand hygiene, room assignment, isolation, aseptic/sterile technique, universal/standard precautions) is among the most common, and most important, nursing actions as identified by nursing organizations. Patient advocacy, interdisciplinary cooperation, and IV therapy are all important, but none is performed as frequently as infection control measures.

Mr. Hammond is a 70-year-old man with a diagnosis of type 1 diabetes who developed a diabetic foot ulcer earlier this year. He has recently been discharged from the hospital and now requires regular wound care. Karen is a community health nurse who provides wound care for Mr. Hammond twice weekly. Which of Karens actions is most likely to empower Mr. Hammond? A) Encourage Mr. Hammond to acknowledge his contribution to the development of his wound. B) Provide information to Mr. Hammond that matches his expressed needs. C) Encourage Mr. Hammond to involve members of his family in his care. D) Delegate wound care to Mr. Hammond and reduce the frequency of her visits.

Ans: B Feedback: Client empowerment is often fostered by assessing and meeting a clients need for information. Encouraging an acknowledgement of the clients contribution to his or her current health state is beneficial in many circumstances, but it less likely to make the client feel empowered. Similarly, family involvement can be beneficial but does not directly foster empowerment. Empowerment does not necessarily mean that the nurse does less and the client performs his or her own care; delegation may not be appropriate.

It has been a frantic morning on the hospital unit and the nurse is unsure whether she will be able to complete her required tasks on time before her scheduled lunch break. Which of the following is the nurses most appropriate response to this problem? A) Skip lunch or trade her lunch break with a colleague who is scheduled for a later break. B) Determine if more of her tasks could be delegated to another member of the care team. C) Ask the unit manager for advice. D) Explain to a colleague that she will likely be unable to complete her required work.

Ans: B Feedback: Delegation is an appropriate and useful strategy for effective time management. This would be a preferred approach over changing the lunch schedule. The nurse should attempt to delegate before approaching her manager for a solution or resigning herself to the fact that she will not complete her work.

The approach that a nurse chooses in the management of a conflict is entirely dependent on many of the factors and variables involved in the specific conflict. In which of the following situations would the nurse be most likely justified in forcing the issue or competing? A) A nurse is embarrassed that a colleague discovered the nurses medication error and completed an incident report. B) A nurse observed a colleague remove an opioid analgesic from the locked medication cupboard and put it in her pocket. C) A nurse disagrees with a colleague about the need for increased staffing levels. D) A nurse has received constructive criticism from his manager during his latest performance appraisal.

Ans: B Feedback: Forcing the issue might be the best approach if the nurse observes a violation of ethical or legal standards, such as suspected substance abuse. Interpersonal disagreements about feedback or staffing levels are more likely to benefit from a more collaborative or constructive conflict management technique.

A nurse who provides care in an acute medical unit is aware of the importance of thorough discharge planning. The discharge planning process should begin A) once the patient has stabilized and is assured of positive outcomes. B) as soon as possible after the patient is admitted. C) once the patient has received a discharge order from his or her primary care provider. D) 48 to 72 hours before the projected date of discharge

Ans: B Feedback: If possible, discharge planning should begin immediately upon admission.

Which of the following is a recommended guideline when resigning a position? A) Provide the employer with 2 weeks to seek a replacement. B) Clearly state the details if you wish to be compensated for any vacation or holiday time accrued. C) If resigning because of problems in the work setting, it is a good idea to put the reason in the resignation letter. D) Place comments regarding positive factors experienced in the workplace in a separate correspondence from the resignation letter.

Ans: B Feedback: If you have accrued vacation or holiday time and want to take the time off or be paid for it when resigning, clearly state that. A months notice is ideal, and a resignation letter should not go into detail regarding the contributing problems in the workplace. Positive factors experienced in the workplace may be included in the resignation letter.

A nurse is assigned for the care of each patient from the time the patient is admitted to the hospital until that patients discharge. What system of care delivery is most likely in place? A) Functional care B) Primary care C) Modular care D) Team care

Ans: B Feedback: In a pattern of primary care, one nurse was assigned the responsibility for the care of each patient from patient admission until that patients discharge. The primary nurse was responsible for initiating and updating the nursing care plan, patient teaching, and discharge planning. An associate nurse worked with this same patient on other shifts and on the primary nurses day off, carrying out the plan of care developed by the primary nurse.

Healthcare institutions are frequently the site of conflict. Which of the following situations exemplifies interpersonal conflict? A) A nurse is undecided whether to pursue a management position or to continue providing bedside care. B) A recent graduate and a more experienced nurse disagree on the thoroughness of the recent graduates assessments. C) A cohort of experienced nurses have concerns about the way that younger nurses dress and present themselves. D) The nurses on a unit are having difficulty getting physicians to return pages.

Ans: B Feedback: Interpersonal conflict occurs between or among individuals. This is where differences in values, ideas, perceptions, and goals play an important role. Intrapersonal conflict occurs within ones self in circumstances in which a choice must be made between two alternatives. Intergroup conflict exists between defined groups of individuals, such as recent nursing graduates, experienced nurses or physicians.

