leadership exam 1

As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas. What is the leadership you are employing? a. Situational b. Trait-based c. Contingency-based d. Transformational

ANS: D Transformational leadership involves attending to the needs and motives of followers, which results in creativity, improvement, and employee development.

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.

According to the complexity theory, what would be the focus of measurement? a. Cost per hospital day b. Bed utilization c. Infection rates d. Staff morale and budgets

ANS: D According to complexity theory and the principle "Think systematically," one cannot ignore objective data or nonmeasurable data, as both inform decisions.

In preparing for a fair interview process as a hiring manager, you should: a. put water out for the candidates. b. ensure that you know the names of all candidates. c. dress comfortably and professionally. d. prepare a schedule of questions to be asked of all candidates.

ANS: D Although providing water, knowing names, and dressing appropriately sets a professional and respectful tone for the interview, developing a schedule of questions to be asked of all candidates is important for gathering comparative data and ensuring equitable treatment.

Marie is a long-term staff nurse on the rehab floor. Her unit manager has been eager to adopt evidence-based recommendations related to family-centered care on the unit. Marie's response has been that she rarely has time to provide care to patients, let alone families, and that there is no good reason to do anything different than what she is already doing. An approach that may gain Marie's support of the idea is to: a. invite Marie to review the studies for herself. b. suggest that she does not need to provide family-centered care. c. avoid discussion of the idea with her until she initiates it. d. secure the support of her closest colleagues on the unit.

ANS: D As a skeptic, Marie, who is a late majority adopter, needs pressure from colleagues to move her toward support of the recommendations. The translation of research into practice requires that nurse leaders and managers understand group dynamics, individual responses to innovation and change (such as the response of late majority adopters), and the culture of their healthcare organization.

Within a multisite healthcare system, the most appropriate strategy for translation of research would be: a. widespread development of protocols using EBP at unit levels. b. dissemination of EBP and recommendations to individuals, units, and the organization. c. development of the skills of individual managers on how to build guidelines based on EBP. d. establishment of an interdisciplinary center to guide and lead the translation of research findings into practice.

ANS: D At a systems level, the most appropriate approach would be establishing a center that leads in, guides, and promotes EDP across and at various levels.

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.

A stroke unit experiences numerous changes related to implementation of new technology, a changed nursing care delivery model, and staff turnover within a period of 6 months. Staff members begin to show signs of reluctance to implement any more changes. The phenomenon experienced by the staff is termed: a. eustress. b. care process. c. stereotypical thinking. d. complexity compression.

ANS: D Complexity compression refers to many changes occurring simultaneously before time is sufficient to assimilate the change.

A staff nurse approaches the unit manager and indicates to her that because of her father's death in the previous month, she is now finding it very difficult to do her work effectively. This would be considered a(n) ________ stress. a. internal source b. familial c. burnout d. external

ANS: D External stress is outside and removed from the work setting, but it is considered work-related stress because of the impact it has on the worker.

Which of the following strategies is most important in developing a strong vision? a. Seeking out evidence to support trends and out-of-the-box thinking b. Spending time with others with whom we discuss ideas c. Setting up focus groups to provide information on current realities d. Being honest and open about what we think for the future

ANS: D Regardless of how we go about developing our vision (gathering evidence, testing ideas with others), honesty and openness are foundational to a strong vision.

Which of the following needs revision on a résumé or CV? a. John Jones 87 Highway Drive City, MI 79110 [email protected] b. M. Howes Anyway Highway City, MO 77700 (H) 777-777-0000 e-mail: [email protected] c. Dr. L. Jones 99 Carway Drive City, NY 84003 (H) 999-999-0000 (Cell) 999-000-9999 d. Tanya Jones 67 Honeywell Drive City, MO 66907 [email protected]

ANS: D When including Web or e-mail addresses, it is important to use addresses that are not overly casual or that communicate personal information.

Nursing research has indicated that the foundation for becoming a nursing leader is the ability to: a. write effectively. b. speak two or three languages. c. focus on day-to-day priorities. d. think futuristically.

ANS: D Whether you are a leader, a follower, or a manager, being able to visualize in your mind what the ideal future is becomes a critical strategy. A vision can range from that of an individual to that of a group or to a whole organization.

Which of the following is an effective approach in the appraisal of research studies? a. Accept only studies that use a RCT design. b. When ranking research studies, choose RCTs over qualitative studies. c. Select only studies with a large sample size. d. Evaluate the quality of the research against the standards for that type of research.

ANS: D While randomized controlled trials (RCTs) are generally considered the gold standard for research, it is important to assess not only the method but also the quality of the study and its applicability to the question that is being asked. The quality of all studies should be appraised against the standards accepted for that type of research.

You have just hired a recent graduate. The graduate is thrilled with the opportunity that she has been given, as well as with the idea that "working means no more essays, tests, or assignments!" She indicates that she has no intention of touching a book, journal, or health information website for a "long time." Which of the following would be your best response? a. The expectations and design of educational programs means that new graduates are better prepared for the work force. b. The new graduate will still have to learn, but it will be job-specific learning. c. An ideal learning plan for nurses emphasizes followership. d. The amount and intensity of knowledge demands lifelong learning that includes assessment of relevancy of knowledge for practice.

ANS:D Knowledge will change dramatically, requiring that we all be dedicated learners. With or without state law, continuing education will be mandatory and essential. Knowledge will evolve from the intensity of the current information evolution so that we will access content with meaning and applicability for our work.

The work group on Nursing Unit 23 is marked by apathy toward the ward's patients, high absenteeism, open conflict among team members, and high turnover of personnel, including managers. The underlying behavior in this situation may be characterized as: a. powerlessness. b. anger. c. apathy. d. oppression.

ANS: A Emotions such as anger and apathy result from a workplace in which powerlessness is exhibited.

Mr. M. complains to you that one of your staff asked him details about his sexual relationships and financial affairs. He says that these questions were probing and unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry with him and would not provide him with good care. Mr. M.'s statements reflect concern with: a. privacy. b. confidentiality. c. veracity. d. informed consent.

ANS: A Privacy protection includes protection against unwarranted intrusion into the patient's affairs.

The nurse is educating older adult patients on staying safe in the healthcare system. What information does the nurse include in the teaching? a. The need to understand and record all medications being taken. b. Bringing their own linens and other personal items to the hospital. c. Washing hands frequently while in a healthcare environment and using a hand sanitizer. d. Following closely the directions and orders of healthcare providers.

ANS: A The Five Steps to Safer Health Care for patients include keeping a list of medications that patients are taking.

What does the SBAR approach to patient safety encourage? a. Consistency in assessment and practices b. Continuing education c. Multidisciplinary approaches d. Patient feedback

ANS: A The use of SBAR (Situation, Background, Assessment, and Recommendation) checklists are designed to decrease omission of important information and practices.

Pleasant Valley Hospital has amended its safety practices and policies. What has the hospital elected to emphasize accordance with changes by The Joint Commission (TJC)? a. Safety goals specific to Pleasant Valley b. Decision-making processes c. Sufficient staffing for safe care d. Increased numbers of baccalaureate-prepared RNs

ANS: A When TJC, a not-for-profit organization that accredits healthcare organizations, changed its focus from processes to outcomes, it emphasized patient safety and issues setting-specific annual patient safety goals.

High levels of work-related stress affect all but which of the following? (Select all that apply.) a. Job satisfaction b. Absenteeism and turnover c. Nurses' health d. Client welfare

ANS: A, B, C, D Many writers and researchers have found that these work-related areas are adversely affected by stress.

One of your staff nurses asks for your advice because a patient refuses to sign a consent for surgery. The patient says that he won't sign because he doesn't understand the nature of the surgery. You advise that: (Select all that apply.) a. consent must not be coerced. b. the patient has a right to choose not to consent. c. the patient must sign the consent because the doctor wants him to sign. d. witnessing a consent is related only to the voluntary nature of the signature.

ANS: A, B, D Consent must be voluntary and not coerced; the patient must understand what he is signing, must have legal capacity, and must understand the consequences of refusal. Witnessing a consent means attesting to the voluntary nature of the patient's signature.

Your colleague Mary, a recent graduate, announces that she intends to leave nursing in 3 to 4 months to pursue a position in marketing. While at your agency, she plans to give patients excellent care and to learn as much as she can, because "Who knows? Nursing is a great job with a great pay and I may return someday." Mary's statements most accurately exemplify which orientation to the concept of nursing? Nursing as a(n): a. profession. b. occupation. c. flexible discipline. d. career with off and on ramps.

ANS: B Concern with nursing as potentially one in a series of possibly well-paid jobs reflects a view of nursing as an occupation.

Politics is identified in what areas? a. Confined to legislatures b. Seen in dysfunctional workplaces c. Found in all social organizations d. A representation of self-interest

ANS: C Politics involves social interaction among organizations and as such, politics permeates in all organizations, workplaces, legislatures, professions, and even families.

An experienced staff nurse applies for a distinct position of patient advocate at a new clinic. Based on the various tools available to her, which of the following should she bring to her interview to best present her skills? a. Résumé b. Annual evaluations c. Portfolio d. Patient advocacy project

ANS: C A portfolio enables prospective employers to view evidence of significant achievements and responsibilities that would be pertinent to the position.

During orientation of new nurse managers, the chief nursing officer stresses strategies that help nurse managers to achieve a powerful image. What behaviors best contribute to a powerful image for the nurse manager? a. Greeting patients, families, and colleagues with a handshake and a smile; listening carefully when problems arise b. For men, no facial hair, always wearing a suit and tie; for women, always wearing a suit and high-heeled shoes c. Maintaining a soft voice during times of conflict; making unbroken eye contact during interactions d. Smiling all the time; always wearing a suit, carrying a briefcase, and, if a woman, wearing no jewelry

ANS: A A powerful and positive approach is communicated through confident behaviors such as greeting others, smiling, and showing respect for the opinions of others through listening. Grooming and dress need to be clean, neat, and appropriate to the situation. Speech needs to be firm and confident.

A staff nurse, who was fired for reporting patient abuse to the appropriate state agency, files a whistleblower lawsuit against the former employer. What reason would the court provide to uphold a valid whistleblower suit claiming retaliation by the nurse? a. Previously reported the complaint, in writing, to hospital administration. b. Threatened to give full details of the patient abuse to local media sources. c. Was discharged after three unsuccessful attempts at progressive discipline had failed. d. Had organized, before filing the complaint, a work stoppage action by fellow employees.

ANS: A An employer is unable to fire an employee who, in good faith, reports what is believed to be a violation of a law, rule, or state or federal law

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.

A nurse manager must implement a 2% budget cut on the nursing unit. What approach would the manager use to most effectively empower the staff of the unit? a. Discuss the guidelines for the budget cuts with the staff, making the decisions with those who participate. b. Inform the staff of the budget cuts in a series of small group meetings and accept their ideas in writing only. c. Provide the staff with handouts about the budget cuts and let them make recommendations in writing. d. Hold a series of mandatory meetings on the budget cuts, asking staff for ideas on the cuts.

ANS: A Empowerment is the process of exercising one's own power to facilitate the participation of others in decision making and taking action so they are free to exercise power. It means releasing authority and enabling others to have accountability, for participation and decisions.

A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who begins to complain loudly about the quality of care his mother is receiving. His behavior is so disruptive that it is overheard by staff, physicians, and other visitors. The family member leaves the unit abruptly, and the nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner? a. Reflect to gain insight into how the situation could be handled differently in the future. b. Try to catch up with the angry family member to resolve the concern. c. Discuss the concern with the patient after the family member has left. d. Notify nursing administration of the situation.

ANS: A Goleman suggests that emotional intelligence involves insight and being able to step outside of the situation to envision the context of what is happening as well as being able to manage emotions such as frustration effectively.

A staff nurse asks the nurse manager for a few days off for personal reasons. The nurse manager turns in the request to the human resources office with a note indicating that the staff nurse has demonstrated excellent working skills and is a valued employee. The nurse manager has used the influence of her position to help this staff member. Influence is the process of: a. using power. b. empowering others. c. understanding power. d. moving past apathy.

