Leadership & Management - Exam 1

The manager calls the 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, the manager explains that the organization values patient-centered care and that evidence supports that acting as an advocate and a listener is helpful to families. The manager asks the staff for ideas and strategies that are effectively patient-centered in dealing with families in similar situations. What is the role of the nurse manager in this situation? a. Leadership b. Management c. Follower d. Visionary

ANS: A As a leader, the manager is providing and communicating vision and direction based on evidence and experience. The manager is engaging others in decision making that moves them toward the vision with a reasonable level of risk taking.

12. After a major flu vaccination campaign, an agency bills a private insurance company for allowable costs for administration of each vaccination according to the schedule established by the insurance company for reimbursement. This is an example of which major payment method? a. Cost-based reimbursement b. Charges c. Contractual allowance d. Prospective reimbursement

ANS: A Because the agency is submitting costs after the campaign is completed and in accordance with an established schedule of allowable costs, a retrospective, cost-based reimbursement payment method is being utilized. If a desire for profit was indicated, then the answer would be "charges."

The difference between a nurse practitioner's charge of $45 for an office visit and the insurance company's payment of $34 is: a. a contractual allowance. b. a profit. c. a flat rate. d. revenue.

ANS: A Because the amount that is allowed for an office visit is less than the amount that the NP charges, this is known as a contractual allowance or discount. If the amount allowed were more than what the NP charges, then a profit would be realized. All of the answers represent sources of revenue.

12. The manager is using self-reflection to gain insight into improving the leadership skills. By using self-awareness what does a leader develop? a. New knowledge b. Personal growth c. Improved self esteem d. Management skills

ANS: A By using the self-awareness, and essential task for leadership the leader cultivates personal insights and new knowledge of themselves as a leader. Personal growth may or may not occur with self-reflection, improved self-esteem is not guaranteed, and management skills are not obtained.

A nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks toward a patient with a previous history of sexual abuse. The patient sues, claiming malpractice. What conditions do not apply in this situation and do not support malpractice? a. Injury b. Causation c. Breach of duty d. Breach of duty of care owed

ANS: A By virtue of employment, the nurse owes a duty of care to the patient; this care has been breached by a nurse, who would be expected to know that this behavior violates usual standards of care. The resultant injury, the fifth malpractice element, must be physical, not merely psychological or transient. In other words, some physical harm must be incurred by the patient before malpractice will be found against the healthcare provider, which is not evident in this situation where the action did not involve physical harm.

16. Sources of occupational stress in nursing include all except which of the following? a. Authoritarian leadership b. Concern about moral wrongdoing by colleagues c. Multiple changes in a short time d. Rotating shifts

ANS: A Ethical distress, complexity compression, rotating shifts, high acuity levels, rotating shifts, and workload are all sources of work-related stress for nurses.

A facility that provides care for patients whose average length of stay is less than 30 days and to patients whose average length of stay is longer than 30 days, and who require inpatient and ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered: a. a healthcare network. b. a tertiary care institution. c. rehabilitative. d. long-term care.

ANS: A Healthcare networks embrace and provide wellness and illness services, including primary, secondary, and tertiary care, through a network of providers.

In designing programs through your institution to address the health needs of Hispanics in your community, you most likely would develop programs related to: a. diabetes. b. cardiovascular disease. c. cancer. d. asthma.

ANS: A Hispanics with diabetes are twice as likely to die from diabetes as non-Hispanics

To engage your staff in awareness of their current practice and how it is affirmed or not by evidence, you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency. You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice. This learning approach is an example of which change management approach? a. Linear b. First-order c. Facilitative d. Integrative

ANS: A In the second stage, the moving or changing stage of Lewin's first-order, planned change process, planned interventions and strategies are executed to support the implementation of the change. One commonly used method is educating staff about the need for the change.

13. A nursing-led classification system that has led to greater reliability and standardization in data utilized for QI processes is: a. NANDA. b. AHRQ. c. NIOSH. d. nursing process

ANS: A NANDA has been developed by nurses and uses standardized terminology that enables study of health problems across populations, settings, and caregivers.

A colleague asks you to give her your password access so that she can view her partner's healthcare record without using her login. This request violates the patient's right to: a. privacy. b. confidentiality. c. undue authorization of treatment. d. protection against slander

ANS: A Privacy refers to the right to protection against unreasonable and unwarranted interference with the patient's solitude. Privacy standards limit how personal health information may be used or shared and mandate safeguards for the protection of health information. Institutions can reduce potential liability in this area by allowing access to patient data, either written or oral, only to those with a "need to know." Persons with a need to know include physicians and nurses caring for the patient, technicians, unit clerks, therapists, social service workers, and patient advocates. Others wishing to access patient data must first ask the patient for permission to review a record.

Of the following, which is the most effective strategy that a nurse manager could employ to reduce unnecessary costs in specific healthcare settings? a. Training nurses on accurate documentation of supplies used for patient care b. Reducing the number of overtime hours worked by staff c. Reducing the number of staff on a unit d. Making decisions for patients about which care is important to their health

ANS: A Reducing overtime hours needs to be carefully assessed against the reasons for overtime (e.g., staff overload, recent illnesses, increased acuity) in terms of whether this reflects an ongoing or temporary situation and therefore whether it is a necessary variance or not. Reducing staff may or may not be effective, depending on the services being provided. Making decisions for the patient misses an important opportunity to invite the patient into discussion about patient priorities and needs and relative costs of options, which may lead to improved adherence with regimens and less waste of resources. An effective approach to cost containment is ensuring that supplies are accurately accounted for and charged in a timely manner.