Nurses have the potential to positively impact the health of communities. Which of the following actions is most likely to improve the health of a community? A) Publicizing the consequences of unhealthy lifestyles B) Advocating politically for laws and policies that foster community health C) Ensuring that nurses are practicing to the full extent of their scope of practice D) Providing nursing care to individuals who are not patients or clients

Ans: B Feedback: One important role of nurses in the promotion of healthy communities is as a supporter and advocate for political measures that would improve the health of the community. Publicizing negative health outcomes is appropriate in some contexts but this is likely less effective than promoting broad change politically. It is not normally appropriate to provide nursing care for individuals who are not patients or clients. Practicing to the full extent of ones scope of practice is not likely to impact community health in a direct way.

A novice nurse apprehensively reflects on what she considers to be an impossible task of delivering quality care on her ward as it is assigned to her. What is the name of this phenomenon first coined by Marlene Kramer? A) Burnout B) Reality shock C) Culture shock D) Job disorientation

Ans: B Feedback: One problem confronted by the new graduate is the seeming impossibility of delivering quality care within the constraints of the system as it exists. Kramer characterized this phenomenon as reality shock, not burnout, culture shock or job disorientation.

During her final clinical placement, a nursing student worked with two of her fellow students to plan a health fair that took place in a local community center. How should she best characterize this activity on her rsum? A) I was a member of the steering committee for a community health fair. B) Organized a community health fair. C) I have strong organizational skills. D) Assisted with the organization of a community health fair.

Ans: B Feedback: Option B provides the most succinct and action-oriented description of the activity. Option A lacks an action verb, while option C is imprecise and not descriptive. Option D is less direct and less action oriented than option B.

Healthcare is a field that continues to undergo constant and profound change, both planned and unplanned. Which of these situations is an example of reactive change? A) Hospital administrators have announced a desire to implement the principles of evidence-based practice. B) A hospitals accreditation review revealed systemic problems and the hospital has been directed to resolve these. C) The introduction of automated medication dispensing machines at a hospital is scheduled for later this year. D) A transition will soon begin whereby the practical (vocational) nurses will begin to practice within their full scope.

Ans: B Feedback: Planned change has a definite design and structure established to facilitate the process, including time lines, identification of stake holders, goals, plans for implementation, and processes for evaluation. Thoughtful planning often results in more effective and efficient change processes and is essential for projects that are complex or large in scope and that require greater time, resources, or skills. Change also may be unplanned and occur as a reaction to another issue, such as a failed accreditation. This is referred to as reactive change. Reactive change occurs when some problem or event arises that requires a different way of doing things.

Researchers have noted a high incidence of burnout among nurses. Which of the following nurses most likely faces the highest risk of burnout? A) An experienced nurse who has long neglected her own physical health and who leads a sedentary lifestyle. B) A nurse who provides pediatric palliative care and who is disillusioned with the overall quality of care on the unit. C) A nurse who has recently graduated with an ADN degree and begun working in a busy, inner-city emergency department. D) A nurse who is few months away from retirement from her current position in community health.

Ans: B Feedback: Prominent among the causes of burnout is a conflict between ideals and reality. As well, practice environments with high mortality rates are associated with burnout. Poor physical health predisposes a nurse to burnout, but this is likely less salient than the combination of disillusionment and high acuity. New graduates and those approaching retirement are not particularly predisposed to burnout.

A hospital manager is accused of quid pro quo sexual harassment. Which of the following is an action that might have been involved? A) Making persistent unwanted attempts to initiate a personal relationship B) Granting job-related benefits in return for sexual favors C) Using suggestive or obscene language D) Making direct sexual advances

Ans: B Feedback: Quid pro quo sexual harassment involves the explicit offer of job-related benefits in return for sexual favors. It is not defined by direct advances, attempting to initiate a relationship, or suggestive language, though some or all of these activities may be present in the exchange.

Healthcare institutions expect that nursing graduates will be able to apply their theoretic knowledge for safe client care. Which of the following actions best demonstrates this? A) Creating a nursing care plan for a newly admitted patient B) Responding appropriately to a patient complaining of chest pain C) Advocating for a patients interests with members of other disciplines D) Conducting a thorough and thoughtful search for nursing employment

Ans: B Feedback: Responding appropriately to an emergent health threat is a demonstration of safe care and the appropriate application of knowledge. Patient advocacy and creating care plans are functions that are less closely related to patient safety. Searching for a job is not linked to safe client care.

Which of the following conditions must be met in order to ensure the efficient and effective operation of a healthcare organization? A) Span of control must be kept as narrow as possible. B) The chain of command must be explicitly and clearly delineated. C) The formal organizational structure must closely mimic the informal relationships that exist (the grapevine). D) Registered nurses must occupy positions in employee, middle management, and executive roles.

Ans: B Feedback: The effective operation of a healthcare organization requires a detailed and clear chain of command. A narrow span of control is not always preferable to broader spans of control and formal structure does not necessarily have to replicate informal structures, though each should be acknowledged and recognized. It is certainly possible, and potentially beneficial, for nurses to occupy a variety of roles in the organizational hierarchy but this is not a precondition for successful organization.