ANS: A Influence involves the use of power to effect certain outcomes—in this situation, to arrange days off for a valued employee.

A unit manager watches a new RN graduate interacting with a patient. When the RN comes out of the room, the unit manager says, "I don't know what they taught you in your nursing program, but if I see you do that again, I will write you up." This example demonstrates: a. coercive use of power. b. appropriate application of control. c. use of informatory power. d. use of power to provide coaching.

ANS: A Influence is the process of using power. Influence can involve the punitive power of coercion, as is used in this example.

What has the literature on oppression in nursing demonstrated? a. Verified the presence of behaviors associated with oppression within nursing. b. Suggested that oppression leads to bullying but has little or no effect on patient outcomes. c. Failed to establish that oppression is present in nursing groups. d. Indicated that nurses use oppression negatively.

ANS: A Oppressed group behavior is apparent when a population is dominated by another group and begins to take on the characteristics of the dominant group (Roberts, 1983), often bullying and abusing their peers. In the twenty-first century, bullying and incivility have become epidemic in both nursing education and clinical settings.

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.

As a charge nurse, you counsel your RN staff member that they have has their duty of care by notifying a child's physician regarding concerns about deterioration in the child's status at 0330 hours. The physician does not come in to assess the child and does not provide additional orders. The child dies at 0630 hours. As the charge nurse, you could be held liable for what? a. Professional negligence b. Assault c. Avoidance d. Murder

ANS: A Professional negligence can be asserted when there is failure to do what a reasonable and prudent nurse would do in the same situation. In this situation, the charge nurse might have advocated further for the patient in light of the evident seriousness of the child's condition.

Which of the following actions is most representative of how health care of the future might be delivered? As a nurse leader, you: a. refer families who require immediate help to a local food bank. You also work with local agencies and families to establish mothers collective in which mothers learn about nutrition and prepare low-cost, nutritious meals that are shared with the mothers in the collective. b. work together with a local agency to set up a free clinic in which addicts and the homeless can receive free health care and prescriptions for immediate needs. c. ensure that individuals who are admitted to your unit are asked about their smoking history and that preoperative and postoperative planning takes into account how smoking will affect status during and after surgery. d. address the health of those who are overweight and obese on your unit by ensuring that hospital meals offer nutritious, healthy food choices that are satisfying.

ANS: A Referral to a food bank addresses the needs of a specific population, while exemplifying an important leadership strength: thinking long-term, acting short-term. The project that involves mothers will teach mothers about nutrition and engage them in preparation of low-cost, healthy meals while promoting longer term changes in healthy eating.

The nurse manager of an ICU wants to implement the revised policy and procedure on central line catheter care. What would be the most effective method of getting the staff nurses to incorporate a new evidence-based practice into their care? a. Conducting an interactive educational workshop b. Distributing educational materials on clinical units c. Sharing the results of a chart audit with staff d. Providing staff with a short DVD on the topic

ANS: A Suggestions for effective strategies that promote behavioral change in health professionals include active involvement strategies such as face-to-face information sessions in small groups and one-to-one interactions. Other approaches have mixed or few results.

An individual in a wheelchair is applying for the position of receptionist in an outpatient clinic. What does the nurse manager understand based on The Americans with Disabilities Act of 1990 requirements for employers? a. Make reasonable accommodations for persons who are disabled. b. Allow modified job expectations for persons recovering from alcoholism. c. Hire disabled individuals before hiring other qualified, non-disabled persons. d. Treat, for purposes of employment, homosexuals and bisexuals as disabled.

ANS: A The purposes of the ADA are to eliminate discrimination against persons with disabilities and to provide consistent, enforceable standards to address discrimination in the workplace.

The primary difference between a résumé and a CV is that a résumé: a. reflects your skills, knowledge, and background in relation to a specific position. b. offers a detailed listing of positions held and where positions were held. c. includes a long and detailed explanation of academic and work experience. d. provides contact information and focuses on your background, in general.

ANS: A A résumé is a short, customized overview of your professional life that relates to the qualifications of specific positions and how you are able to match your background to the qualifications that are desired. Provision of contact information is common to both the résumé and the CV. Résumés are more effective if details of particular positions that have been held are highlighted as compared with a detailed listing of positions held.

A new graduate is seeking a new position in nursing and wants to "sell" herself effectively. The best strategy is to: a. create a résumé. b. practice interviewing. c. call the personnel offices. d. create a curriculum vitae.

ANS: A A résumé provides a customized overview of details of your professional background that relates specifically to a position for which you are applying. Résumés advertise your skills to a prospective employer.

"Stress-buffering" behaviors can be elicited to reduce stress. All of the following behavioral coping responses can be used by nurse managers to reduce and manage stress except: a. distancing oneself from work. b. using cognitive reframing to change irrational thoughts. c. refusing a request to sit on a committee to evaluate scheduling software. d. exercising regularly.

ANS: A Achieving balance between work and leisure is a useful strategy for stress reduction. Distancing, however, can be a sign of depersonalization that includes negative attitudes as well and is a characteristic of burnout.

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.

A family is keeping vigil at a critically ill patient's bedside. Distant family members call the unit continuously asking for updates and expressing concern. The nurse speaks with the distant family members and states she is referring them to the hospital social worker, whose role is to work with family in this situation. What role is the nurse assuming through this action? a. Manager b. Leader c. Follower d. Laissez-faire

ANS: A As a manager, you are concerned with managing and coordinating resources to achieve outcomes in accordance with established clinical processes. Referral to a social worker alleviates demand on staff time and is consistent with hospital procedures.

Knowing your professional strengths is important to: a. find your fit in positions and a career path. b. maintain a professional status. c. act in a manner that is legal and ethical. d. understand the role expectations of a position.

ANS: A Being aware of your strengths is critical in determining what you will bring to a position and can be used to find your fit and possible career path. Knowledge and experience are important in maintaining the privilege of belonging to a profession and of behaving ethically and legally.

Three gravely ill patients are candidates for the only available bed in the ICU. As the supervisor, you assign the bed to the patient with the best chance of recovery. This decision reflects which of the following ethical principles? a. Beneficence b. Autonomy c. Veracity d. Nonmaleficence

ANS: A Beneficence refers to doing what's good for the patient; in this situation, doing what's good means providing care to the patient with the best likelihood of recovery.

Once evidence related to the use of prompted voiding in patients with cognitive impairment has been appraised and integrated with practice, it is important to: a. consider whether patients' families see this as necessary for the well-being of family members. b. search large databases such as CINAHL to amass further evidence. c. clarify the clinical practice question. d. solicit input regarding integration with practice.

ANS: A EBP is the integration of best research evidence with clinical expertise and the patients' unique values and circumstances. In this situation, the family's values and preferences would be considered. Search of databases, clarification of the question, and gaining staff input would occur in the process.

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.

In a job interview for a nursing position, Marley can be assured that which of the following will occur? a. Both eustress and distress b. Only eustress c. Only distress d. Neither eustress nor distress

ANS: A Eustress is defined as stress that is pleasant in nature, and distress is defined as stress of an unpleasant nature. One can assume that every interview has both of these stresses.

The chief nursing officer at a local hospital seeking Magnet® status creates staff development classes about incorporating evidence-based practice in nursing. What best describes evidence-based practice? . Applying best research evidence to care of patients b. Using research-based information to develop practice guidelines c. Conducting a randomized control trial to determine effectiveness of handwashing techniques d. Developing standards for practice.

ANS: A Evidence-based medicine is derived from evidence-based medicine and involves integration of the best research evidence with clinical expertise and the patient's unique values and circumstances in making decisions about the care of individual patients. It is focused on searching for, appraising, and synthesizing the best evidence to address a specific clinical practice problem.

A functional résumé focuses on: a. experience and skills gained in positions. b. positions held and specific roles in the positions. c. academic qualifications and achievements. d. relating skills and experience to qualifications in a specific position.

ANS: A Functional résumés highlight skills and experience gained rather the details of specific positions. As with résumés in general, skills and experiences are customized to create an image of an individual in a particular position.

The nurse manager wants to use evidence-based recommendations to prevent ventilator-associated pneumonia. What is the critical first step to effectively gather evidence for guiding practice? a. Develop the clinical question. b. Identify the databases to be used. c. Appraise the evidence. d. Integrate available evidence with unit expertise.

ANS: A Identifying the question may be the most challenging part of the process. Once the clinical question has been identified, writing it down will help in moving on to the next step of gathering evidence.

The manager of a surgical area has a vision for the future that requires the addition of RN assistants or unlicensed persons to feed, bathe, and ambulate patients. The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea. What would be the best initial strategy for implementation of this change? a. Exploring the values and feelings of the RN group in relationship to this change b. Leaving the RNs alone for a time so they can think about the change before it is implemented c. Dropping the idea and trying for the change in a year or so when some of the present RNs have retired d. Hiring the assistants and allowing the RNs to see what good additions they are

ANS: A Influencing others requires emotional intelligence in domains such as empathy, handling relationships, deepening self-awareness in self and others, motivating others, and managing emotions. Motivating others recognizes that values are powerful forces that influence acceptance of change. Leaving the RNs alone for a period of time before implementation does not provide opportunity to explore different perspectives and values. Avoiding discussion until the team changes may not promote adoption of the change until there is opportunity to explore perspectives and values related to the change. Hiring of the assistants demonstrates lack of empathy for the perspectives of the RN staff.

Which of the following will require greater attention in the future? a. Chronic disorders b. Obstetrical outcomes c. Prevention of hospital-based errors d. Team conflict resolution strategies

ANS: A Lifestyle choices, obesity, and an aging population will lead to an increased emphasis on prevention, personal accountability, and innovations such as robotics in the management of chronic illnesses.

Which of the following is a meta-analysis? a. Review of 35 studies on nurse work satisfaction to determine the significance of the aggregated research findings b. Review of multiple chart audits to determine which errors are being reduced through implementation of evidence-based guidelines c. RCT comparing the effectiveness of a local anesthetic in reducing the pain of venipuncture in young children d. Analysis of factors contributing to nurse burnout and dissatisfaction at emergency room sites

ANS: A Meta-analysis statistically combines the results of several similar studies to determine whether aggregate findings are significant.

As a manager in a new nursing home, where might you consult for guidance and evidence to support the development of safe patient practices? a. Hospitals b. Business c. Industry d. Outpatient clinics

ANS: A Practices that were once mostly studied in hospital settings are now scrutinized for implementation in other settings, such as outpatient clinics, rural settings, and nursing homes.

What facilitate the development of decision-making skills related to safe patient care for a nurse manager? a. Regular reflection on decisions b. A culture of perfectionism c. Recognition of who should be held responsible for individual errors d. A culture of trust between the staff and you

ANS: A Reflection on how well decisions were enacted enables knowledge of the complexity of situations and ramifications of the decisions made. Reflection enables elimination of strategies and methods that are inappropriate in meeting needs and aids in narrowing choices of best actions to take.

A necessary leadership strength for nurses of the future is: a. inspiring others to work their best to create the future. b. understanding the nuances of fundraising to make up funding shortfall. c. guarding the tendency of other professions to encroach on nursing roles. d. adapting work life to an aging nursing work force.

ANS: A Senge said that all leadership is about is people working at their best to create the future. Predictions of the future highlight the importance of interprofessional teams and of a shift toward understanding the importance of health care.

The nurse manager of a unit has lost many staff members, and the unit is now staffed with a large number of agency and traveling nurses. She knows that the agency and traveling nurses are all contracted to stay on the unit for the next 3 months. One way to improve morale and decrease stress in the unit would be to: a. plan a social event and include the agency and traveling nurse staff members. b. plan unit-based social events for your remaining permanent staff members. c. request hospital-based "floating" nurses to substitute for the temporary staff. d. implement team nursing.