The hospital administration gives approval to the chief nursing officer to hire clinical nurse specialists in staff positions rather than in administrative positions. A clinical specialist who has staff authority but no line authority typically is able to: a. function through influence. b. take complete responsibility for the care of clients. c. interview and hire staff nurses for designated nursing units. d. be granted functional authority to determine standards of nursing care and enforce them

ANS: A Staff positions provide support to line positions but have no direct accountability for staff or patient outcomes and therefore function through influence.

17. At the end of a shift, the charge nurse shares with the new nurse she had done an excellent job with a difficult patient that day. The new nurse was upset by the way the family of the patient had treated her. She shared her feeling with the charge nurse. The charge nurse offered to change the assignment the following day. What is the charge nurse displaying? a. Emotional intelligence b. Comportment c. Compassion d. Management of conflict

ANS: A The charge nurse is demonstrating emotional intelligence. Emotional intelligence requires an individual to relate to others based on emotions and social awareness of situations. The charge nurse displayed emotional intelligence by supporting the new nurse and offering to change the assignment the next day.

The chief nursing officer is given the task of reviewing and proposing revision of the organization's mission, philosophy, and technology. In reviewing them, the chief nursing officer understands that they should be reflected in: a. the organizational structure. b. line and staff responsibilities. c. the policies and procedures. d. government regulations.

ANS: A The mission statement is an important foundation for the organizational structure and defines technology and human resources required for the organization.

In assisting new graduates to make the role transition to graduate nurse, Ted, the unit manager initiates which of the following? a. Self-check list to assess competencies that have been strengthened b. Discussions that focus on what the new graduates have yet to learn c. Fixed target dates for acquisition of competency and transition to RN role d. Frequent formal meetings to provide feedback on performance and areas to be strengthened

ANS: A Transition to the new role is facilitated through reflection and ongoing development of awareness of strengths (as compared with a focus on weaknesses) and of weaknesses. The value of the employee may not depend on quickness in making the role transition.

The nurse on the 7-7 shift is assigning a specific component of care to an unlicensed nursing personnel (UNP) employee. The night nurse would remain: a. accountable. b. responsible. c. authoritative and liable. d. responsible and task-oriented.

ANS: A When a registered nurse delegates care to a UNP, responsibility is transferred; however, accountability for patient care is not transferred. Thus, "accountability rests within the decision to delegate while responsibility rests within the performance of the task" (Anthony and Vidal, 2010, p. 3).

Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." After speaking with Elizabeth, a few days later you discover that she is now fine with the change but is concerned that other areas of the organization might resist the change because of perceptions related to patient safety and cost. She suggests that it is important to bring pharmacy on board as they have had previous concerns about the use of heparin. In relation to change theory, this is indicative of: a. systems level thinking. b. linear thinking. c. interprofessional collaboration. d. first-order change.

ANS: A Senge complexity theory, Bevan Seven Change Factors, and general systems theory all highlight connectivity and the idea that changes are not isolated events.

The nurse manager frequently interacts with staff and other hospice facility employees. Communication is purposeful because the manager assesses current issues, such as specific satisfactions and dissatisfactions with the newly implemented computerized documentation system. Informally, the manager gathers available staff members to address similar learning needs. Many times, staff members are found coaching other staff about improving use of the new system. According to Senge (1990), the activities demonstrated in this example are: a. dialogue, team learning. b. resilience, personal mastery. c. shared vision, systems thinking. d. mental models, teachable moments.

ANS: A Building shared vision occurs when leaders involve all members in moving personal visions of the future into a consolidated vision common to members and leaders.

Leaders in nursing must advocate for information and knowledge systems that support nursing practice. This is best accomplished by: a. participating in organizational information technology committees. b. submitting written requests for needed information systems. c. requesting budgetary funds needed for systems. d. sending staff nurses to conferences that discuss cutting-edge technologies.

ANS: A Nurse leaders and direct care nurses must be members of the selection team, participate actively, and have a voice in the selection decision. The information system must make sense to the people who use it and fit effectively with the processes for providing patient care.

5. Complex change situations require that the change leader promote ongoing visioning among staff members. One strategy is to: a. consciously evaluate invisible mental models. b. allow for individual outcomes. c. encourage cooperative activities. d. operate between order and disorder.

ANS: A Senge theory on change suggests that each individual or organization bases activities on a set of assumptions, or a set of beliefs, or mental pictures about the way that the world should work. When these invisible models are uncovered and consciously evaluated, it is possible to determine their influences on work accomplishment.

With regard to nursing practice, nurse managers are held responsible for: (Select all that apply.) a. practicing within legal guidelines established under state law and nurse practice acts. b. ensuring that nursing staff under their supervision are currently licensed to practice. c. referring all errors in nursing judgment to state discipline boards. d. ensuring that physicians are properly licensed to provide care on patient care

ANS: A, B Nurses are responsible for knowing and practicing under state law and nurse practice acts. Managers are responsible for monitoring staff practice and ensuring that staff hold current, valid licensure.