What is the primary objective of a performance appraisal? A) Establish written documentation of incompetent behavior to facilitate dismissal B) Maintain and develop employee performance C) Establish criteria for accreditation standards D) Determine who receives pay raises

Ans: B Feedback: The primary objectives of performance appraisal are to maintain or improve employee performance and to enhance the development of employees. They are not intended to be punitive measures or criteria for accreditation. Performance appraisals may have an influence on a nurses pay but this is not their primary objective.

As part of the development of a new inner-city clinic, a group of nurses and members of other health disciplines have drafted a mission statement for the clinic. This statement will most likely specify A) the priorities for the health of the identified population. B) the main goals and functions that the organizers envision for the clinic. C) the philosophies and beliefs that underlie the existence and functioning of the clinic. D) the health outcomes that the organizers see as currently lacking in the community.

Ans: B Feedback: The purpose of an organization is often expressed in the form of a mission statement, which outlines what the organization plans to accomplish, including its goals and function. This may or may not identify the philosophy of the organization, specific health outcomes, or priorities for the health of residents.

Experts have identified a close relationship between the practice of transformational leadership and the empowerment of employees. What action should a nursing leader take to foster employee empowerment? A) Have the performance of each employee appraised by his or her peers rather than by a manager or leader. B) Share information as openly as possible in order to make employees aware of problems. C) Adopt a hands-off approach in order to allow leadership to organically emerge from within the group of employees. D) Eliminate the practice of conducting performance appraisals of employees.

Ans: B Feedback: Transformational leaders foster empowerment by openly sharing information with workers so that everyone is aware of problems and the need for action. Performance appraisals are not necessarily contrary to the philosophy or practice of transformational leadership, and these should not be conducted by an employees peers. Transformational leadership is characterized by constructive engagement, not a hands-off approach.

The staff, the administrators, and the executives of a large, urban hospital are currently celebrating the fact that the hospital has recently been granted Magnet Recognition by the American Nurses Credentialing Center (ANCC). This designation suggests that the hospital A) pays nurses higher wages than the national median. B) has lower staff turnover than most hospitals. C) integrates the principles of evidence-based practice into care. D) has a committed and responsive bureaucracy.

Ans: B Feedback: While all of the given options may underlie or contribute to a hospitals Magnet designation, low staff turnover is one of the key attributes of such a hospital. Magnet Recognition is not explicitly based on high wages, effective bureaucracy, or evidence-based practice.

All performance evaluations, whether formal or informal, should be based on appropriate standards of performance. In the context of a performance appraisal, which of the following are appropriate performance criteria? (Select all that apply.) A) The managers experience base B) The nurses written job description C) The institutions policies and procedures D) Nursing standards of practice E) The nurses career goals

Ans: B, C, D Feedback: Standards of performance include job descriptions, policies and procedures, and professional standards of practice. A leaders personal experience base and the nurses goals may be relevant but neither is an objective measure for appraising the nurses performance.

A nurse leader has been commissioned to implement a new electronic documentation system in a hospital, replacing the existing paper-based system that has been in place for decades. What is the first step that this nurse should take toward facilitating this change? A) Enlist the support of the physicians and advanced practice nurses in the hospital. B) Publicize the deficits of the existing documentation system. C) Understand how and why individuals are often resistant to change. D) Begin the process of evaluation before the change is implemented.

Ans: C Feedback: A first step in facilitating change is gaining a thorough understanding of resistance to change. This should precede the evaluation process, even though this should indeed begin early in the change process. An understanding of the change process is necessary before the nurse begins eliciting support from care providers or publicizing the deficits of the current system.

Which of the following is a characteristic of an effective performance evaluation system? A) The appraisal system operates outside of the scope of administration. B) Employees do not know in advance who will be evaluating them. C) The final disposition of the appraisal is shared with the employee. D) Evaluation concentrates on the personality of the employee.

Ans: C Feedback: A sound performance appraisal is shared with the employee who is the subject of the appraisal. The appraisal system should be strongly supported by administration and employees should be made aware of who will appraise them. An employees personality should not be the focus for appraisal.

Despite the long history of collective bargaining in the nursing profession, many nurses have concerns regarding membership in a collective bargaining unit. Which of the following statements by nurses best conveys one of the primary concerns that are prevalent among nurses? A) I think that physicians recognize our value and sufficiently advocate for our best interests. B) I think that a collaborative model results in higher wages than a confrontational model such as collective bargaining. C) Im not sure that joining a union is congruent with the philosophy of the nursing profession. D) In the end, I think that the costs of being in bargaining unit outweigh the potential benefits.

Ans: C Feedback: Among the major issues of collective bargaining that affect the nursing profession is the fact that some nurses see collective bargaining as unprofessional. The other most common concerns involve the matter of which bargaining group will represent nursing when nurses participate in collective bargaining, the question of whether to join a union when one exists, and the issue of the role of the supervisor.