ANS: A Social support, in the form of positive work relationships, can be an important way to buffer the effects of a stressful work environment. Including all staff in the social event enables those who are not normally part of the team to experience this support and provides an opportunity for the staff as a whole to develop supportive relationships

The staff development educator presents a series of programs on stress management to the nurse managers. Research has indicated that an individual's ability to deal with stress is moderated by psychological hardiness. Psychological hardiness is a composite of: a. commitment, control, and challenge. b. commitment, powerlessness, and passivity. c. commitment, control, and passivity. d. decreased isolation, challenge, and passivity.

ANS: A Some people have the capacity to accept changes in life with good humor and resilience, which, in turn, influences behavior that prevents illness. Hardiness involves the capacity to manage time and stress, to reframe situations positively, and to commit.

Mr. T. Jones and Mr. R. Smith are both going to become residents in Sunny Haven Lodge. Mr. Jones views it as an opportunity to socialize and meet new friends. Mr. Smith views this as abandonment by his family and is worried that the care will be inadequate. Each senior perceives the situation differently. This is a good example of stress that is: a. both a positive stressor and a negative stressor. b. occurring only because of age. c. positive in both cases. d. harmful in both cases.

ANS: A Some researchers have determined that stress is a person-environment process in which the person appraises the situation as taxing or not. Appraisal is an important concept that explains why two people react in different ways to the same situation. Stress can be viewed as positive (eustress) or negative (distress).

Steady state styles would be most likely in which of the following situations? a. Small hospital, in an isolated rural setting, with limited hierarchy b. Large urban teaching hospital c. Health network with several organizations d. Travel nurse agency

ANS: A Steady state career styles (career-long commitment to a particular position) are more likely in rural settings, where commitment to the community is high and alternative career opportunities are limited.

A hospice nurse has been feeling very stressed at work because of both the physical strain and the emotional drain of working with clients with AIDS. She tries to walk 1 to 2 miles three times a week and to talk regularly with her husband about her work-related feelings. One reasonable stress-management strategy would be to: a. start taking yoga lessons. b. make an appointment to meet with a psychiatrist. c. start jogging 5 to 6 miles every day. d. plan to go out for a drink with fellow nurses after work every day

ANS: A Stress relief techniques include 30 minutes of exercise five times a week, as well as techniques such as yoga that relieve mental stress.

A nurse manager is implementing strategies to support the steps in the AHRQ document "Five Steps to Safer Health Care." What does the manager include in the implementation? a. Patients are actively encouraged to make decisions related to care. b. Rules and decisions are made through centralized processes. c. You monitor the performance of each staff member closely. d. Preference is given to increasing staff numbers rather than staff credentials.

ANS: A The Agency for Healthcare Research and Quality (AHRQ) outlines "Five Steps to Safer Health Care," which suggests that safe, patient-centered care is facilitated by assisting patients to become active partners in their own care.

You notice that Sally, a student on your unit, is giving information to an anxious young teen who seems very uncertain about preparation for an upper GI series. After Sally leaves the room, you ask her how she thought her conversation with the patient. What is the appropriate response for you to give Sally? a. Encourage her to ask the patient if he has questions or concerns about the procedure. b. Advise her to consider providing the patient with more information. c. Suggest that she leave some brochures on the procedure with the patient. d. Suggest that she also provide teaching to the adolescent's parents.

ANS: A The Five Steps to Safer Health Care for Patients includes the step of asking questions if there are doubts or concerns. The nurse can encourage patients to take a larger role in care by taking these steps and by providing patients with coaching in the steps.

A client requires an appendectomy. The surgeon explains the procedure and asks the client to sign the consent. The patient speaks very little English and looks worried. What is the appropriate action by the nurse? a. Suggest that an interpreter explain the procedure to the client and answer any questions. b. Ask the client if he has any questions. c. Draw a picture to show the incision. d. Not intervene.

ANS: A The Five Steps to Safer Patient Care identifies that encouraging patients to ask questions when there are doubts and concerns and ensuring understanding before surgery is performed are ways in which nurses can support patients in having greater influence in their own care. In this situation, asking an interpreter to help enables access to information for the patient and active assessment of his understanding.

What would managers and staff review annually in order to ensure compliance with The Joint Commission (TJC) to improve patient safety? a. Appropriateness of charting terms and abbreviations b. Nursing hours per patient c. Acuity of patient admissions d. Wait times for care

ANS: A The Joint Commission issues setting-specific patient goals annually, as well as a list of "do-not-use" terms, abbreviations, and symbols and sentinel events.

To achieve Nurse-Sensitive Care Standards developed by the NQF, you advocate for which of the following in your health facility? a. Evidence-based practice to reduce the prevalence of pressure sores b. Implementation of informatics at the bedside c. Staff-manager conferences to review reporting of adverse medical events d. Patient councils to review food, recreation, and nurse-patient relations

ANS: A The National Quality Forum (NQF) outlines nursing-centered intervention measures related to prevalence of pressure sores, ventilator-associated pneumonias, volunteer turnover, nursing care hours per day, and skill mix of staff

Sarah is a second-year nursing student. The clinical instructor overhears Sarah telling a patient that she "always" checks patients' bracelets before giving medication and she is not sure how the nurses on the unit "get away with" not making more errors than they do. The clinical instructor pulls Sarah aside and explores with her how her communication might affect the patient and what it reflects about her beliefs related to the team. What competency does this action outline? a. QSEN b. IHI c. DNV/NIAHO d. AHRQ

ANS: A The Quality and Safety Education for Nurses (QSEN) project provides resources related to competencies that prelicensure and graduate students need to develop to serve as safe practitioners. These competencies include leading and managing, teamwork and collaboration.

A dispute arises between an RN and an LPN over a patient issue. The tension continues between the two and begins to affect other staff members, who are drawn into the conflict. Over time, the team becomes polarized toward either the RN or the LPN. How might this situation be prevented? a. Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves b. Asking other staff members what the real issues were in the dispute between the RN and the LPN c. Reassigning one of the parties to another unit when it became apparent that the two individuals could not resolve the dispute themselves d. Calling a staff meeting at the onset of the dispute to allow the team and the RN and LPN to discuss the initial dispute

ANS: A The initial step in conflict resolution should have involved an expedient response to the issues and putting a focus on the issues involved in the dispute between the LPN and RN through negotiation involving the two parties, before the dispute involved others.

During review of back injuries, it is determined that a large number of injuries are occurring in spite of mechanical lifts being used. Furthermore, it is determined that some lifts are outdated. In addressing this concern, the unit manager: a. meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure. b. after consultation with the staff about the review, orders new lifts to replace older ones that are malfunctioning. c. blames the system for inadequate funding for resources. d. reviews the system of reporting incidents to ensure that appropriate reporting is occurring.

ANS: A The involvement of staff nurses in safety on the unit is imperative in improvement of quality and the provision of patient care. This is a relationship engagement by the manager to engage the nurses and building these relationships improves quality.

The implementation of saline flushes for capped angiocatheters across all areas of practice in the facility is an example of: a. how multilevel and interprofessional application of a procedure can slow adoption of EBP. b. how competition among disciplines can lead to negative patient outcomes. c. the reluctance of hospital administrators to act on recommendations from EBP. d. how a safe, well-known practice outweighs the benefits of adopting a newer practice.

ANS: A The translation of research into practice operates at four levels: The individual healthcare professional, healthcare groups or teams, organizations, and the larger healthcare system or environment. The adoption of saline flushes illustrates the challenges of communicating EBP to other disciplines and organizations and of the involvement of different levels. This particular innovation needed endorsement by nurses, physicians, and pharmacists, as well as by administrators who needed evidence of lost savings to support adoption.

As a team, you and the staff have determined that there is a need to reduce medication errors on your unit. Together, you developed the questions that you would like addressed and searched the literature for relevant research studies. Based on the evidence, you suggested a change to your practices and now are involved in implementation of these changes. Today, there was a major study released that would significantly change what you have decided to do. What are you and your staff experiencing? a. Compression complexity b. Distress c. Information lag d. Technology advancement

ANS: A This situation exemplifies complexity compression, a term that means many changes are happening almost simultaneously and before one practice can be firmly implanted in our minds, we are already addressing some other new change. This compression can be distracting or useful.

The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are upset about the change and ask for a meeting to discuss the new model. After hearing their concerns related to reduction in professional autonomy, what is the initial response by the manager to address the concerns? a. Acknowledge the loss. b. Explain the reasons for change, emphasizing the need to reduce costs. c. Repeat the information several times, giving detailed budget overviews. d. Adjourn the meeting and provide explanation through e-mail.

ANS: A Visioning involves engaging with others to assess the current reality, specify the end point, and then strategize to reduce differences. This requires trusting relationships that acknowledge the differences in values and ideas. When done well, the nurse manager and the nurses within a unit experience creative tension that inspires working in concert to achieve desired goals.

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 units.

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.

A new graduate nurse wonders about the directions that her preceptor has given her regarding management of incontinent, confused patients. The new nurse brings the preceptor evidence-based information she located regarding incontinence interventions for confused patients and asks to talk about the guidance that given after the preceptor reviews the information in the article. What is the new nurse demonstrating in this situation? (Select all that apply.) a. Assertiveness b. Followership c. Management d. Insubordination

ANS: A, B This is an example of followership in which a staff nurse is demonstrating assertive behavior and presenting evidence that may influence the decision making of her nurse leader and manager.

In developing curricula that will address needs based on forecasts for the future, nursing educators need to contemplate: (Select all that apply.) a. prevention strategies. b. leadership skills and knowledge. c. violence de-escalation strategies. d. strategies for job security.

ANS: A, B, C Future forecasts suggest that health factors such as obesity that are implicated in the development of chronic disorders will increase, as will chronic disease. Leadership skills have been identified as a key competence for nurses of tomorrow, and competence with technology will be needed as technology continues to revolutionize health care. Rather than emphasizing job security, nurses will need to be prepared to be in an environment with many options and episodic employment.

A nurse manager introduces prompted voiding into nursing practice on a unit, which is supported by clinical guidelines based on evidence-based practice. The nurses on the unit resist implementation, indicating that the bathroom facilities are too far away for efficient implementation of the guidelines, and that resources are too few to accomplish the initial voiding observations. For the nurse manager in this situation, it is important to have further discussion with the staff regarding: (Select all that apply.) a. compatibility of this intervention with the values of staff on the unit. b. advantages of prompted voiding over incontinence products and catheterizations. c. usefulness of prompted voiding with the particular population of patients on the unit. d. feasibility of the program with respect to unit design.

ANS: A, B, C, D Various theories related to the translation of evidence into practice point to strategies for success in introducing innovation and EBP on units, including determination of how well the innovation fits with the values of the staff; benefits of this practice or innovation over current practice; appropriateness of the innovation or practice for the target group for which the practice is intended; and the feasibility of the innovation from a variety of perspectives, including the physical design or layout of a unit.

What patients would be considered "at risk" consumers during a healthcare visit? (Select all that apply.) a. Clyde requires an anticoagulant. He tells the nurse about his medications. He does not include an herbal supplement. b. George is very shy and withdrawn. He asks the nurse to leave him alone. c. Sarah is a new parent who finds that nurses on the children's unit are very helpful. She is eager to accept all suggestions, including those that she does not yet understand. d. Claude is booked for bowel surgery. His doctor explains about the colostomy. Later, Claude tells his wife that he really doesn't know what the doctor meant by colostomy.

ANS: A, C, D Safer health care involves the patient as an active consumer who keeps and brings a list of all medications, including natural remedies and questions if there are doubts, concerns, or lack of understanding

Amy has worked in the dialysis unit on staff for about 12 years. She is frequently consulted by other nursing staff regarding protocols and policies on the unit. What type of power is Amy using? a. Position power b. Expert power c. Personal power d. Competency power

ANS: B According to the types of power outlined in the text, Amy is most likely evidencing expert power in that she is being consulted regarding areas of knowledge and competency on the unit and is at the same level, potentially, in the hierarchy as her colleagues.

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.