As a nurse manager in a for-profit hospital, you are interested in promoting teaching programs for physicians, because evidence suggests that hospitals with teaching programs tend to promote better care for patients. Your administration indicates that it cannot support your ideas or proposal because of: (Select all that apply.) a. increased salary costs. b. duplication of tests and procedures. c. graduate medical education. d. potential damage to reputation through learner error.

ANS: A, B, C Teaching hospitals tend to incur higher costs because of the salaries required for supervision of physicians, duplication of tests and procedures through the learning process, longer times required to process patients, costs of state-of-the art technology, biomedical research, and stand-by capacity of specialized care. Because of the additional costs, few for-profit agencies and organizations support teaching programs.

Organizational culture includes: (Select all that apply.) a. norms. b. traditions. c. behaviors. d. values.

ANS: A, B, C, D Organizational culture, the reflection of the norms or traditions of the organization, is exemplified in behaviors that illustrate values and beliefs.

1. Which of the following are examples of application of the Leadership Rounding Tool? (Select all that apply.) a. "What is working well for you during bedside reporting?" b. "What has not worked for you today?" c. "Is there someone on your team who deserves special recognition for her efforts in the implementation?" d. "Did you have a good vacation?"

ANS: A, B, C, D The Leadership Rounding Tool suggests establishing and maintaining rapport and asking what is working well, what was a barrier, and who should be recognized, as well as answering tough questions.

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: a. request all staff to accept new risk management practices. b. hold staff accountable for safe practices. c. document inappropriate behavior. d. hire more police security.

ANS: B Active involvement of staff in risk management activities is key to prevention of adverse events. Nursing has a primary role in leadership in optimizing patient outcomes, preventing patient care issues, and mitigating adverse events. Accountability for safety can be one aspect of performance evaluations.

You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Determination of Evelyn's educational preparation and certification is related to the concept of: a. accountability. b. authority. c. role performance. d. assignment.

ANS: B Authority refers to the right to do and may be designated by law, educational preparation, or job description.

Which ethical principle is primarily involved in informed consent? a. Veracity b. Autonomy c. Beneficence d. Nonmaleficence

ANS: B Autonomy refers to the right to choose freely, which is inherent in informed consent.

The chief nursing officer and the dean of the School of Nursing create a partnership based on belief that by establishing rules and regulations and controlling the environment, this partnership will: a. promote professional medical authority, autonomy, and responsibility. b. need a degree of flexibility to engender success. c. be essential for self-governance. d. provide for the establishment of medical committees.

ANS: B Bureaucratic structures have a centralized command structure (chain of command) with a clear division of labor and well-articulated and commonly accepted expectations for performance. Rules, standards, and protocols ensure uniform actions and limit individualization of services and variance in workers' performance. Although bureaucracy enhances consistency, by nature, it limits employees' autonomy and thus the potential for innovations.

As a leader on a rehab unit, the manager encourages all staff members to see themselves as having a role in decision making and quality care. The manager sees their role as involving particular responsibilities in decision making but not as a hierarchal role. What is this view of the role consistent with in this situation? a. Trait theories b. Complexity theory c. Situated theory d. Emotional intelligence

ANS: B Complexity theory involves envisioning each member of the team involved in decision making, management, and leadership, with the leader not seen in a hierarchal relationship to other team members.

Functions such as "delegates tasks to assistive personnel" that are outlined in a position description for an RN Team Leader would be considered: a. active delegation. b. passive delegation. c. passive accountability. d. active responsibility.

ANS: B Delegation of functions that are normally considered part of or an essential part of the practice of a licensed person through a position description is considered passive delegation.

As a nurse manager, the one activity you should not overlook is: a. posting the yearly rotation schedule. b. reviewing vacation requests. c. scheduling staffing for holidays 6 months in advance. d. anticipating staff sick days.

ANS: B Free time and vacation time are needed for individuals to recharge. If time for work is more than 60% of wake time, or when self-time is less than 10% of wake time, stress levels increase.

A new RN staff member asks you about the difference between QA and QI. You explain the difference by giving an example of QI. a. "Last year, the management team established new outcomes that addressed issues such as medication errors." b. "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?'" c. "A process audit was done recently to determine how much time was being spent on patient documentation." d. "Errors are reported on our new computerized forms, and I follow up with staff to make sure that they understand the seriousness of their error."

ANS: B In QI, followers invest in the process by continually asking "What makes this indicator important to measure?" "What has been done to improve it?" "What can I do to improve it?"

The chief nursing office continues to seek ways to improve healthcare services to clients and to save the hospital money. However, with the federal guidelines of paying agencies based on capitation, the chief nursing office faces a challenge. Capitation provides incentives for healthcare providers to control costs by: a. providing fewer services to fewer clients. b. using fewer services per client. c. using high-technology treatments. d. requiring second opinions.

ANS: B In a capitated environment, a single fee is paid for all services provided. To be financially viable under this reimbursement model, organizations would be interested in decreasing the volume of services used and increasing the volume of patients. High-technology treatments and second opinions may increase the number of services used.