Jessica is a recent nursing graduate who was able to secure a position on the postsurgical unit where she completed the final preceptorship of her baccalaureate degree. Jessica has just received word that there will be sweeping changes in the organization of care on the unit, a development that she finds intimidating since she has only recently become adept at working in the existing system. How should Jessica best respond to this news? A) Elicit support from nurses who support maintaining the existing system B) Learn as much as she can about the proposed system C) Research alternatives to the change that has been proposed D) Express her concerns about the proposed change to the nurse manager

Ans: C Feedback: As a novice nurse, you should take all available opportunities to learn about any anticipated changes. This is more beneficial that actively or passively opposing a change and should precede a presentation of concerns to the manager.

In what type of healthcare setting are the most RNs currently employed? A) Ambulatory care centers B) Doctors offices C) Acute care hospitals D) Long-term care facilities

Ans: C Feedback: As of 2008, over 89% of nurses worked in hospital settings, 4.8% worked in long-term care, and 4.3% worked in community-based or ambulatory care settings. Only 1.7% of nurses indicated that they worked in other settings.

Melissa is a nurse who graduated earlier this year with a baccalaureate degree in nursing and immediately began working on a busy surgical unit with a high turnover of both the patients and the staff. As a result, Melissa has found the adjustment to full-time employment particularly stressful. Which of the following actions should Melissa take in order to manage the stress in her life? A) Schedule a vacation for later in the year and focus on this upcoming trip when she is experiencing high levels of stress. B) Reduce her workload to part-time and supplement this with casual employment on a lower-stress unit. C) Be vigilant in personal habits that result in adequate rest, a healthy diet, and adequate physical exercise. D) Reduce or eliminate the specific interactions in the clinical setting that cause her the most stress.

Ans: C Feedback: Attending to diet, rest, and activity is important in the management of job-related stress. These measures are more likely to be of benefit than trying to endure until a distant vacation. Adding another workplace has the potential to increase stress and it is not normally realistic to eliminate stressful interactions in the workplace.

A counselor diagnoses a critical care nurse with having the syndrome known as burnout. Which of the following is a characteristic of this condition? A) Burnout occurs when a nurse first enters the workplace and is overwhelmed by the workload. B) All of the symptoms of burnout are psychological in nature. C) Burnout is accompanied by a decreased ability to function on the job and at home. D) Burnout occurs less often in high-energy areas, such as critical care or burn units.

Ans: C Feedback: Burnout is accompanied by a decreased ability to function both on the job and in the personal life. Burnout occurs more frequently in nurses who work in particularly stressful areas of nursing, such as critical care, oncology, or burn units. It does not typically occur early in a nurses time in a particular setting and it can result in physical manifestations.

Nurses working in a hospital initiate a negotiating session in which they offer to take a pay cut to allow management to provide job security and to hire more nurses to alleviate understaffing. What is the term for this type of session? A) Interest-based bargaining B) Collective action bargaining C) Concession bargaining D) Good faith bargaining

Ans: C Feedback: Concession bargaining is a process in which there is an explicit exchange of reduced labor costs for improvements in job security. This specific tradeoff is not a characteristic of interest-based bargaining, collective action bargaining, or good faith bargaining.

A hospital manager evaluates the workplace to ensure that ergonomics are working. Which of the following statements describes this scientific theory? A) Ergonomics is the study of client outcomes related to economic theories in healthcare. B) Ergonomics empowers clients to have a voice in their own plan of care. C) Ergonomics ensures that jobs are fitted to the physical abilities of the employees. D) Ergonomics provides guidelines for delegating responsibilities for client care.

Ans: C Feedback: Ergonomics is the science of fitting a task to ones physical characteristics in order to enhance safety, efficiency, and well-being. When the task does not conform to ones physical characteristics, musculoskeletal stress and injuries may occur. Ergonomics does not address client outcomes, delegation, or client autonomy.

Three times in the past several weeks a physician has commented on a nurses body and each comment has been more explicit and sexually suggestive than the last. How should the nurse first respond to this form of sexual harassment? A) Avoid contact with the physician except in locations where there are colleagues or other witnesses. B) Ignore the physician if more comments are made in the future. C) Confront the physician directly and explain that such comments are unacceptable and unwanted. D) Document the events in detail and inform the state medical board.

Ans: C Feedback: Individuals should take steps to stop sexual harassment by giving clear, direct verbal messages indicating that the behavior in question is unwanted, unpleasant, and must stop. Sometimes this action alone stops inappropriate behavior. If clear, direct messages are not successful, the individual then should report the matter in writing to an immediate supervisor. Simply avoiding the offender or attempting to manage the behavior by reducing opportunities are not sufficient responses.

A string of recent assaults perpetrated on nurses by clients has prompted the hospital administrators to address this disturbing trend. What action should the administrators prioritize in an effort to reduce the incidence of workplace violence? A) Ensure that at least one male nurse is present at all times on each nursing unit. B) Teach self-defense techniques to all the nurses who provide care in high-risk settings. C) Train nurses how to effectively manage the behavior of aggressive patients and clients. D) Withhold care from patients and clients who have a history of aggression.

Ans: C Feedback: One form of violence prevention is to train employees in the management of hostile and violent behavior. Ways of identifying hostile and assaultive clients should be developed so that staff can be warned to take extra personal safety precautions. This is different from teaching self-defense techniques, which are normally physical in nature. It is not normally possible to withhold care from an individual, even if the person has a history of violence or aggression. The presence of male nurses is not an adequate measure in the prevention of violence.