Nurses who engage in infighting, seek physician support against nursing colleagues, and avoid political advocacy through membership in nursing organizations: a. refuse to believe that they are acting like members of groups that suffer socioeconomic oppression. b. do not understand how their failure to exercise power can limit the power of the whole profession. c. purposefully choose to exercise their power in the workplace through indirect means. d. suffer from learned helplessness as a result of abuse by powerful nurse executives.

ANS: B Becoming an active, productive, collegial member of groups and teams within the workplace and in professional associations and community groups ensures that the nursing voice is heard on healthcare issues and problems and is an appropriate exercise of power.

As a nurse manager, you trial a new pain scale on your unit that is supported by numerous research studies. You compare the patient outcomes with the new scale against the existing scale. Feedback from staff suggests that the new scale is too difficult for patients who have limited language skills and who are already under duress to understand. The difficulty in implementing the new scale refers to testing: a. efficacy. b. effectiveness. c. practice failure. d. comparative error.

ANS: B Comparing the effectiveness of interventions can help to address the needs of clinicians in determining best practices for their patients. Comparative effectiveness research (CER) is the "generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care" (Institute of Medicine, 2009, p. 29). Efficacy is testing an intervention or treatment in a traditional randomized clinical trial under carefully controlled conditions and is used to determine whether an intervention or treatment works, whereas effectiveness is testing whether the intervention or treatment works in the real world of practice.

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.

A member of a patient's family calls the nurse manager of the palliative care unit to express concern that a member of the family, who died on the weekend, had requested analgesics from the RNs on duty. An RN came with the analgesic nearly 45 minutes later, just after the patient had died. The manager is aware that the unit was especially busy that weekend because many patients were seriously ill, staff had called in ill, and the staffing manager was unable to completely replace staff who were absent. The manager is deeply troubled that the family member had to die in pain because it violates what she knows should have been done. This manager is experiencing: a. compromised agency. b. moral distress. c. moral sensitivity. d. moral dilemma.

ANS: B Moral distress is experienced when nurses cannot provide what they perceive to be best for a given patient. Examples of moral distress include constraints caused by financial pressures, limited patient care resources, disagreements among family members regarding patient interventions, and/or limitations imposed by primary healthcare providers.

Two nurses approach their manager about a conflict regarding the next month's schedule. The nurses are talking loudly and at the same time. The manager most effectively uses communication skills to resolve the conflict by: a. taking both nurses aside, separately and then together, and charging them with resolving the problem without her direct intervention. b. listening to each nurse speak to the other without interruption and asking clarifying questions to help them resolve the issue themselves. c. separating the nurses, instructing each to decide how the problem can be resolved, and meeting with them the next day. d. calling an emergency scheduling committee meeting and asking volunteers to resolve the conflict between the two nurses.

ANS: B Negotiation involves the presentation of an opening position with each party, then moving on until they achieve a mutually agreeable result or until one or both move away from a failed negotiation. Negotiation occurs when one party has something that the other party values, such as a desired schedule.

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.

A nurse manager is experiencing poor staff morale on her unit. While participating in a baccalaureate course, the nurse manager had learned that one of the reasons nurses lack power today is related to the past. In the early decades of the profession, nurses lacked power because: a. nurses freely chose to defer to physicians and administrators with more education. b. women lacked legal, social, and political power because of legal and cultural barriers. c. the first nursing licensure laws prohibited nurses from making most decisions. d. nurses astutely recognized the risks of grabbing too much power too soon.

ANS: B Nursing mirrored the lack of legal, social, and political power that was prevalent in the early decades of the profession.

To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk manager. Risk management is a process that attempts to identify potential hazards and: a. compensate for previous injuries. b. eliminate these risks before anyone else is harmed. c. supersede the need for staff members to file incident reports. d. discipline staff members who have been involved in previous incident reports.

ANS: B Risk management involves taking proactive steps to identify and eliminate risks and liability.

While walking past a patient's room, you overhear one of the RN staff telling a patient that the patient has no right to refuse chemotherapy treatment because the family and the doctor think the treatment is the best option for the patient. This patient is 40 years of age and alert. When you meet later to discuss what you heard with the RN, it is important to: a. discuss how statute law enforces the right of the doctor, but not of families, to ensure that patients comply with recommended treatment plans. b. discuss that statute law provides for patient autonomy and refusal of treatment. c. remind the nurse to provide clearer explanations to aid in the patient's comprehension of the treatment and compliance. d. acknowledge the nurse's role in ensuring that she does not fail in her duty of care for the patient.

ANS: B Statute law states that the patient must be given sufficient information, in terms he or she can reasonably be expected to comprehend, to make an informed choice. Inherent in the doctrine of informed consent is the right of the patient to informed refusal. Patients must clearly understand the possible consequences of their refusal.

The clinical guidelines for management of incontinence developed by the Registered Nurses Association of Ontario (RNAO): a. reflect practice that is fiscally directed and sound. b. articulate practice recommendations developed from synthesis and review of evidence. c. are intended to increase awareness of issues in incontinence management. d. reflect a compilation of information from a variety and range of sources related to incontinence.

ANS: B The evidence-based practice (EBP) movement has grown exponentially with scientific publications, establishment of collaboration centers, resources on the Web, and grants focused specifically on translating of research into practice. A number of evidence-based nursing centers have been established around the world. These centers have teams of researchers who critically appraise evidence and then disseminate protocols for the use of evidence in practice. In this example, clinical guidelines have been developed by a professional nursing organization on the basis of best possible evidence on incontinence management. Although issues may be raised in the recommendations, the purpose is to guide practice for the purposes of better patient care.

The institution where you are a nurse manager has resisted the adoption of a new document management software, citing cost as a concern. You meet with other nurse managers who are in favor of the software and prepare a proposal to take to the senior executive with the goal of persuading the executive to adopt the software. This is an example of: a. collaboration. b. a coalition. c. networking. d. policy building.

ANS: B The formation of temporary groups to achieve particular goals involves the development of coalitions.

In a telehealth organization, a nurse who is licensed in New York and Pennsylvania provides teaching to a patient who resides in Pennsylvania. The patient charges that the teaching failed to provide significant information about a potential side effect, which led to delay in seeking treatment and untoward harm. Under which state nurse practice act and standards would this situation be considered? a. New York b. Pennsylvania c. Neither New York nor Pennsylvania d. Both New York and Pennsylvania

ANS: B Under the law, the state in which the patient resides and not the state where the nurse holds his or her license determines the state nurse practice act that is considered.

A nurse is applying for a new position. This position is one in which she will serve as a liaison between a hospital and a school of nursing. The nurse must update her résumé to include her teaching experience. The goal of creating a curriculum vitae is to: a. have a listing of facts about your professional life. b. provide potential employers with information about where you are in your career. c. respond quickly whenever a position becomes available. d. be certain you can recall facts for a prospective position.

ANS: B A curriculum vitae provides an all-inclusive but not detailed listing of your professional life. This approach allows a prospective employer to find the most recent information quickly and gain a sense of where you are in your career.

To develop a curriculum vitae, or résumé, a nurse must develop a personal data file. The goal of a personal data file is to: a. create an opportunity to be interviewed. b. have a listing of facts about your professional life. c. have a tool in place for marketing yourself. d. create a document that lists your skills.

ANS: B A personal data file enables storage and recall of career-specific details that can be retrieved and shaped for a specific purpose using cut-and-paste approaches rather than creating whole new documents.

During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is discussed. What is considered when the suggestion by the manager is for the unit mission to be derived from the organization mission? a. Empowering b. A leadership tag c. A symbol d. A management task

ANS: B According to complexity theory, leadership tags, which are similar to values, reflect the patient-centered philosophies and values-driven characteristics that define an organization and give it personality.

Before implementation of the new policy and procedure on central line catheter care, the nurse manager uses an appraisal system to evaluate the evidence. What is important in using an appraisal system to evaluate the evidence gathered in preparation for development of a new protocol? a. Limiting the search to randomized clinical trials b. Matching the appraisal tool to the type of evidence c. Eliminating qualitative research studies d. Using only preprocessed evidence

ANS: B Appraisal tools are specific to the number of studies, as well as to the study design (type of evidence), type of review, and strategy for determining the applicability of evidence to your practice

You are excited by evidence supporting the use of workstations on wheels (WOWs) at the bedside to improve documentation and patient outcomes. You have disseminated the information through discussions and e-mails and are now ready to begin the process of considering implementation on the unit. To develop positive attitudes toward the use and implementation of the technology, you would discuss your ideas with (Rogers' diffusion of innovations theory): a. Harvey, RN, a technology guru, who enthusiastically tries on all new software. b. Berta, RN, who thoughtfully considers evidence and regularly uses it to try new approaches in her practice. c. Carol, LPN, who is positive about new ideas but looks to her friends for their ideas about whether or not to try something new. d. Ben, a 10-year veteran of the unit, who wonders why technology should be used at all. He says that he will use it when there is no chance of security breaks.

ANS: B Berta is the one with whom you should now have informed conversations, because she is an early adopter who is respected for her thoughtful acquisition and critique of knowledge and application of knowledge to practice. Berta, an early adopter (Rogers' characteristics of innovation adopters), is more effective in this stage than Harvey, an innovator who may be seen as open to all new ideas regardless of merit.

You overhear a new graduate RN telling a nurse colleague that leadership and management belong to the unit manager, not to her. As a nursing colleague, what do you know to be true in regard to the statement? a. The statement is correct. Leadership is not the role of the staff nurse. b. The new graduate would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals. c. The new graduate has been influenced by nurse leaders and managers who leave for other positions. d. The general perception is that nurse leaders and managers are not satisfied in their jobs.

ANS: B Care coordination that involves the intersection of individual, family, and community-based needs requires that nurses have self-confidence, knowledge of organizations and health systems, and an inner desire to lead and manage. There is often a view that leadership is isolated to those holding managerial positions, and that a direct care nurse is subject to following by adhering to the direction of others. Such views fail to acknowledge that to be a nurse requires each licensed individual to lead, manage, and follow when practicing at the point-of-care and beyond.

The education consultant at St. Joseph Hospital is giving a workshop on cognitive reframing. The consultant explains that cognitive reframing reduces stress by: a. aiding individuals in identifying positive stressors. b. helping people realize that negative thinking causes emotional distress. c. eliminating negative stressors. d. replacing positive self-statements with negative irrational beliefs.

ANS: B Cognitive reframing is a therapy that aids individuals in discovering that their irrational thoughts can be replaced with responses that are more rational. It enables individuals to gain a sense of control over the situation and can change "I'll never ..." to "I can ..." or "She always ..." to "Sometimes she ..." It is an approach that allows individuals to replace negative thoughts and statements with others that are more realistic and helpful

Several changes are introduced to a unit, including changes to familiar clinical procedures and the use of WOWs to enable bedside documentation. You, as unit manager, anticipate which of the following will contribute most to complexity compression? a. Meaning of the change b. Pace of changes c. Previous experiences with change d. Confidence of the leader in the value of the change

ANS: B Complexity compression is a term that means that many changes are happening almost simultaneously and before one practice can be firmly implanted in our minds, we are already addressing some other change

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.

A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of the older adult patient. Using complexity principles, what would be the best approach to take for implementation of this change? a. Leverage the hierarchical management position to get unit staff involved in assessment and planning. b. Engage involved staff at all levels in the decision-making process. c. Focus the assessment on the unit and omit the hospital and community environment. d. Hire a geriatric specialist to oversee and control the project.

ANS: B Complexity theory suggests that systems interact and adapt and that decision making occurs throughout the 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.

To enhance team leadership skills for your team leaders, you arrange opportunities for: a. certification. b. continuing education. c. graduate courses. d. volunteerism.

ANS: B Continuing education provides systematic learning opportunities that augment existing skills and knowledge for delivery of quality care and advancement of career goals. Graduate and certification courses provide advanced knowledge and skills.