The parents of a toddler who dies after being brought to the ER launch a lawsuit, claiming that the failure of nurses to pursue concerns related to their son's deteriorating condition contributed to his death. How is senior nurse executive named in the suit? a. As a global respondent b. Under the doctrine of respondeat superior c. As a frivolous action d. Under the element of causation

ANS: B Known as vicarious liability, the doctrine of respondeat superior makes employers accountable for the negligence of their employees, using the rationale that the employee could not have been in a position to have caused the wrongdoing unless hired by the employer

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? a. Talk to the staff individually to determine why this is occurring. b. Call a meeting of all staff to discuss this issue. c. Have a group of staff nurses review the established standards of care for postoperative patients. d. Document which staff members are not recording vital signs and write them up.

ANS: B Leadership must identify safety shortcomings and must locate resources at patient care levels to identify and reduce risks. One method of doing this is to invite all staff into a discussion related to solutions to an identified concern. This approach encourages teamwork.

A local hospital has formed a corporate partnership with a reputable HMO (health maintenance organization). The nurse manager has had to educate staff and personnel about the financial implications of this partnership. An HMO: a. provides more expensive care than other types of insurance plans. b. has a centralized administration that directs and compensates physician services. c. pays physicians on a fee-for-service basis. d. does not pay as much for acute care as other practice plans.

ANS: B The HMO is a configuration of healthcare agencies that provide basic and supplemental health maintenance and treatment services to voluntary enrollees who prepay a fixed periodic fee without regard to the amount of services used. HMOs have a centralized administration that directs and pays salaries for physician practice (e.g., HMOs)

After reviewing her monthly budget report, the nurse manager sees that she has a negative variance, which prompts her to change the staffing schedule. A negative or unfavorable variance in a monthly expense report may result from: a. overestimation of inflation. b. higher than expected client acuity. c. net revenue exceeding net expenses. d. not replacing staff who called in sick.

ANS: B Variance reflects the difference between what was projected and the actual performance in a budget. When the variance is negative or unfavorable, the amount spent is more than what was budgeted (expenses exceed revenue); this may be a result of higher acuity. To help managers interpret and use variance information better, some institutions use flexible budgets that automatically account for census variances.

6. During a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on: a. supportive behavior by the leader and immature followers. b. the development level of the followers and the behavior based on the situation. c. well-developed followers combined with a strong leader who acts quickly. d. the leader's ability to evaluate personnel and communicate that evaluation.

ANS: B When abilities, relationships, and/or time is limited (as in a crisis situation), the leader assumes a bigger role in guiding and in making decisions, or "telling" behavior. Leaders need to behavior differently and use different leadership styles in different situations.

1. When goals/outcomes are somewhat unclear in early preparation for a complex change, the manager and the change management team develop several acceptable goals/outcomes. This change in management approach is termed: a. unfreezing. b. nonlinear. c. cybernetic. d. linear.

ANS: B While Lewin theory was designed to describe planned or first-order changes, many scholars think the theory is too simplistic to address how unplanned or second-order change occurs. In complex situations with an uncertain change environment, a nonlinear approach that involves flexibility improves overall outcomes. Linear change is appropriate to stable, less complex, and more predictable situations.

A nurse manager was orienting new staff members to computerized charting. To understand computerized charting, staff members must understand informatics. The three core concepts in informatics are: a. hardware, software, and printers. b. data, information, and knowledge. c. decision making, data gathering, and reporting. d. wireless technology, voice recognition, and handheld devices.

ANS: B Informatics is the application of technology to all fields of nursing to facilitate and extend nurses' decision-making abilities and to support nurses in the use, storage, and linkage of clinical information to provide effective and efficient patient care

8. One means of ensuring that the nurses floated to other patient care areas in healthcare organizations are qualified to work in the areas they are floated is: a. employing additional staff to assist with orientation processes. b. cross-educating staff members to other areas of the institution. c. transferring patients to units where the staffing pattern is optimal. d. orienting staff members to all patient care areas as part of their general orientation to the institution.

ANS: B Nurses should be floated to units as similar as possible to their own to decrease the potential for liability. Negotiating cross-training, a proactive approach to temporary staffing problems, reduces the potential for liability.

The day shift nurse asks an LPN/LVN to complete a task for a patient. The day shift nurse is engaging in what function? a. Delegating b. Assigning c. Sharing d. Authorizing

ANS: B Delegation refers to transfer of responsibility for work; the day shift nurse retains accountability for the outcomes of patient care therefore is using assigning of the task rather than delegation.

4. The core of leadership is awareness. The text by Don Miguel, The Four Agreements, presents a set of agreements to enhance personal growth and awareness. What is not one of the four agreements? a. Be impeccable with your word. b. Take things personally. c. Do not make assumptions. d. Always do your best.

ANS: B The four agreements include all with the exception of taking things personally. The second agreement is to not take things personally. When a person speaks or engages a leader, it is often from their reality and not reflective of your reality. Listen to their information, and assess, then formulate decisions.

A staff nurse has been recently promoted to unit manager. During the time on the unit, the nurse formed a strong social network among staff, has promoted the development of relationships between staff and workers in other areas of the organization, and has formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, what principle is being engaged? a. Empowerment b. Systematic thinking c. Development of networks d. Bottom-up interactions

ANS: C According to complexity theory, social networks evolve around areas of common interest and are able to respond to problems in creative and novel ways.