A student nurse is scheduled to graduate in a few weeks and is preparing to begin searching for employment. Which of the following statements best conveys an aspect of the current job market for nurses? A) Most nursing graduates are expected to perform in the role of a nursing assistant or practical (vocational) nurse after graduation. B) The majority of nursing opportunities for new graduates are in international settings. C) Job openings in acute care have decreased in many places but long-term care openings continue to grow. D) The increasing severity of the nursing shortage means that job opportunities for nursing graduates are greater than ever.

Ans: C Feedback: Positions for new graduate RNs have recently decreased. This is due in part to the effects of the economic recession. Although hospital vacancies have decreased in many places, those in long-term care continue to increase. Some, but not most, graduates may find work in other roles, and a minority of positions are in international settings.

Jennifer is a registered nurse who works in a busy emergency department. As one of her goals for the current year, Jennifer has resolved to develop her emotional intelligence. How should Jennifer best meet her goal? A) Try to remove emotion from her clinical decision-making whenever possible. B) Become more assertive when responding to the emotional responses of patients, families, and coworkers. C) Become more aware of the way that her emotions function and how they influence her actions. D) Try to limit her expressions of emotion to times when she is not interacting with others.

Ans: C Feedback: Self-awareness is one of the central aspects of emotional intelligence. Emotional intelligence does not necessarily involve removing emotion from decision-making or removing emotion from interpersonal interactions. Awareness of others emotions is a dimension of emotional intelligence, but the appropriate response to this is not normally increased assertiveness.

Nurses, as well as individuals outside the profession, have sometimes expressed concern around the involvement of state nurses associations in collective bargaining. What factor most often underlies such concerns? A) State nurses associations lack the legal authority to engage in bargaining though this has been their traditional role. B) State nurses associations tend to be unaware of many of the issues that nurses face when providing care. C) It can be difficult to reconcile the professional obligations of nurses associations with their role in bargaining. D) Few practicing nurses participate in the activities of state nurses associations.

Ans: C Feedback: Some individuals contend that it is not realistic for state nurses associations to work with the professionalism aspect of nursing as well as with the issues of wages, benefits, and working conditions. State nurses associations do not lack the legal right to bargain and participation of nurses in the operations of state nurses associations does not directly affect their right or ability to bargain.

The nature of healthcare requires the development of healthcare teams and collaboration among its members. Which of the following statements represents an element of this teamwork? A) Each group member of a team is the leader of the team. B) The organization sets the goals for its teams. C) Communication patterns in teams flow both up and down. D) Team members are not legally responsible for decisions and outcomes.

Ans: C Feedback: Teams may be led by facilitators or coaches, have members who share responsibility for decisions, setting goals, and achieving outcomes, use communication patterns that flow both up and down, and have members who share responsibility for decisions and outcomes. Not every member of the group is in a leadership role and goals may be set independently. A team may be legally responsible for the decisions its members make.

A recent nursing graduate has asked an expert nurse how best to foster her leadership abilities, since she wishes to explore leadership opportunities later in her career. How should the expert nurse best respond? A) Even if you dont trust a decision that you have to make, act like you chose the best option. B) Become as specialized as possible in your nursing experience. C) Develop your interpersonal skills by having a wide variety of interactions. D) Become as assertive as you can and take every opportunity to guide the behavior of others.

Ans: C Feedback: The development of sophisticated interpersonal skills is important to building leadership abilities. Effective leadership does not depend on feigned confidence, though self-confidence is a trait that can be fostered. In most cases, variety and depth of experience are superior to narrow specialization. Effective leadership is more nuanced and complex than simply directing the behavior of others or demonstrating assertiveness.

A hospital patient who suffered a spinal cord injury has expressed an interest in exploring complementary/alternative therapies. The nurse should encourage the patient to begin this process by doing which of the following activities? A) Asking practitioners of different therapies to provide lists of satisfied clients B) Asking the patients primary care provider for permission to explore nonbiomedical treatments C) Finding reliable evidence regarding the safety and effectiveness of therapies D) Determining whether the patients health insurance would cover the cost of alternative/complementary therapies

Ans: C Feedback: The first step for an individual interested in complementary/alternative therapies is to assess the safety and effectiveness of the therapy in relationship to his or her own condition. This must precede the identification of specific practitioners or making financial arrangements. Communication with the care team is important, but the patient does not need to seek permission before exploring treatment alternatives.

A nurse recognizes the importance of safely and efficiently delegating tasks in order to achieve a high standard of care. Which of the following is one of the NCSBNs five rights of delegation? A) Right education B) Right assessment C) Right circumstances D) Right motivation

Ans: C Feedback: The five rights of delegation include the right task, circumstances, person, direction/communication, and supervision/evaluation.