Which of the following would be most effective in implementing the findings of a new clinical treatment for problems associated with bowel motility for the staff nurses? a. Lecture by a nurse practitioner b. Workshop for surgical nurses that involves discussion of case studies and application of evidence c. Discussion of the findings on the bulletin boards at the workstation d. Education of unit opinion leaders regarding the evidence presented in the studies

ANS: B Current research suggests that translation of research into practice is best facilitated through interactive learning such as workshops. Least effective strategies included didactic learning and distribution of learning materials.

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.

As a nurse manager, it is important to become a "future thinker." Which is an example of a "future thinker"? a. Keeping traditional practices b. Moving toward evidence-based practices c. Finding less need for more knowledge d. Believing that macromarketing will be a necessity

ANS: B Future forecasts include evolutions in power, structure, and knowledge; rapid change in the healthcare system; the demise of macromarketing; and increased evidence-based practice.

As the RN charge nurse on the night shift in a small long-term care facility, you've found that there is little turnover among your LPN and nursing assistant (NA) staff members, but they are not very motivated to go beyond their job descriptions in their work. Which of the following strategies might motivate the staff and lead to greater job satisfaction? a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night LPNs and NAs. b. Allow the LPNs and NAs greater decision-making power within the scope of their positions in the institution. c. Hire additional staff so that there are more staff available for enhanced care, and individual workloads are lessened. d. Ask the director of nursing to increase job security for night staff by having them sign contracts that guarantee work.

ANS: B Hygiene factors such as salary, working conditions, and security are consistent with Herzberg's two-factor theory of motivation; meeting these needs avoids job dissatisfaction. Motivator factors such as recognition and satisfaction with work promote a satisfying and enriched work environment. Transformational leaders use motivator factors liberally to inspire work performance and increase job satisfaction.

The chief nursing officer listens to nurse managers verbalize their feelings of internal stress. One common source of internal stress seems to be: a. the death of a loved one. b. perfectionism. c. getting married. d. losing a job.

ANS: B Losing a job, the death of a loved one, and getting married are examples of external stress.

At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. What is the appropriate next step? a. Arrange another meeting in a week's time so as to allow a cooling-off period. b. Elevate the next negation session to the next manager, one level above. c. Insist that participants continue to talk until a resolution has been reached. d. Back the unit manager's actions and end the dispute.

ANS: B Part of leadership is understanding conflict resolution and ability to negotiate and manage for resolution of issues and concerns. This situation has failed a second negotiation session, elevation to a manager with additional training to facilitate conflict resolution is important at this point.

What is a strategy that can be used by a small community hospital with limited resources to develop an evidence-based nursing practice program? a. Hiring a nurse researcher b. Partnering with nurse researchers at a local university c. Subscribing to journals devoted to evidence-based nursing d. Including research competencies in managers' job descriptions

ANS: B Partnering with nurse researchers assists in providing nurse researcher expertise and leadership to organizations that do not have the size or the resources to hire nurse researchers.

Volunteers in a study are assigned randomly to groups. Some of the volunteers receive an herbal supplement that is reputed to control nausea, and some of the volunteers are assigned to a control group where a placebo is administered. This is an example of a(n): a. longitudinal study. b. RCT. c. meta-analysis. d. appraisal tool.

ANS: B RCTs, or randomized controlled trials, always involve testing of a treatment through the random assignment of subjects in the study to an experimental or treatment group or to a control group that receives a placebo.

The chief nursing officer understands that a nurse manager can exhibit stress that is related to trying to keep up with the number of electronic messages that arrive, as well as trying to remain accessible to staff. What is a strategy that would assist the manager to manage the information overload effectively? a. Ignore messages unless they are labeled as important. b. Determine who is most likely to send useful or important information or requests. c. Check e-mail messages once a day. d. Encourage face-to-face meetings rather than e-mail.

ANS: B Reduction of stress related to information overload requires the development of information-receiving and information-sending skills. Information-sending skills include determining most common sources of useful data, labeling files and folders to which e-mail messages can be directed, deletion of e-mails, and focusing on the most important pieces. Information-sending skills include keeping e-mail messages short (and calling if the message needs to be long) and considering the most appropriate medium for messages (telephone, fax, face-to-face).

An example of role stress occurs when: a. the director of the ICU and the manager of the surgical unit wish to hire the same new employee. b. two part-time staff members are hired to work in a unit, but the job expectations for them are not clear, and the head nurse expresses disappointment in their performance. c. the nurse manager for the ICU wants to advocate for more staff and finds it difficult to find data to substantiate his proposal. d. line managers believe that support staff use their technical knowledge to intrude on their authority.

ANS: B Role stress is an additional stressor for nurses. Viewed as the incongruence between perceived role expectations and achievement, role stress is particularly acute for new graduates. Failure to comply with expectations can lead to role conflict. Role conflict and role ambiguity are major sources of conflict for nurses.

Your organization is in the middle of re-designing patient care units, with decisions based on best practices and various other sources of evidence. In the middle of the transition, there is a temporary halt called to the transition because of a re-design of the health care system and greater emphasis on primary care. What would be a healthy response to this situation? a. Salvage as much of the original planning as possible so as to reduce expenditures. b. Engage in consultation to create innovative solutions that bridge the existing plans and the new directions. c. Abandon the current planning in favor of addressing the new trends. d. Continue with the current planning because trends come and go.

ANS: B Stability and total chaos are the ends of a continuum. Moving in some way between those two ends suggests that we live in a constant state of disequilibrium in which we strive toward stability while recognizing we experience chaos. As we continue to move from "traditional" practices to evidence-based ones and from a heavy focus on tertiary care to one that values primary care, we can assume that we might experience more chaos. Chaos can lead to new learning and new, innovative solutions. As nurses, it is important to be able to function in an evolving environment.

A strategic goal for nursing in the facility developed by the chief nursing officer is to implement an evidence-based practice program. What is an appropriate strategy that can be used by a nurse manager who is beginning to implement an evidence-based practice program on the unit? a. Conducting a review of adverse events and incident reports b. Soliciting input from staff members c. Reviewing specialty organization guidelines d. Identifying patients with extended lengths of stay

ANS: B Stakeholders need to be involved early, and staff members need to be involved when initiatives involve direct patient care. Involvement assists in understanding issues and concerns, motivations, and unmet needs.

The manager of a unit is finding it difficult to work with a new graduate nurse. The new nurse has many ideas; however, his manner of presenting them irritates the manager. After reflection and discussion with others, the manager recognizes that she feels threatened by his behavior. She comes to understand that the new nurse is trying to establish his own role on the unit; is not trying to challenge her; and needs guidance, coaching, and affirmation. What is the nurse manager demonstrating in this situation? a. A positive self-concept b. Deepening self-awareness c. Leadership d. Acquiescence

ANS: B Stepping outside oneself to envision the situation while assuming ownership is a component of emotional intelligence. This is an example of self-awareness to identify the resolve to self-conflict in this situation.

The NQF provides a model for advancement of healthcare quality that could be used in healthcare organizations. What does the use of this model by the Centers for Medicare and Medicaid Services specificity link with adverse patient events for healthcare facilities? a. Staffing b. Funding c. Composition of executive councils d. Composition of consumer-based councils

ANS: B The Centers for Medicare and Medicaid Services (CMS) have adopted a policy based on the NQF's "Never Events." The CMS will no longer pay for patient conditions or events that result from poor practice while patients are under the care of a health professional.

What did the IOM Health Professions Education report highlight as a concern for patient safety? a. A normal risk in professional practice b. A result of disciplinary silos c. A reflection of frontline staff d. Related to systems errors

ANS: B The IOM Health Professions Education report (2004) highlighted the education of health disciplines in silos as a major concern in patient safety and endorsed five recommendations. One to be increased and improved communication between the health disciplines.

Tara, the unit manager, is explain to her colleague her recent project, which involves seeking the most effective approaches to incontinence care, with the intention of adopting evidence-supported approaches on her dementia care unit. Her colleague suggests that translation of research into practice is: a. less important than knowledge-generating research, which is required to advance the nursing profession. b. a priority of all healthcare practitioners to improve patient care. c. characterized by lack of knowledge about how to use evidence to guide practice. d. so difficult that it is useless to begin the query in the first place.

ANS: B The National Institutes of Health identified translational research or getting research into the hands of practitioners to improve patient care, as a priority.

Your unit has several patients who have undergone limb amputation. In working with the clients, you begin to think beyond therapies such as pharmacotherapeutics and surgery and you explore biomechanics, robotics, mind-body approaches, and cognitive behavioral therapies as possibilities in working with these clients. You begin to amass information in several areas with which you previously had little familiarity. According to the Wise Forecast Model©, you are: a. acting wildly. b. learning wildly. c. engaging in interprofessional care. d. increasing your complexity compression.

ANS: B The first step, learn widely, means that we must extend our sources of knowledge beyond our role and clinical areas of interest. In fact we must extend our learning beyond nursing and health care. Widely might encompass another discipline such as architecture or engineering.

Nursing professionals in the twenty-first century will accomplish most of their work: a. through teams of internationally prepared professionals. b. in teams and through group work. c. through long term, secure jobs. d. in competitive environments and work groups.

ANS: B The future is about teams and group work. Competition will be out and collaboration will be in. Job security will be out and career options will be in. Our brightest and best may leave more often than they do at present to pursue career options internationally.

Chart audits have revealed significant omissions of data that could have legal and financial guideline ramifications. The unit manager meets with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. What is the manager demonstrating? a. Leadership b. Management c. Decision making d. Vision

ANS: B The process of guiding others to meet established goals, outcomes, and procedures is management. This can require collaborative decision making to determine how best to reach predetermined goals and follow established practices.

Jeff, an RN in his 30s, has lost a parent, just purchased a new home, and is laid off with 6 months' severance pay. At the same time, Jerry, an RN in his 50s, is financially secure and is asked to take early retirement with a buyout. How will the two men react to the emotional and physical influences and the sequence of stress? a. The younger man will feel more stress. b. The two men may or may not feel the same amount of stress. c. The older man will feel more stress. d. Neither man will experience any stress.

ANS: B The response to similar stressors does not always result in a similar experience of stress in individuals. Responses are mediated by the appraisal of the event as well as by factors such as gender, personality, lifestyle, and age.

The starfish analogy is exemplified in which of the following? a. A unit manager resigns after continued tension between the administration and her regarding implementation of primary nursing. The primary nursing project dies. b. Nurses try to establish a clinic that provides ambulatory care to parents and young children in an impoverished neighborhood. Community members advocate for funding from political leaders and insurers. c. Alana, a new graduate, promotes continence care based on evidence. When she presents her ideas, senior staff refuses to consider it. d. The head of a community health service moves on to another position. Programs are disbanded.

ANS: B The starfish analogy points to the connectivity that we have with one another and how we influence and are influenced by others all the time. This affords many opportunities for leadership that are dependent not on formal titles but on opportunities to shape the work at hand.

A young male nurse began in nursing as a staff nurse at a hospital. After 3 years, he moved to a home healthcare agency for increase in pay and taking a position as a manager in the agency. What type of motivation does this exemplify in career success? a. Internal b. External c. Spiral d. Entrepreneurial

ANS: B This type of career success is exemplified by external focus or motivation. The motivation in external focus is from tangible measures such as salary and promotions.

As a new manager in the ED, you meet with each of the staff to ask about their priorities and what they think is going well in the department or what is of concern to them. Almost all of the staff express frustration and distress at being treated rudely or disrespectfully by patients, staff from other departments, and physicians and complain that they feel that nurses in the ED are not valued. With the staff, you brainstorm to raise the profile of nurses. Which of the following strategies would be most effective? (Select all that apply.) a. Requesting increased compensation b. Speaking positively about one's work c. Dressing and grooming in a clean and neat manner d. Using titles (e.g., Mr., Mrs., Ms.) and last names e. Submitting a written complaint to senior administration regarding rude behaviors f. Developing a code of conduct for the ED staff.