You volunteer at a free community clinic. A 13-year-old girl presents with chlamydia. The team leader at the clinic advises that: a. the state-defined age of legal consent is 18; therefore, no treatment can be delivered. b. the teen is underage and should be referred to the family general practitioner. c. care can be provided as long as consent is voluntary and information about treatment and options is provided. d. treatment is provided as long as telephone consent is obtained from a parent or legal guardian.

ANS: C All states have a legal age for consent; generally, this age is 18. However, emancipated minors, minors seeking treatment for substance abuse, and minors seeking treatment for communicable diseases can provide their own consent.

A new graduate is asked to serve on the hospital's quality improvement (QI) committee. The nurse understands that the first step in quality improvement is to: a. collect data to determine whether standards are being met. b. implement a plan to correct the problem. c. identify the standard. d. determine whether the findings warrant correction.

ANS: C Before further action (data collection, decision making related to correction, and implementation of a plan) can occur, it is necessary to identify the standards against which data collection and decision making will occur. Institutions may or may not adopt standards that are already established by organizations such as the ANA.

The nurse manager wants to increase motivation by providing motivating factors for the nurse on the unit. What action would be appropriate to motivate the staff? a. Collaborate with the human resource/personnel department to develop on-site daycare services. b. Provide a hierarchical organizational structure. c. Implement a model of shared governance. d. Promote the development of a flexible benefits package.

ANS: C Complexity theory suggests that systems interact and adapt and that decision making occurs throughout systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts, and therefore all levels of staff would be involved in decision making. This principle is the foundation of shared governance

Cultural diversity is the term used to describe a vast range of cultural differences. Events have symbolic meanings for the nurse manager and the staff. The event that would be most likely to provide symbolic meaning to a nurse manager and staff is a: a. task force formed to commemorate a New Year's celebration in the Western tradition. b. project to provide Christmas gifts to the children in a daycare program. c. celebration of National Nurses Week with the focus on cultural care. d. task force to develop a poster for the unit depicting religions of the world

ANS: C Human cultures have material items or symbols such as artifacts, objects, dress, and actions that have special meaning in a culture. National Nurses Week, with a focus on nursing interests, reflects the culture of nursing.

An RN colleague, who is a long-standing and collaborative member of your team, is performing a complex dressing with new orders written for the first time for the assigned patient. Which of the following would be the most appropriate communication with her? a. "How do you usually do this kind of dressing?" b. "The dressing needs to be done today and tomorrow with the supplies on thiscart." c. "Here is what you need for the dressing, and I will show you what needs to be done." d. "I know you know what you are doing. Let me know if you have any problems."

ANS: C If a situation involves a new task and the relationship is ongoing (two individuals who will usually continue to work together), the delegator explains what to do and how to do it. Hersey described the leader's behavior as explaining or persuading, which, is characterized as "selling." The RN who is assigned to the patient is an experienced nurse and team member, but is new to this specific situation. In situations where the nurse is experienced but the task is new, explain (and demonstrate) what needs to be done.

10. On your nursing unit, you employ LPNs, RNs, and advanced practice nurses. You will need to be familiar with at least: a. two nursing practice acts. b. two nursing practice acts in most states. c. one nursing practice act. d. one nursing practice act and a medical act.

ANS: C In all states, you will need to be familiar with at least one nursing practice act. In some states, there may be two nursing practice acts if RNs and LPNs/LVNs come under different licensing boards

The unit manager is working in a large metropolitan facility and is told that two UNPs are to be assigned to work with her. Delegation begins with: a. acknowledging the arrival of the second UNP on the unit. b. providing clear directions to both UNPs. c. matching tasks with qualified persons. d. receiving reports from the prior shift.1

ANS: C In delegating to the UNPs, the nurse must consider what cannot be delegated, as well as the factors of safety, time, critical thinking, and stability of patients.

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: a. assemble a team. b. establish a benchmark. c. identify a clinical activity for review. d. establish outcomes.

ANS: C In theory, all aspects of clinical activity could be improved through the QI process. However, QI efforts should be concentrated on changes to patient care that will have the greatest effect.

17. Elizabeth is an example of a(n): a. early adopter. b. late majority. c. laggard. d. resister.

ANS: C Laggards prefer keeping traditions alive ("We have always done it this way") and openly express their resistance to ideas (speaking out against the change). Late majority individuals are openly negative but will engage with new ideas when most others adopt the change.

6. In keeping with standards of The Joint Commission (TJC), the nurse manager organizes an orientation for new staff members. As part of the orientation, the nurse manager reviews the employee handbook. What is the basis that binds employers to statements in the employee handbook? a. Under the doctrine of apparent agency b. Under the doctrine of respondent agency c. Based on the employee's or the employer's expectations d. Based on the theory that the handbook creates an explicit contract

ANS: C The handbook is an implied contract and frames the employment contract. This contract binds the employer to meeting the handbook statements

22. A new graduate RN joins your unit. After a few weeks, she complains about some of her peers on the unit and compares their practices negatively to what she learned in her nursing program. She also is vocal about how she has learned so much here that she did not learn in her program. She is best described as: a. having cultural sensitivity. b. experiencing cultural diversity. c. experiencing cultural marginality. d. experiencing acculturation.