A nurse will soon become a member of a newly-established care team. Which of the following is a goal of team building? A) Acknowledging individual achievements B) Providing client care based on the direction of the team leader C) Creating a type of synergy when addressing client care D) Allowing care to be determined by nurses who are not too close to the situation

Ans: C Feedback: The goal of team building is to create a type of synergy, in which the effect of everyone working together toward the shared goal results in a greater total effect than could be achieved by the sum of the efforts of everyone working individually. Individual achievements should be acknowledged, but this is not the goal of team building. The process of building the team does not immediately result in changes to client care

An elderly female client who resides in the community tends to defer decisions regarding her care to her eldest son. How should the community health nurse respond to the clients reluctance to make independent decisions? A) Discuss this observation with the client and her son in an open manner and explore alternatives. B) Organize care so that it takes place at times when the son is not present in the home. C) Accommodate this aspect of the clients family dynamics when planning and carrying out care. D) Teach the client assertiveness skills that she can apply in her interactions with her son.

Ans: C Feedback: The nurse should respect the clients desire to organize her care in the way that she prefers. It is not the responsibility of the nurse to reorganize or overcome this familys dynamics.

A nurse is aware of the pivotal role that motivation plays in the formation of effective teams and the provision of excellent nursing care. Which of the following actions is most likely to motivate a team member? A) Ensure that the consequences of substandard performance are well-known. B) Publicize those individuals who have made exceptional contributions and point out those who have failed to perform adequately. C) Openly acknowledge team members who have made a particularly valuable contribution. D) Be clear that only the highest levels of performance are acceptable to the team.

Ans: C Feedback: There are numerous ways to foster motivation in others, including the use of genuine praise and acknowledging high performance. Negative methods, or punishments, have been shown to be less effective. These would include emphases on consequences, shame, and threats.

A patient has just been transferred to the acute medicine unit from the intensive care unit and the patients arterial line has not yet been discontinued. The nurse on the acute medicine unit is a recent graduate and does not have experience in caring for an arterial line. As a result, the nurse is unsure how to safely address this aspect of the patients care. How should the nurse best respond? A) Look up arterial lines in the policy and procedures manual on the unit. B) Inform the unit manager that this patient assignment is inappropriate. C) Enlist the help of a more senior nurse on the unit. D) Have the patient transferred back to the intensive care unit.

Ans: C Feedback: To provide safe care, the nurse must identify when a situation requires greater expertise or knowledge and when assistance is needed. Asking a colleague for assistance is an appropriate demonstration of this competency. Looking up a procedure in a policy manual is an appropriate action but does not show a willingness to ask others for help. It would likely be premature to refuse the care of this patient or to have him or her transferred.

A nurse is called into work to perform triage in the aftermath of an earthquake. Which of the following are the expected responsibilities of this nurse? A) Set up and monitor IV lines. B) Prepare the emergency room for multiple victims. C) Screen victims to prioritize treatment. D) Check available blood products and assist with transfusions.

Ans: C Feedback: Triage involves the initial screening of victims for the purpose of prioritizing treatment and making the most effective and efficient use of both human and material resources. The other noted tasks are within the scope of disaster nursing but are not triage activities.

A recent nursing graduate has become overwhelmed with reality shock in recent weeks, despite the fact that he secured a job in the setting that was his first choice. This nurses best response to his experience with reality shock is to A) confront the manager of the unit with the details of his experience. B) reduce the performance expectations that he places on himself. C) prioritize physical assessments and interventions over patients psychosocial needs. D) seek input from a trusted nurse who can act as a coach or mentor.

Ans: D Feedback: A coach or mentor can be of great assistance when recent nursing graduates are faced with reality shock. Such a person may be of more benefit than the manager of the unit, who may be too busy to assist the nurse with his adjustment. Reducing the quality of care or reducing expectations may place the burden of the nurses reality shock on patients themselves, which is inappropriate.

A nurse was helping a colleague boost a patient higher in his bed she felt sudden pain in her lumbar region. How should the nurse follow up this event? A) Make an appointment with a physician and document the injury if there are significant results. B) Have a trusted colleague perform a musculoskeletal assessment and monitor the nurses range of motion for the remainder of the shift. C) Go home immediately and take enough sick time to allow her back to recover completely before returning to work. D) Document the event as soon as possible using the hospitals designated forms.

Ans: D Feedback: A nurse who suspects an injury should report the event promptly using the appropriate paperwork. A common error is to delay reporting in the belief that you should report something only if you know it will be serious or require medical care. It is insufficient to leave work without documenting the event or to rely on a colleagues assessment and care.

A nursing student who has held a variety of nonnursing positions is scheduled to graduate in a few weeks and is searching for a nursing job. The student has responded to a posting at a local hospital that asks for two references. Which of the following individuals would be the best choices for these two references? A) A trusted coworker and a nurse who supervised the student during a preceptorship B) A family friend who knows the student well and the associate dean of the nursing school C) The two work supervisors with whom the student has the strongest rapport D) A nursing instructor and the supervisor of the students latest job

Ans: D Feedback: A primary reference should be an instructor from your basic educational program. This person would be able to affirm your ability in the nursing field. Another reference should be someone who has employed you and who can describe your work habits and effectiveness as an employee. Coworkers and family friends are not normally appropriate references.