ANS: B, C, D, F Demonstrating a positive and professional attitude about being a nurse to nursing colleagues, patients and their families, other colleagues in the workplace, and the public facilitates the exercise of power among colleagues while educating others about nurses and nursing. A powerful image is an important aspect of demonstrating this positive professional attitude and includes how we identify ourselves, how we dress, whether we are punctual for commitments, and whether we speak positively about our work. Bullying and incivility are negative expressions of power that can affect patient outcomes. The Joint Commission standard demands that leaders ensure that a code of conduct is implemented to ensure patient safety and a culture of quality.

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 patient refuses a simple procedure that you believe is in the patient's best interest. What two ethical principles are in conflict in this situation? a. Fidelity and justice b. Veracity and fidelity c. Autonomy and beneficence d. Paternalism and respect for others

ANS: C Autonomy refers to the freedom to make a choice (e.g., refuse a procedure), and beneficence to doing good (performing a procedure that will benefit the patient).

A manager relies on his director (immediate supervisor) for advice about enrolling in graduate school to prepare for a career as a nurse executive. The director may exercise what kinds of power in the relationship with the manager in this advisory situation? a. Expert, coercive, and referent b. Reward, connection, and information c. Referent, expert, and information d. Reward, referent, and information

ANS: C Because the director is in a leadership role, he comes with knowledge or expertise that is required to assume a leadership role, and he has information that he is willing to share, which gives him the power of information. The employee sees him as credible and seeks his advice, which gives him referent power.

The principle that requires nurses to uphold a professional code of ethics, to practice within the code of ethics, and to remain competent is which of the following? a. Veracity b. Autonomy c. Fidelity d. Honesty

ANS: C Fidelity refers to promise keeping or upholding one's promise to practice as a reasonable and prudent nurse would do and in an ethically competent manner.

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.

One day, at coffee, your co-worker suggests that you and she sit with unit members of the hospital research committee. She suggests that this would be an excellent way to get to know people who share her interest in research. Her actions are an example of: a. mentorship. b. politics. c. networking. d. empowerment.

ANS: C Meeting individuals outside the normal work group to share ideas and gain support and encouragement is an example of networking.

A nurse manager recognizes the need to expand her professional network as she begins a job search for a middle-management position. What action is least likely to expand her job-searching network? a. Reviewing her address book or card file for names and phone numbers of former colleagues who are now in middle-management positions b. Making an appointment to meet with a former instructor from her graduate program in nursing administration c. Making a long overdue return call to a former colleague who is now a chief nurse executive d. Attending a state-level conferences for nurse managers and executives and volunteering to help with professional organizations' informal luncheons and receptions

ANS: C Networking is the result of identifying, valuing, and maintaining relationships with a system of individuals who are sources of information, advice, and support. Many nurses have relatively limited networks within the organizations where they are employed. Active participation in nursing organizations is the most effective method of establishing a professional network outside one's place of employment.

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 contrac

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

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.

Despite repeated invitations by his colleagues to become involved in regional and state nursing practice committees, Tom refuses. His reason is that "nursing committees rarely get anything worthwhile done because of politics and conflicts." According to the text, Tom's view of involvement: a. is rare in nursing today. b. reflects a fear of power. c. reflects the essential process of power. d. reflects empowerment and capacity to make his own decisions.

ANS: C Tom's response reflects a distancing from other nurses related to discomfort with conflict associated with human interactions. The text defines human interactions within organizations as politics, a component of which is the essential process of power.

A well-written letter of resignation is critical to: a. first announce your intent to resign. b. formally signal discontent in your current position. c. maintain a positive relationship with your former organization and colleagues. d. fulfill your legal obligations as a departing employee.

ANS: C A well-written resignation letter outlines your intent to leave the organization and your appreciation of the organization but should follow an initial meeting with your manager to first discuss your intention. A well-written letter maintains a positive relationship with the organization.

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.

Which aspect of our tradition and history in nursing may impede our movement toward future-oriented thinking? a. Lack of confidence b. Focus on the discipline of nursing c. Focus on details in the everyday practice d. Mistrust of trends and new evidence

ANS: C Because of our history of attention to details, we may need to challenge ourselves in developing our ability for leadership. Moving from micromanaging to focusing on setting expectations for those for whom we are accountable may feel uncomfortable. However, that movement reinforces our ability to deal with longer term issues.

The chief nursing officer has been developing her portfolio for years. What is the chief nursing officer modeling? a. Her clinical expertise b. Affection for tradition c. Her employability d. Her busy professional life

ANS: C Being employed is no longer sufficient; we must be employable. A portfolio outlines achievements and experiences that communicate employability.

A nurse manager has been employed in the same facility for 20 years and has held the same position. This career style is known as: a. linear. b. spiral. c. steady state. d. entrepreneurial/transient.

ANS: C Career styles that are marked by selecting and staying in a role throughout a career are characterized as steady state.

A unit manager recently graduated as a clinical nurse specialist with a focus in gerontology. She applied to take a certification exam. Certification is designed to recognize: a. basic knowledge in a specified area. b. advanced practice in functional roles. c. special knowledge beyond basic licensure. d. continued competence as a registered nurse.

ANS: C Certification is an expectation in some settings for career advancement in advanced practice or in specialized areas and goes beyond basic preparation.

At an organizational level, which of the following strategies would assist in ensuring that EBP is incorporated into nursing care? a. Formation of nursing-only implementation teams b. Restriction of evidence to RCTs c. Formation of a network of individuals doing research and/or interested in research utilization d. Avoidance of partnership with experienced researchers

ANS: C Collaboration, partnerships, and consideration of a variety of evidence appropriate to the clinical questions are important in ensuring translation of evidence into practice. Collaboration is considered particularly critical and can occur through practice-based networks.

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.

Mary, an 85-year-old patient with cognitive impairment and gross instability, wanders continuously. Lately, she has fallen twice, and the family demands that she be restrained. As the unit manager, you have initiated a least restraint practice. What is an appropriate action in this situation? a. Setting up a nursing team meeting to review practices b. Calling the family to inform them of the practice c. Initiating a multidisciplinary and family meeting to focus on Mary's needs d. Restraining Mary to satisfy the family's wishes

ANS: C Crossing the Quality Chasm emphasizes the importance of rendering care with the client (client-centered) rather than to the client. In this situation, the patient includes family in transparent discussions about quality needs and takes a team approach that involves healthcare professionals, the family, Mary's needs, and evidence associated with safe practice.

Nathan tells you that he has selected nursing as a career because many jobs are available and he will have job security. Your best response to Nathan is: a. "With many young people going overseas, many jobs and options will be available. Stable jobs and job security will be part of the nursing employment market." b. "The job market for nurses will be diminished with funding cuts to hospitals." c. "The employment prospects for nurses are positive with many options to choose from. Flexibility and adaptability are essential to income security." d. "It is unlikely that nursing will survive in the long term with funding cuts and a declining population of seniors."

ANS: C Employment for nurses continues to be positive, although roles will change in a rapidly changing environment, which will increase options. With the number of options available and sporadic work opportunities, nurses will need to be flexible and able to adapt rapidly. Job security will be out; career options will be in.

During an interview for a manager's position, you find the supervisor and staff unfriendly. Responses to questions are met with vague responses. After the interview, you decide not to pursue the position. What follow-up, if any, is most appropriate? a. There is no need for you to do anything further. You likely will not be offered the position anyway. b. You should file a complaint with human resources about the supervisor's lack of interviewing skills. c. You should send a thank-you note to the interviewer, indicating appreciation for her time. d. You should call and leave a voicemail, indicating your disinterest in the position.

ANS: C Even if you are disinterested in the position or think that the interview has gone badly, an appropriate follow-up is a thank-you note to the interviewer. This recommended follow-up creates a positive impression and may leave open the possibility of future interactions.

A grievance brought by a staff nurse against the unit manager requires mediation. At the first mediation session, the staff nurse repeatedly calls the unit manager's actions unfair, and the unit manager continues to reiterate the reasons for the actions. What would be the best course of action at this time? a. Send the two disputants away to reach their own resolution. b. Involve another staff nurse in the discussion for clarity issues. c. Ask each party to examine their own motives and issues in the conflict. d. Continue to listen as the parties repeat their thoughts and feelings about the conflict.

ANS: C For resolution of conflict, one should address the interests and involvement of participants in the conflict by examining the real issues of all parties.

A family is keeping vigil at a critically ill patient's bedside. The nurse approaches the unit manager with concern over the family dynamics for the patient concerned there are patient-family conflicts based on patient's wishes. The nurse suggests that the patient's provider may need to discuss the treatment plan with the family. The unit manager states he will arrange a discussion with the patient's provider and ask the nurse to support the provider's decisions. What is the role of the nurse in this situation? a. Leadership b. Management c. Follower d. Evidence-based

ANS: C In the followership role, you bring to the manager your concerns about concerns for patients and the outcomes and accept the direction given by the manager in response to your concerns.

On your curriculum vitae, which of the following is the recommended approach for listing employment and educational history information? a. 1979 RN Diploma 1985 BScN 2002 MN b. 2002 Mount Rush Health Center Staff Nurse 1997 Cedar Falls Clinic Staff Nurse 2007 Kilkarney Rehab Center Case Manager c. 2007 MN 2005 BScN d. 1997 Sturgeon County Hospital Head Nurse 2002 Sturgeon County Supervisor 2007 Sturgeon County Director

ANS: C Information that is included in the body of the curriculum vitae should always be in reverse chronological order so that the most recent and, presumably, most relevant job information appears first.

A business condition that may assist forecasting but add to the complexity of change is: a. consulting with professional groups about change. b. researching about trends on futuristic sites. c. asking patients to examine options for change. d. building profit projects and sustainability into planning.

ANS: C It is suggested to ask the customer for feedback on options may assist with forecasting. Adopting this strategy runs counter to current practice and would increase the complexity of healthcare planning and forecasting.

During performance appraisal interviews, Joanne's nurse manager notices Joanne's excitement when she talks about how she has helped patients on a rehab unit understand the complexities of their regimens. When Joanne's nurse manager asks her about her career path plans, Joanne says that she wants to become a nurse administrator. The best response to Joanne would be: a. "Nursing administration is rewarding. What experiences would help you along this path?" b. "You do not appear excited about nursing administration. Unless you are excited by that career path, I wouldn't advise going in that direction." c. "You seem to find teaching others very rewarding. Have you considered that as a possible career path?" d. "You are too inexperienced to consider administration. Work for a few years, and then consider administration."

ANS: C Joanne evidences excitement about teaching patients, and although administration could be a rewarding path for her, education might be a better option for her to consider. Looking at job aspects that are rewarding is helpful in determining which career direction to pursue.

To help staff nurses adjust to using research in practice, what strategy would the nurse manager use? a. Attendance at a regional research conference b. Formal classes in electronic search techniques c. Establishing a journal club d. Issuing reports on the adverse consequences of outdated practices

ANS: C Journal clubs provide opportunities for engagement in reading research and considering how it might be applied to clinical practice problems, which is considered very effective in behavioral change.

As a unit manager, you chair the unit meetings. For each meeting, you consider and establish the purpose of the meeting. Second, you prepare an agenda. Arrange the following steps in an order that would make the meetings productive and successful. 1. Distribute an agenda. 2. Distribute minutes. 3. Select team members. 4. Start on time. 5. Keep the meeting focused and directed toward accomplishing the set objectives. Select the correct order from the following options a. 1, 2, 4, 5, 3 b. 4, 1, 2, 5, 3 c. 3, 1, 4, 5, 2 d. 3, 4, 2, 1, 5

ANS: C Planning, organizing, and keeping the group on task are critical in ensuring that meetings are productive and that time is managed well.

Professional associations: a. set regulatory requirements and establish entry requirements for nursing. b. offer graduate programs for clinical and career advancement. c. provide opportunities for career networking and support. d. are open to all individuals who meet the criteria for membership.

ANS: C Professional associations are frequently, although not always, voluntary groups whose members provide leadership in issues and policies of interest to nurses. Professional associations also offer networks of nurses with similar interests.