ANS: C The new graduate is caught between two cultures at this point—work and education—and expresses feelings of belonging to neither.

The charge nurse walks into Mr. Smith's room and finds him yelling at the LPN. He is obviously very upset. The charge nurse determines that he has not slept for three nights because of unrelieved pain levels. The LPN is very upset and calls Mr. Smith an "ugly, old man." The charge nurse acknowledges the LPN's feelings and concerns and then suggests that Mr. Smith's behavior was aggressive but was related to lack of sleep and to pain. The charge nurse asks, "Can you, together with Mr. Smith, determine triggers for the pain and effective approaches to controlling his pain?" This situation is an example of what? a. Lack of empathy and understanding for Miss Jones b. Concern with placating Mr. Smith c. Leadership behavior d. Management behavior

ANS: C The situation between Mr. Smith and Miss Jones is a complex situation involving unrelieved patient symptoms and aggressiveness toward a staff member. Providing engaged, collaborative guidance and decision making in a complex situation where there is no standardized solution reflects leadership.

8. The oncology clinical manager and the educational coordinator asked nursing staff to complete a brief written survey to assess their attitudes and knowledge related to having used the new infusion equipment for 6 weeks. The stage of change in this situation is: a. developing awareness. b. experiencing the change. c. integrating the change. d. perceiving awareness

ANS: C This particular initiative assesses the success with which the change has been integrated into everyday practice after it has been experienced, or the degree to which staff members have accepted using the new infusion equipmen

County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah provides Colleen, her RN colleague with details regarding the patients to whom Colleen has been assigned on the day shift. This is an example of: a. accountability. b. responsibility. c. assignment. d. delegation.

ANS: C When an RN assigns care to another RN, it is termed an assignment and not delegation, because both accountability and responsibility are transferred.

John, a new nurse manager, complains to his colleague that he feels very uncomfortable with the conflict between what he thinks he should be doing as the manager and what his supervisor thinks he should be doing. According to Hardy's role theory, John is experiencing: a. stress. b. role stress. c. role strain. d. role exploration.

ANS: C According to Hardy's role theory, role strain is the subjective feeling of distress that occurs when role stress or a social condition of conflicting demands or difficult conditions is present

A staff nurse in the area that you manage has excelled in the delivery of patient education. You are considering implementing a new job description that would broaden her opportunity to teach patients and orient new staff members to the value of patient education. What ethical principle is being reinforced? a. Justice b. Fidelity c. Paternalism d. Respect for others

ANS: C The principle of paternalism allows one person to make partial decisions for another and is most frequently deemed to be a negative or undesirable principle. Paternalism, however, may be used to assist persons to make decisions when they do not have sufficient data or expertise. Paternalism becomes undesirable when the entire decision is taken away from the employee

Sarah is a nursing graduate of 5 years who is very confident in her clinical skills. She has taken some certificate courses in leadership and management and has considered beginning a graduate degree with this focus. She is excited about being able to use her knowledge and interest by being hired as a nurse manager. Before beginning her new position, Sarah spends time with her nurse executive to clarify the executive's expectations of her and of the unit that she has been hired to manage. After a year, Sarah successfully transitions into the nurse manager role and considers taking the examination to become a certified nurse executive. Amy advises her that this is not possible because Sarah will need: a. a graduate degree. b. at least a nursing diploma. c. 24 months of experience. d. 5 years of successful experience

ANS: C Nurses with baccalaureate preparation and holding a nurse executive position with at least 24 months of experience can take the examination to become a certified nurse executive

After several months of heavy patient loads in the Emergency Department and inability to secure sufficient and experienced staff, the department is especially taxed by a train accident that brings in many seriously injured individuals. You observe that Rama ignores the requests of several of the injured, even when time is available to care for them and is rude to two older adult patients. You are concerned that Rama is evidencing which state? a. Hardiness b. Depression c. Role ambiguity d. Depersonalization

ANS: D A characteristic of burnout is depersonalization, a state characterized by distancing oneself from the work itself and developing negative attitudes toward work in general (Greenglass et al., 2001). Depersonalization is commonly described as a feeling of being outside one's body, feeling as if one is a machine or robot, an "unreal" feeling that one is in a dream or that one "is on automatic pilot." Generally, subjective symptoms of unreality make the nurse uneasy and anxious. Nurses pushed to do too much in too little time may distance themselves from patients as a means of dealing with emotional exhaustion.

9. An example of one strategy to improve participation in the change process by staff fitting the behavioral descriptions of laggards, early majority, late majority, and rejecters is to: a. encourage teamwork. b. transfer to a different unit. c. require attendance at staff meetings. d. delegate the roles and tasks of change.

ANS: D According to Rogers's work, the individual's decision-making actions pass through five sequential stages. The decision to not accept the new idea may occur at any stage. However, peer change agents and formal change managers can facilitate movement through these stages by encouraging the use of the idea and providing information about its benefits and disadvantages.