Racial and ethnic discrimination has been identified as a reality within healthcare institutions. Which of the following goals for the nursing profession is most appropriate? A) The nursing workforce should transcend racial and ethnic categorization and should not be appraised through this lens. B) The nursing workforce should have fewer Caucasian members and more racial/ethnic minorities. C) The nursing workforce should be made up of members from as many cultures as possible. D) The nursing workforce should reflect the population for whom it provides care

Ans: D Feedback: A workforce that reflects the population is more likely to meet the healthcare needs of that population in a culturally sensitive manner. It is simplistic to presume that the solution to discrimination lies with fewer Caucasians and more minorities. Similarly, increasing the number of cultures represented within nursing will not necessarily eliminate discrimination.

A patient is receiving a transfusion of packed red blood cells and consequently requires frequent vital signs. A set of vital signs was just due during the nurses scheduled lunch break and so a colleague took the patients vital signs. After returning from lunch, the nurse confirmed with the colleague that the scheduled vital signs were taken, to which the colleague replied, Yes, it seems like Im covering you a whole lot lately. How should the nurse best respond to the colleagues statement? A) I dont think thats a fair thing to say because I cant help when a set of vitals are due. B) If youre implying that I dont pull my weight I think that youre badly mistaken. C) Well, what goes around comes around, right? D) Could you explain what you mean by that?

Ans: D Feedback: An important principle of communication is to ensure that meanings are clearly understood by both parties. This is especially true in the case of a statement that may be accusatory. Responding confrontationally or sarcastically is rarely appropriate.

A nurse decides to pursue a career in community-based nursing. Which of the following statements represents the environment in which the nurse will be working? A) Community-based nursing is limited to work in public clinics, schools, and industry. B) The key to community-based settings is that the nurse is in charge. C) The nurse serves as an educator, guide, and resource person and determines the action taken by the client. D) Care in the community is cost-effective.

Ans: D Feedback: Care in the community is cost-effective and often more acceptable to the client because it causes less disruption in life. It takes place in a wide variety of settings and involves the nurse entering into a collaborative relationship with clients.

After several months of working on an acute care for elders (ACE) unit following her graduation, Theresa has decided to focus her nursing career on working with older adults. What action is most likely to help Theresa meet this career goal? A) Cultivating a passion for the health of the older adult population B) Networking with prominent older adults in the community C) Performing original research that adds to the knowledge of this populations needs D) Working toward certification in gerontological nursing

Ans: D Feedback: Certification in a particular nursing specialty has the potential to increase a nurses opportunities in that field. Passion, networking, and research may all be of some benefit, but certification is more likely to create tangible career opportunities.

Which of the following statements accurately describes a basic guideline for using communication skillfully? A) Managers should communicate how to perform a task even if it is something the subordinate has already learned. B) Managers should not be afraid of making judgmental statements when dealing with a subordinate who has broken policy rules. C) Managers should attempt to formulate a response to an individual who is still speaking to avoid awkward pauses in the conversation. D) Managers should present direction as briefly as possible while still providing adequate data.

Ans: D Feedback: Effective managers state the necessary information as briefly as possible while still providing enough data to be clear. Interruptions, judgmental statements, and repeated explanations are characteristics of ineffective communication.

A hospital patient has discussed with the nurse her use of visualization, biofeedback, and relaxation exercises in managing the chronic pain that results from her fibromyalgia. The nurse should recognize this patients use of what category of complementary/alternative medicine (CAM)? A) Biologically-based practices B) Manipulative practices C) Traditional indigenous medicine D) Mind-body medicine

Ans: D Feedback: Examples of mind-body medicine include relaxation exercises, hypnosis, meditation, dance, prayer, visualization, and biofeedback. Biologically-based practices focus on food and dietary supplements while indigenous medicine applies the collective health knowledge of a particular culture. Manipulative practices involve the systematic application of touch.

One of the expressed goals of Healthy People 2020 is to achieve health equity and eliminate disparities. What health indicator can most accurately gauge whether this goal is being achieved? A) Environmental quality B) Injury and violence C) Mental health D) Access to healthcare services

Ans: D Feedback: Health equity is achieved when all Americans have equitable access to health services and there a fewer disparities in health access and health outcomes. Environmental quality, mental health and injury, and violence are important health indicators but these are less directly indicative of health equity and the elimination of disparities.

A nurse who has a baccalaureate degree in nursing has begun working at a hospital in which the principles of primary care nursing are used to organize care. Which of the following actions should the nurse anticipate? A) Performing the most complex nursing tasks on the unit for all of the patients B) Taking action to ensure that neither too much nor too little care is provided for each patient C) Directing a team of practical (vocational) nurses and unlicensed care providers D) Being responsible for specific patients from the time of their admission to the time of discharge

Ans: D Feedback: In a pattern of primary care, one nurse is assigned the responsibility for the care of each patient from patient admission until that patients discharge. Patient care is not fragmented according to complexity, as in functional nursing. Collaboration of a group of RNs, PNs. and UAPs is characteristic of team nursing. Tight control of the amount of care a patient receives is a key characteristic of case management.