Your organization is in the middle of re-designing patient care units, with decisions based on best practices and various other sources of evidence. In the middle of the transition, there is a temporary halt called to the transition because of a re-design of the health care system and greater emphasis on primary care. As a manager in this situation, your staff experience a gap between what they expected (the original re-design of the units) and what is actually happening (a need to integrate primary care in some way). According to Selye, the nurses on your nursing team are likely experiencing what? a. Eustress b. Distress c. Stress d. Compression

ANS: C Selye described stress as being on a continuum between stress that is positive (eustress) and stress that is negative (distress). Because individuals perceive the same event differently, from the information that is given, it is not possible to determine whether the nurses experience the events as eustress or distress; what is most likely is that the nurses are experiencing stress, which is what occurs when there is a gap between expectations and what is actually occurring.

A stroke unit experiences numerous changes related to implementation of new technology, a changed nursing care delivery model, and staff turnover within a period of 6 months. Staff members begin to show signs of reluctance to implement any more changes. This exemplifies: a. a poor relationship between leaders and staff. b. lack of knowledge regarding the importance of changes. c. striving to achieve stability during great disequilibrium. d. the importance of chaos in promoting adherence with established practices.

ANS: C Stability and chaos are at opposite ends of a continuum. When chaos is present, change occurs but life may seem uncontrollable. Resisting further change is a move toward establishment of equilibrium.

As a nurse manager, you observe a staff nurse who over the past few weeks has become withdrawn and has had several absences due to minor ailments. Your best action would be to: a. ask the nurse if she is okay during report. b. refer the nurse to the employee assistance program. c. ask the nurse to meet with you for a few minutes before she leaves for the day. d. write a note to the nurse advising her that her work attendance must improve.

ANS: C Stress can lead to emotional symptoms such as depression and a variety of ailments. Meeting with the nurse privately may assist in identifying stress and possible solutions.

Which of the following statements would best define stress? Stress is: a. the comfortable gap between how we like our life to be and how it actually is. b. everyday life, both the highs and the lows. c. a consequence or response to an event or stimulus that can be positive or negative. d. identical to distress.

ANS: C Stress is defined as a gap between how we would like our lives to be and how they actually are and as a consequence or response to an event or stimulus. It is not inherently bad (distress), and whether highs and lows are seen as distress or eustress is dependent on each individual's interpretation of the event.

Based on studies of workplace environments for nurses and future projections, the workplace of the future will be: a. less intense because of more technology. b. about the same as it is now. c. more intense because of more technology. d. fluctuating between intense periods and less intense periods.

ANS: C Technology will continue to revolutionize health care and contribute to complexity compression. In addition to access to knowledge, electronic records, and current applications of technology, technology will include robotics, which will change how chronic disease can be managed, and bioengineering will make possible interventions that do not yet exist.

The Rehabilitation Unit at Pleasant Valley Hospital has a high number of falls. What interventions might assist to reduce the number of falls on the unit? a. Determining who is responsible for the falls b. Strengthening unit policies to avoid inappropriate admissions c. Encouraging involvement of nurses in education related to falls and safety d. Ensuring that patients are appropriately restrained if they are at risk for falls

ANS: C The IOM (2010) emphasizes the need for nurses to engage in lifelong learning and to use evidence and best practices to inform practice and ensure safety.

How would the nurse executive begin to increase safety in patient care areas of the Valley Hospital? a. Asking the community what the safety issues are b. Consulting with a management expert about staffing schedules c. Ensuring that the senior nursing officer attends the board meetings d. Instituting improved practices to reduce needlestick injuries

ANS: C The IOM report (2004) highlighted the importance of the attendance of the senior nurse executive at board meetings to be a key spokesperson on safety and quality issues.

In order to plan long term, you consider what the client of the future will look like. Which of the following client profiles would best capture shifting demographics and trends in health care? a. Younger, knowledgeable about health options b. Female, uses emergency care services for parents and children c. Older, one or more chronic disorders, diverse background d. Male, various occupationally generated disorders, diverse ethnic background

ANS: C The client base is aging, and more people will be living with chronic disorders. Persons will travel more and there will be increased need to speak two or more languages to address the needs of a mobile global population.

You notice that wait times in your Emergency Department are growing longer, because of factors such as increases in the numbers of persons with chronic disorders, discharge of patients into the community at a higher level of acuity, and limited resources for transfer of inpatients. You begin to think about an application that would use your knowledge of the Emergency Department but also software and business applications and wonder if this would reduce wait times. You have not encountered anything similar to this idea. According to the Wise Forecast Model©, you are in what phase? a. Wild thinking b. Act widely c. Think wildly d. Learn widely

ANS: C The second step in the Wise Forecast Model© is to think wildly. Step two is designed to create connections among disparate thoughts. This thinking might be seen as the start of innovations.

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.

After searching the literature, Tara, the unit manager develops a table that outlines the findings of studies on management of incontinence. She then examines the studies in terms of risk and whether the findings fit within her practice context and for her population of moderately to severely cognitively impaired patients. This is which phase of a research utilization model? a. Preparatory b. Validation c. Evaluation d. Application

ANS: C The third phase, comparative evaluation and decision making, involves making a decision about the applicability of the studies by synthesizing cumulative findings; evaluating the degree and nature of other criteria, such as risk, feasibility, and readiness of the finding; and making a recommendation about using the findings of the studies.

Which of the following situations is most likely to result in a productive, whole work situation? a. Amy, RN, 5 years of experience in the Emergency Department. Amy accepts a position working with older clients in a home health agency because she has relocated, and this is the only full-time position available. b. Adam, RN, 8 years of experience in various nursing positions, including that of a nurse manager. Adam accepts a new nurse manager position because he has a family and wants more regular hours. He is most comfortable working in direct client care. c. Louise, RN, 10 years of experience in an Emergency Department. She accepts a position as a case manager in home health care, working with older clients. She especially enjoys working with older adults and wants to take on leadership and management challenges. d. Courtney, RN, a new graduate. Courtney is getting comfortable with delivering nursing care as an RN. She is offered a position on surgery as a permanent team leader. The unit has had a great deal of turnover recently, and only limited mentorship is available.

ANS: C The whole of any work situation is composed of two elements: person and position. A productive, whole work situation results when a person's talents and strengths are successfully blended with expectations of the position. Of the situations described previously, the one most likely to result in a productive, whole work situation is that of Louise, who, although her experience has not been in home health, is interested in both the roles and the responsibilities of the position, as well as the target group being served. She also considers the group being served as an area in which she demonstrates strength.

An example of a career is: (Select all that apply.) a. employment in short-term contract jobs in business, nursing, and whatever is available. b. involvement in an area of practice that is regulated. c. continuous employment in the same position and the same arrangement for 20 years. d. moving into and out of nursing positions in various cities while pursuing travel and education that develop understanding of global health.

ANS: C, D Career refers to progression of skills, consistency, knowledge, and/or status. This movement through nursing life is predicated on having a vision of a career as opposed to a series of jobs. Career styles can be defined as linear, steady state, entrepreneurial, or spiral. Deepening skills in one area is an example of a steady state career style, whereas moving into and out of positions in various cities can characterize an entrepreneurial style. Involvement in a regulated field defines a professional interest but not necessarily a career.

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.

During a unit meeting, you notice that Vivian listens attentively when Mary is speaking and offers support and advice when Mary presents ideas to the group. You are surprised because Vivian has often confided that she does not like Mary. Vivian's behavior is best described as: a. insincere. b. networking. c. politically sophisticated. d. collegial.

ANS: D Collegial behavior requires respect, not friendship.

Sondra, a new graduate, recently began a position as a registered nurse in a rural hospital, where she is the youngest and newest staff member. Although she has limited experience, she has a strong knowledge base, is confident, and was considered to have strong entry-level skills on graduation. Sondra meets with her former instructor and confides that she is very frustrated that others do not seem to accept her leadership. What might you suggest that would help Sondra to understand what is happening in terms of power and influence? a. As a new graduate, it is unlikely that she has acquired the experience and knowledge of other staff, including aides and practical nurses. b. Rural settings tend to be closed systems and therefore are, not welcoming of those who are not from their community. c. Morale on her unit can be improved by engaging in shared decision making. d. Identify the informal leaders on her unit and how they affect care decisions.

ANS: D Developing organizational savvy includes identifying the real decision makers and those persons who have a high level of influence with the decision makers. Recognize the informal leaders within any organization may have more power than the formal leader because of more knowledge of the organization, more informational power, or more expertise

As the manager on an acute care medical unit, you note that the incidence of medication errors has increased since the implementation of staffing changes. What is an important stratagem to reduce errors? a. Revisit reporting standards for medication errors in your organization. b. Ensure that medication errors are consistently reported. c. Provide staff with additional education related to safe practice in medication administration. d. Involve RN staff in determining reasons for errors and practice solutions to increase the safety of medication administration.

ANS: D Keeping Patients Safe: Transforming the Work Environment of Nurses (2004) identified many past practices that had a negative impact on nurses, and thus on patients, and recommended the inclusion of nurses in direct care in decision making involving their practice. Future of Nursing: Leading Change, Advancing Health (2010) also emphasizes the role of nurses as leaders in changes that improve health.

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.

What interaction is MOST consistent with the idea of networking? a. Meet with the same colleagues daily to have coffee and share concerns about the workplace and stories about colleagues. b. Join an online workplace forum to gain ideas about how to handle workplace conflict. c. Suggest that you and a new team member meet after work for coffee to review unit guidelines. d. Join a nurse executive interest group to meet other executives for support and for sharing ideas of expertise.

ANS: D Networking is the result of identifying, valuing, and maintaining relationships with a system of individuals who are sources of information, advice, and support. Many nurses have relatively limited networks within the organizations where they are employed. Active participation in nursing organizations is the most effective method of establishing a professional network outside one's place of employment. Successful networking involves sharing similar ideas and maintaining relationships within a system of individuals who serve as sources of information, advice, and support.

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 is participating in a baccalaureate course. For the class, she has to attend the legislative session regarding the new role of medication assistants. Why is it important for nurses to be involved in shaping public policy? a. Involvement will enable nurses to take over the healthcare system at some point in the future. b. Other healthcare professions are less concerned about the essential needs of clients. c. Such activities are important career builders for nurses who seek top-level executive positions. d. They are closest to the front line of health care and see how it affects clients and families.

ANS: D Nurses can no longer be passive observers of the political world. Political involvement is a professional responsibility. Nurses' perspectives of the critical issues for improving the healthcare system can shape the policy agenda of the nation's political leadership

A nurse belongs to several professional organizations, serving on a state-level committee of one group and on two task forces at work. The nurse is committed to a range of health issues and knows the state senator from the nurse's district, as well as the name of the representative in Washington, DC. This nurse exemplifies which level of political activism in nursing? a. Gladiator b. Buy-in c. Self-interest d. Political astuteness

ANS: D Political involvement is a professional responsibility and nurses' perspectives of the critical issues for improving the healthcare system can shape the policy agenda of the nation's political leadership. This nurse exemplifies several of the skills associated with political astuteness.

What is the best example of skilled negotiation? a. Linda, the manager on pediatrics, takes a proposal to her supervisor, outlining the benefits of a walk-in preoperative area for children. b. Kim, RN, asks for leave to pursue a semester of full-time study in her graduate program. She proposes to accept less popular rotations during peak vacation time, in return. c. George, the head nurse in ER, asks for additional staff for his department and points out the benefits of being able to keep patients for longer periods. d. Jerry speaks with his supervisor about his supervisor's concerns related to bedside reporting before presenting a proposal to change this process.

ANS: D Successful negotiators are well informed about not only their own positions but also those of the opposing side. Negotiators must be able to discuss the pros and cons of both positions. They can assist the other party in recognizing the costs versus the benefits of each position.

Lucy, head nurse on the surgical unit, works with her staff to find ways in which they can work together with other disciplines to provide more effective care for patients on the unit. Lucy likely knows her power is: a. limited, thereby necessitating involvement of others in implementing ideas. b. restricted, which necessitates finding alternative means to achieve strong patient outcomes. c. directed primarily toward those who are subordinate to her. d. of unlimited capacity when shared with others.