You are a member of a team assigned to care for 15 general medical/surgical clients. You have all worked well together in the past in this same type of care. If you are assigned to coordinate this team's work, your best strategy, based on the Hersey model, would be to: a. have a list of tasks to be accomplished and tell each member of the team what he or she must do. b. encourage people to discuss their frustrations in providing this care. c. ignore them—they've done it before. d. provide minimal direction and let them come to you with questions.

ANS: D According to the Hersey model, when ability (skills, job knowledge) and willingness are strong, the role of the delegator is less ("delegating behavior").

During a staff shortage, you hire an RN from a temporary agency. The RN administers a wrong IV medication that results in cardiac arrest and a difficult recovery for the patient. Liability in this situation: a. is limited to the temporary agency. b. is restricted to the RN. c. could include the RN, the agency, and your institution. d. may depend on the patient's belief regarding the employment relationship

ANS: D Apparent agency may apply here because your liability and that of your institution could be established if it can be shown that the patient believes that the RN was an employee of yours and of your institution.

A method commonly used in quality assurance to monitor adherence to established standards is: a. a Pareto chart. b. brainstorming. c. patient interviews. d. chart audit

ANS: D Chart audits are a common method of addressing process standards. Chart audits over time yield trend charts.

What is an example of an HMO? a. Nurse practitioners are paid promptly at discounted fees for each service rendered at a women's health clinic. b. Physicians in a large urban center are reimbursed for visits made to their clients. c. Physicians are paid for each service delivered to enrolled patients through a prepaid plan. d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.

ANS: D Fee-for-service systems provide compensation to healthcare providers in group practices based on fee-for-service, which in PPQs means that fees are paid promptly but at a discounted rate. HMOs are configurations of healthcare agencies that provide health maintenance and services for enrolled patients for a fee that is preestablished regardless of utilization of service.

To prepare for the orientation of newly hired nurses, the nurse manager plans a presentation outlining the concept of healthcare networks. Healthcare networks are: a. units that provide only primary care services. b. owned by the institutions. c. a feature of all public institutions. d. units that serve large populations.

ANS: D Healthcare networks are interconnected units. Their aim is serving large regional populations

Sarah is a clinical nurse educator in the dialysis unit at Pines Health Center and provides education, consultation, and training support. Sarah has: a. direct responsibility for patient care. b. direct accountability for patient outcomes. c. an authority relationship to staff. d. an influence over patient outcomes.

ANS: D In a staff position, Sarah supports line positions in accomplishing the primary goals and objectives of the unit and provides support, counsel, and advice, but she has limited or no authority for decision making

The night nurse understands that certain factors need to be considered before delegating tasks to others. These factors include the: a. complexity of the task and the age of the delegatee. b. potential for benefit and the complexity of the task. c. potential for benefit and the number of staff. d. complexity of the task and the potential for harm.

ANS: D In delegating tasks to others, the nurse considers factors such as stability of the patient, safety of the situation and of the patient, time and intensity involved, and level of critical thinking required to achieve desired outcomes.

To satisfy duty of care to a patient, a nurse manager is legally responsible for all of the following except: a. notifying staff of changes to policies related to medication administration. b. scheduling and staffing to ensure safe care. c. delegating in accordance with practice acts. d. supervising the practice of the physician.

ANS: D Legally, the nurse manager is accountable to nursing practice standards, standards for nurse administrators, and hospital policies and procedures.

Because of rapid turnover and the ongoing hiring of new graduates, the skill levels of staff in a busy CCU are varied. Senior staff are becoming burned out with the need to provide mentorship and guidance to new staff. As the manager, you propose the addition of a nurse in advanced practice to provide consultation and education for staff. What is this position considered? a. Hierarchical position b. Ancillary c. Line position d. Staff position

ANS: D Line personnel have authority for decision making, whereas personnel in staff positions provide education, support, advice, and counsel. The nurse in the advanced practice is providing advice and support through education as well as consultation.

A nursing informatics specialist hired by Blue Cross/Blue Shield Insurance System (a form of third-party payers benefit package for a prepaid fee that uses specific standards to approve a period of time for the use of inpatient and community health services) is participating in: a. critical pathways. b. healthcare networks. c. health maintenance organizations. d. managed care.

ANS: D Managed care strives to contain costs (e.g., through limitation of time in care) while maintaining quality. Managed care combines care delivery with financing and provides comprehensive services for a fixed prepaid fee. Group practice plans take various forms. One form has a centralized administration that directs and pays salaries for physician practice (e.g., HMOs).

What patients would most likely be covered under Medicare? a. Jim, who lives on the street and has occasional infections b. Alysha, who is on social assistance and has a 5-year-old daughter with frequent ear infections c. Karen, a housewife, 45 years of age, whose husband recently abandoned the family d. Dan, who is 68 years of age and in good health

ANS: D Medicare is a federal government program for individuals over 65 and with certain permanent illnesses, such as end-stage renal disease. Medicaid provides financing of health care for the medically indigent.

The manager in the coronary care unit believes an important ethical consideration in performance evaluations is to include the employee's good qualities and give positive direction for professional growth. What ethical principle does this represent? a. Justice b. Fidelity c. Beneficence d. Nonmaleficence

ANS: D Nonmaleficence refers to "doing no harm." For a nurse manager following this principle, performance evaluation should emphasize an employee's good qualities and give positive direction for growth. Destroying the employee's self-esteem and self-worth would be considered doing harm under this principle.