A nurse decides to apply for a position in a hospital in her hometown. Which of the following statements provides good advice for her job quest? A) She should call the human resources department and speak to the person who is in charge of hiring nurses. B) She should include a cover letter with her rsum that is no more than two pages long and briefly reiterates the information found in the rsum. C) She should invest in a professionally prepared rsum to make a better impression on potential employers. D) She should focus her rsum on accomplishments and use active verbs to describe her skills.

Ans: D Feedback: In a rsum, it is best to focus on accomplishments and use active verbs to describe skills. Professional preparation of a rsum is not necessary, and telephone communication is generally discouraged. A cover letter should ideally not exceed one page in length.

The manager of a hospital unit has unilaterally decided on a change in the way that overtime is distributed among the nursing staff and has followed up this decision with an e-mail to all employees. What leadership style is exemplified by this manager? A) Participative leadership B) Permissive leadership C) Laissez-faire leadership D) Autocratic leadership

Ans: D Feedback: In autocratic or authoritarian leadership, the leader/manager makes the majority of the decisions without direct consultation with employees. Laissez-faire or permissive leadership occurs when little or no direction or guidance is provided. Participative leadership involves extensive input from employees.

A client receives the care of a physician, a nurse, an occupational therapist, and a counselor working together as a team. What is the term for this type of healthcare? A) Cross-discipline healthcare B) Comprehensive healthcare C) Holistic healthcare D) Interdisciplinary healthcare

Ans: D Feedback: Interdisciplinary healthcare involves collaboration and extensive communication between members of different health disciplines. This model is not termed cross-discipline, comprehensive, or holistic healthcare.

A nursing leader has expressed a desire to foster the characteristics and behaviors associated with transformational leadership. Which of the following actions best demonstrates transformational leadership? A) The leader makes it clear to employees that positive work performance will be rewarded and that sub-standard performance will bring consequences. B) The leader ensures that decisions are based on the consensus of every employee. C) The leader prioritizes the needs of each individual employee over the interests of the larger organization. D) The leader takes action to build trust and relationships between him or her and the employees.

Ans: D Feedback: Leader activities associated with transformational leadership include creating a vision, building relationships, developing trust, and building self-esteem. An emphasis on rewards and punishment is associated with transactional leadership. Consensus is not appropriate for every decision, and the interests of individual employees cannot always supersede the interests of the organization.

Which of the following statements accurately reflects what employers generally should expect when hiring a newly graduated RN? A) The RN should be proficient with the documentation system used by the institution. B) The RN should be able to perform all nursing skills, enabling him or her to work independently. C) The RN should function with speed comparable to that of the other nurses. D) The RN should be able to develop plans of care and follow plans developed by the agency.

Ans: D Feedback: New graduates should be able to develop plans of care and follow plans, such as care pathways, that have been developed by the agency. Proficiency, speed, and complete independence are developed over time and with increased experience and orientation.

A nurse has concerns about some of the practices on the hospital unit and met with the unit manager to explain these concerns. After the meeting, the nurse felt misunderstood and rebuffed by the manager. How should the nurse determine who in the organization to meet with next? A) Consult with the hospital bureaucracy B) Enlist the help of a union representative C) Ask colleagues about who is most influential in the organization D) Refer to the hospitals chain of command

Ans: D Feedback: The chain of command represents the path of authority and accountability from individuals at the top of the organization to those at the base of the organization. The nurse should most likely meet with the person who is above the manager in the chain of command. The hospital bureaucracy, the union, and the persons who are informally influential are less likely to help the nurse identify the appropriate person with whom to meet.

The movement of a client from acute care to a long-term nursing care facility involves planning to provide continuity of care. What is the term for this type of planning? A) Discharge planning B) Comprehensive planning C) Ongoing planning D) Transition planning

Ans: D Feedback: Transitions are the movement of the patient from one care environment to another. Transition planning refers to the planning process that takes place to assure that the patients well-being is maintained throughout the time of transition. Organizing this transition from one care setting to another is not termed discharge planning, comprehensive planning, or ongoing planning.

Collective bargaining has a long history in nursing. Which of the following milestones in the history of collective bargaining resulted from the 1974 amendment of the Taft-Hartley Act (Labor Management Relations Act)? A) Nurses were granted the right to form unions and engage in collective bargaining. B) The maximum length of a work week and the minimum nursing wage were established. C) Nursing was formally recognized as a professional occupation. D) Nonprofit hospitals were obliged to bargain with nurses around wages and working conditions.

Ans: D Feedback: Under the 1974 amendment of the Taft-Hartley Act, nonprofit hospitals were required to bargain with nurses for better salaries and working conditions. The formation of unions and the recognition of nursing as a profession predated this act. The 1974 amendment did not specify wages and hours of work.

A nurse begins to feel comfortable on her unit and views client care in terms of long-range goals. She is able to prioritize among clients and deliberately plan her actions, which may still lack speed and flexibility. Which of Benners levels of function has this nurse achieved? A) Novice B) Advanced beginner C) Competent D) Proficient

C. Competent Feedback: Characteristics of the competent nurse include beginning to see the current situation in terms of long-range goals. This nurse is able to prioritize among patients and base actions on conscious deliberate planning but may still lack speed and flexibility. As such, the competent nurse is more adept than the novice and advanced beginner but less skilled than the proficient nurse.