ANS: D Those like Lucy, who share power, tend to be the strong collaborators and see power as an unlimited quantity when shared. Empowered nurses make professional practice possible, creating a culture that satisfies all nurses.

How would a nurse manager and the staff prepare for redesignation as a Magnet® Hospital? a. Commit staff resources over a 6-month period to updating procedure manuals. b. Educate staff through meetings and training sessions regarding appropriate answers to questions. c. Prepare a manual that outlines orientation procedures and ensure that all safety issues are addressed. d. Ensure that there are empirical data to support review of patient outcomes, actions taken, and results of actions.

ANS: D Through the Magnet® model, organizations must demonstrate how they provide excellence in five areas. Between designation and redesignation as a Magnet® organization, greater emphasis is placed on empirical quality results.

Which of the following is most accurate regarding evidence-based practice? a. Evidence-based practice replaces continuous quality improvement. b. Evidence-based practice began with medicine and assists in determining which medical models can be applied in nursing practice. c. Effective and efficient care can already be demonstrated, which means that EBP will soon become redundant. d. EBP is generally recognized across disciplines and by policymakers as state-of-the-art clinical practice.

ANS: D EBP is recognized across nursing and other disciplines as reflective of state-of-the-art clinical practice, as it is based on best available evidence.

In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital reduced the number of its managers and increased the number of units for which each manager was responsible. Within a year, the number of adverse events on the units had doubled. How do the increase in adverse events relate to decreased managers? a. The overload of staff nurse duties b. Resistance to change by staff c. A change in reporting system for everyone d. Fewer clinical leaders facilitate best practice

ANS: D Eliminating barriers to the implementation of best practices is the role of managers and leaders. When there are insufficient resources for leadership to encourage a culture in which evidence-based practice is embraced, frontline nurses recognize this as a stumbling block for delivering quality care.

What would be the primary emphasis in designing and implementing a quality, safe healthcare environment? a. Evidence-based practice b. Informatics c. Staffing d. The patient

ANS: D Focusing on the patient moves care from concern about who controls care to a focus on what care is provided to and with patients, which was an aim identified in the IOM report Crossing the Quality Chasm.

The nurse manager has been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperatively. The program is to be implemented across the entire facility. What illustrates effective leadership in this situation? a. The training modules are left in the staff room for times when staff are available. b. The current approach is continued because it is also evidence-based and is more familiar to staff. c. You decide to implement the approach at a later date because of feedback from the RNs that the new approach takes too much time. d. An RN who is already familiar with the new approach of volunteers to take the lead in mentoring and teaching others how to implement it.

ANS: D Followership occurs when there is acquiescence to a peer who is leading in a setting where a team has gathered to ensure the best clinical decision making, and actions are taken to achieve clinical or organizational outcomes. Followership promotes good clinical decisions and use of clinical resources.

After consulting with practice environments about quality and safety concerns in health care, a dean in a health care program implements what to improve quality and safety in health care? a. A nursing program that emphasizes the development of a strong disciplinary identity. b. Programming that stresses discipline-based research. c. Partnerships with health care to develop software for the reporting of adverse events. d. An interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizes collaborative learning teams.

ANS: D Health Professions Education identified that education related to health disciplines in silos leads to compromised communication and inability to function as an integrated whole for patient-centered care.

As the unit manager, you are interested in determining whether patient autonomy is preserved through informed consent in surgical settings. You determine that participatory action research is the best method to address this question. Which of the following is consistent with a participatory action research design? a. You interview 125 patients who have recently undergone surgery and transcribe the interviews to determine themes. Themes are validated with an expert in informed consent. b. You circulate a questionnaire to patients who recently underwent surgery and ask for their opinions regarding consent. Data is analyzed and the findings distributed to administration and other groups. c. An audit is undertaken of signed consents for treatment, to determine if the consent is properly witnessed and signed. Findings are used to inform changes in policies. d. You meet with a patient group to determine which questions should be asked about patient informed consent and what issues might be encountered and addressed during the research.

ANS: D In participatory action research (PAR), the members of the community being studied are integral members of the research team and are involved in identifying the questions and addressing the issues involved in the implementation of the research project.

Social stressors are considered a major factor in the stress nurses experience in the healthcare system. Which of the following is not considered to be a social stressor? a. High amounts of stress in the nursing home environment b. Changes in the current healthcare system such as nursing strategies c. Disruptive behavior coming from physicians and other healthcare workers d. Stress triggers such as self-criticism and overanalyzing

ANS: D Personal stress triggers such as self-criticism are considered intrapersonal stressors; environmental factors such as change, work environment, and interactions with others are considered social stressors.

A nurse manager has decided that she must institute some personal time-management steps to survive work and home life. Her first step should be to: a. determine what takes up so much of her time and energy. b. organize her personal and work spaces. c. purchase a handheld personal digital assistant to help remind her of important meetings. d. determine her personal and professional goals.

ANS: D Personal time management refers, in part, to "the knowing of self." Self-awareness is a critical leadership skill, and being self-aware and setting goals helps managers determine how their time is best spent.

A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled but must often care for his wife, who is undergoing treatment for breast cancer. According to Maslow's need hierarchy theory, what would be the best approach to satisfying the needs of this nurse, other staff, and patients? a. Line up agency nurses who can be called in to work on short notice. b. Place the nurse on unpaid leave for the remainder of his wife's treatment. c. Sympathize with the nurse's dilemma and let the charge nurse know that this nurse may be calling in frequently in the future. d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife's treatments.

ANS: D Placing the nurse on unpaid leave may threaten the nurse's capacity to meet physiologic needs and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect patient care and threaten the needs of staff to feel competent. Arranging the schedule around the wife's needs meets the needs of the staff and of patients while satisfying the nurse's need for affiliation.

Which one of the following statements has been proven to be true? a. Recent research has found that women do not have a unique physiologic response to stress. b. Both men and women interpret the same stressor in the same manner without regard to past experiences. c. Stress influences the immune system in one complex manner. d. Stressors that are identical do not necessarily have similar effects on each individual.

ANS: D Stressors may be unique to certain environments, situations, and persons or groups, and individuals may respond to the same stressor in different ways.

As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety and reducing morbidity and mortality on your unit. What recommendations would be consistent with the IOM The Future of Nursing report? a. Careful screening of nursing staff for substance use and abuse b. Increased RN staffing on the unit c. Salary and benefits that reflect nursing accountabilities d. Increase in the percentage of baccalaureate-prepared nurses to 80

ANS: D The Future of Nursing advocates for having 80% of the nursing population at a baccalaureate-prepared level. This recommendation reflects research that suggests that improved mortality and morbidity rates occur with a better educated work force.

On the West Surgery unit, you want to institute a new system for checking armbands that evidence suggests may increase safety in medication administration. The system involves technology. What strategy may assist with rapid adoption of the technology and system? a. Employ a centralized decision-making approach. b. Use simulators for initial practice to build confidence. c. Bring in a nurse consultant who is familiar with the technology. d. Use early adopters among the staff as leaders and role models in implementation.

ANS: D The Institute for Healthcare Improvement (IHI) is dedicated to rapid improvement in patient care through a variety of mechanisms such as rapid cycle change. Rapid cycle change diffuses innovation and changes quickly through early adopters who share information and energy over time and act as role models for others.

The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility. While making rounds on the units, the staff development coordinator overhears RN staff complaining that they feel it is insulting to be required to participate in a competency program. What behavior by the staff development coordinator is most appropriate in this situation? a. Disregard staff concerns and continue with development of the program. b. Inform the nurses that this program is a requirement for JCAHO accreditation. c. Schedule a meeting with the chief nurse executive to apprise her of the situation. d. Facilitate a meeting so nurses can articulate their values and concerns about a competency program.

ANS: D The manager role involves guiding others through a set of derived practices that are evidence-based and known to satisfy preestablished outcomes such as participation in a competency program. This involves engagement of staff through sharing of concerns and ideas. A close analysis of the IOM report and the summary of the PPACA suggests that no health reform can unfold without active nursing engagement. Each document emphasizes that nurses must lead, manage, and behave as active collaborators with other members of the health team and with those being served.

After assessing an older adult patient in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. What is the most likely basis for the nurse manager's request? a. An established clinical pathway b. Confirmatory scientific evidence c. Unit protocol d. Experience

ANS: D The nurse manager is employing knowledge and experience in determining that the patient is dying, because the course of dying is not standardized and cannot be determined by clinical pathways.

The chief nursing officer at a local hospital seeking Magnet® status creates staff development classes concerning translation of research into practice (TRIP). What best describes TRIP? a. Conducting an integrative review of the literature b. Searching the literature for a systematic review c. Providing the results of research studies to practitioners d. Applying strategies that aid in adoption of research in practice

ANS: D The science of how research is adopted is known as translation science, the science of translating research into practice (TRIP). The primary aim of research utilization is to activate the change process to move research findings into practice to improve patient outcomes.

To move beyond stereotypical thinking and toward thinking about the future, which of the following would be most consistent with thinking wildly in the Wise Forecast Model©? a. Listing everything that we know about our current situation b. Defining which practices will remain unchanged and which will change c. Asking someone with a great deal of experience to share ideas about best practice d. Challenging current and future practices with questions of "what if?"

ANS: D Thinking wildly includes creating wild questions. Sometimes they are what lead to a wild idea.

Before beginning her own nursing agency, a nurse worked with other temporary nursing agencies in nine states and multiple agencies. She had set a personal goal to start her own agency. What type of motivation does this exemplify in career success? a. Linear b. Spiral c. External d. Internal

ANS: D This is an example of internally motivated career success for the nurse. She set a goal and achieved the goal, meeting her own internal focus and resulting in her career success.

Thomas has been a nurse in your ICU for 10 years. In facilitating Thomas' professional development, the nurse manager would focus on: a. certification for the ICU environment. b. discussions about how Thomas can fit with role expectations and relationships. c. possible changes to other ICU environments. d. encouraging him to lead changes that leave long-term impacts after his retirement.

ANS: D Thomas is a mid-career professional. As such, you would expect him to be interested in honing areas of expertise (such as leadership or developing a deeper expertise in a particular area of ICU nursing) as opposed to gaining skills necessary for his work environment such as certification or becoming comfortable with his role and relationships in ICU, which would be critical to an early career nurse. Legacy building is characteristic of mid-career professionals.

In helping nurse managers to manage their time, the chief nursing officer suggests that they: a. maintain a perfectionistic attitude. b. set up a complaint list. c. have good negotiation skills. d. have good information literacy skills.

ANS: D Time can be saved by using information technology effectively, as it assists with effective data retrieval and information gathering and with communication related to a variety of needs in the management setting.

Time management is very essential for the nurse manager. Which of the following is not a good time-management technique? a. Decide what not to do. b. Learn to say "No." c. Learn to delegate. d. Break down your workload into smaller, manageable tasks.

ANS: D To manage time successfully, it is important to break down your workload into smaller, manageable tasks. Developing PERT and Gantt charts will aid in dealing with larger, complex projects. Both charts can be used to outline how an individual will approach a large project

A cover letter and a résumé together should be no longer than ________ page(s). a. two b. one c. four d. three

ANS: D Two pages are recommended for a résumé and one for a cover letter.

You are offered an opportunity to take a temporary leave from your position as a nurse manager to lead a technology implementation project. Which of the following reasons for accepting the opportunity is most consistent with developing a solid career path? a. You are pressured to do so by your supervisor. b. The organization has no other suitable candidate for the position. c. You have limited knowledge of information technology and no real interest, but this will increase your knowledge. d. Accepting a position outside of your established skill set may establish you organizationally as an innovative, adaptable leader.

ANS: D Although giving into organizational or supervisory pressure may bring an enhanced learning and organizational profile, what is to be gained needs to be assessed against your career goals, interest, and aspirations. Increasing and expanding your skill set within defined career interests is a valid reason to consider a chance opportunity.