A nurse manager working for a not-for-profit organization should be familiar with the regulations that impact the organization. Not-for-profit organizations: a. pay dividends to stockholders. b. can refuse clients who are unable to pay. c. have no paid employees. d. pay no taxes.

ANS: D Not-for-profit organizations, often referred to as voluntary organizations, are controlled by voluntary boards and provide services to both paying and charity clients. Funds are redirected toward maintenance and growth as opposed to profit shares for stockholders. Historically, non-profit organizations have been exempt from paying taxes as they commit to providing an important community service.

The core of nursing leadership incorporates integration of unique qualities to include us as individuals. Which is not considered part of leadership integration? a. Person b. Leader c. Nurse d. Position

ANS: D Position is not considered part of leadership integration. The provided model discusses the use of nurse, person, leader, and integration of the unique personal aspect to form the integration of leadership

As a nurse manager, you notice that Maria, a Hispanic nurse aide, is visibly upset. When you ask her if something is wrong, she becomes tearful and says, "Why is it that when John and I work together in giving patients care, he jokes about my being "a little fat Mexican"? The nurse manager's best response is, "Do you think he: a. is sensitive to your culture?" b. wants to learn more about you?" c. has been hurt and wants to hurt others?" d. is stereotyping you without thinking?"

ANS: D Prejudices enable us to predict behaviors and make sense of situations but constrain our understanding and development of new insights.

Resistance is most likely when change: a. is not well understood. b. involves many layers in an organization. c. involves nonprofessional workers. d. threatens personal security.

ANS: D Resistance and reluctance commonly occur when personal security is threatened and may involve loss of confidence in abilities or loss of job or financial security.

Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She is assigned David, a patient who has been admitted with a severe head injury. In communicating with Sally, what does is an appropriate action by the charge nurse? a. Provide a detailed explanation of what she needs to do with ICP monitoring. b. Tell her when she needs to provide an update about David's status. c. Ask her to tell you what she knows about ICP monitoring and share expectations about reporting. d. Advise her that you are available if she needs you

ANS: D The charge nurse and Sally have a well-established relationship and Sally has the expertise to work effectively with David; therefore, the charge nurse would need to provide little guidance but would need to communicate that they are available if needed. Hersey refers to this leader behavior as "delegating."

Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." According to Havelock (1973), this comment may originate from failure in which phase of the six phases of planned change? a. Generating self-renewal b. Choosing the solution c. Diagnosing the problem d. Building a relationship

ANS: D The first phase of this model of planned change involves building a relationship as a basis for later phases, which include diagnosing the problem and choosing the solution. At this point, as a new manager, the relationship may not have yet developed sufficiently with Elizabeth.

20. Individuals living with asthma, who also live in poverty, are much less likely to seek early care and are more likely to go to emergency rooms for assistance. This example reflects: a. stereotyping. b. cultural diversity. c. ethnocentricity. d. transcultural care.

ANS: D Transcultural care involves consideration of health beliefs and practices between genders among races, ethnic groups, and those with different socioeconomic status.

Which of the following factors is not implicated in rising healthcare costs? a. Rising expectations of consumers for cure and care b. Marketing of drugs to consumers c. Large administrative staffs to process medical billings d. Rising Medicare costs

ANS: D Unintentional injuries, socioeconomic conditions (e.g., poverty and violence), marketing of pharmaceuticals, and the rising expectations of consumers with regard to what should be done to manage health concerns all contribute to rising healthcare costs. The costs of Medicare are not considered in relation to rising costs of health care.

Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and as a result, a suit is launched in which both Sarah (the delegator) and Leslie (the delegatee) are named. Sarah is named in the suit because she: a. retains accountability for the care of the patient. b. worked the same shift as Leslie. c. has passive accountability for delegation. d. retains accountability for the outcomes of care for the patient.

ANS: D Whenever care is provided by someone other than a registered nurse, accountability for care remains with the manager/delegator even though others provide aspects of care.

A necessary, basic condition for successful integration of clinical information systems is: a. software. b. standard medical nomenclature. c. confirmatory evidence from nursing-led studies. d. strong interdisciplinary cultures.

ANS: D An integrated clinical information system draws on specific knowledge from many involved disciplines that interface at the patient. Successful integration of clinical information systems requires that the various disciplines work together collaboratively to transform the data into meaningful knowledge.

6. The nurse manager is implementing a shared governance model to help with communication and decision making. Although staff members like the concept, change is difficult. Staff nurses feel: a. more empowered. b. more communicative. c. less stressed. d. more powerless and devalued.

ANS: D Change can lead to feelings of being overwhelmed and powerless, especially if complexity compression or rapid, intense changes have been involved.

As part of an information technology implementation team, you are implementing a clinical decision support system. Particular considerations for successful implementation of this project include: a. ensuring that the system is reliable. b. ensuring that patient information is reliable. c. developing unique identifiers for individuals. d. developing rules that support inferences.

ANS: D Clinical decision support systems provide support for novice nurses, in particular, as they enable entry of real-time data from patient situations and inferences that apply the logic that expert nurses would use. These inferences require rules to be developed for the system.