leadership exam 2

29. Which of the following describes reward power used by the nurse manager? (Select all that apply.) a. A nurse manager who uses fear of consequences to motivate staff b. A nurse manager who uses salary increases to motivate staff c. A nurse manager who is perceived as an expert due to specialized knowledge d. A nurse manager who is well liked by the majority of staff e. A nurse manager who has information that others need to perform their jobs

ANS: A, B Reward power occurs when nurse managers provide or withhold rewards. A nurse manager who is perceived as an expert has expert power. A nurse manager who is well liked the majority of staff has referent power. A nurse manager who has information needed by others to perform their jobs has informative power

23. Which actions can the nurse take to improve personal credibility? (Select all that apply.) a. Wear well-fitting clothes. b. If female, wear a reasonable amount of make-up. c. Be as original as possible at work. d. Maintain a flattering, neat haircut. e. Maintain a reasonable weight.

ANS: A, B, D, E To improve the nurse's credibility, the nurse should wear well-fitting clothes and a reasonable amount of make-up (if female). The nurse should maintain a flattering, neat haircut and maintain a reasonable weight. The nurse should reserve individuality for outside of work.

The American Nurses Association recommends the use of assistive devices for safe client handling. What was the research that initiated this recommendation? a. Clients were being injured by falls during transfers b. Back injuries in staff nurses were occurring even with good body mechanics c. Increased number of law suits resulted from client falls d. Reports from state boards of nursing showed increased back injuries

ANS: B In many situations, proper body mechanics are not adequate to protect the nurse. The nurse cannot adjust in a way that fully protects the back. Teaching nurses to use proper body mechanics to lift and turn clients has not resulted in fewer injuries. The current recommendations by the ANA include the use of assistive patient-handling devices for lifting, transferring, and turning clients

24. The nurse manager identifies which of the following as the most critical step in problem solving? a. Brainstorm all possible solutions. b. Identify the problem. c. Evaluate possible solutions. d. Choose a solution.

ANS: B The most critical step in the problem solving process is to identify the problem. Brainstorming solutions, evaluating possible solutions, and choosing a solution occur after the problem has been identified.

5. A graduate nurse is observing nurses on a busy surgical unit. The graduate nurse notices that the nurses work together as an interchangeable part of the team and have an appropriate level of skills. When questioned by the charge nurse, the graduate nurse identifies this type of team as a. potential. b. pseudo. c. basic. d. real.

ANS: D Each person on a real team has the skills and abilities to be goal and group oriented. Each member has the ability to work as an interchangeable part of the team and is accountable for the team's outcomes. The other options are not types of team.

17. If many complaints arise about a newly developed procedure, what is the best way to handle them? a. Discontinue the change because it is not working. b. Persuade a few friends to talk positively about it. c. Consider the complaints as indications that change is being resisted. d. Analyze the complaints and alter the plan as needed.

ANS: D In handling complaints about a new procedure, consideration should be given to bringing in a person with expert power and returning to the moving phase for analysis and adjustment of the procedure if needed. Because a complaint occurs does not mean that the change is being resisted. Until the complaint is investigated, the change should continue; it should not be discontinued until the issue is fully determined and resolved about the newly developed procedure

22. A nurse manager has received a report that indicates the infection rate on the unit has gone up by 25% in the past month. The control phase of management requires that the nurse manager take action. What should the nurse manager do? a. Post the report for staff to read. b. Pull a couple of the nurses aside and discuss the issue with them. c. Send an email out to the staff with information regarding upcoming infection prevention conference. d. Provide a mandatory handwashing in-service to all staff.

ANS: D The nurse manager has a duty to implement and mandate interventions to reduce infection rates for her unit. Providing a mandatory handwashing in-service to all staff is the best way to do this and to ensure that every staff member is competent. The other options may be used in the process for the nurse manager to set up or reinforce the handwashing in-service program.

17. The charge nurse is determining which activities to delegate to the nursing assistant. Which of the following would not be appropriate for the charge nurse to delegate to the nursing assistant? a. Changing soiled linen b. Taking a blood pressure on someone receiving blood c. Removing a urinary catheter d. Assessing a patient's lung sounds

ANS: D When delegating care, the charge nurse must remember that she cannot delegate nursing judgment. Therefore, in this scenario, the nurse cannot delegate the task of assessing lung sounds. This is a task that must be performed by the nurse. Taking blood pressures, removing a urinary catheter, and changing bed linens are all activities that can be delegated.

12. The nurse is using assertive communication skills to express self rights, when stating: a. "I shield others from my anger." b. "I do not compromise." c. "I am avoiding direct confrontation." d. "I am responsible for what I say."

ANS: D When you use an assertive communication style, you send the message that you will take responsibility for the consequences of both your words and your actions. Assertive individuals often compromise and may confront people directly about issues. Assertive individuals express anger appropriately rather than shielding others or repressing the feeling. The other statements do not express an assertive communication style.

8. What are critical points to communicate during a shift report or hand-off communication? a. Patient name, current physical status, activities that have contributed to current status, problems that have occurred during the shift, nursing care to address problems, and a readback or response b. Patient name, room number and date of birth, changes in current orders, provider's visits, laboratory tests that have been completed, and physical activity of the patient c. Patient name, health care provider, diagnosis, review of all current orders, family visits and involvement in care, review of history leading to hospitalization, and current status of the patient d. Physician orders for past 24 hours, patient name and date of birth, medical and social history prior to hospitalization, and review of health problems since hospitalization

ANS: A According to the I-SBAR-R tool—Identification (patient name), Situation (current physical status), Background (activities that contributed to current status), Assessment (problems that occurred during shift), Recommendation (nursing care to address problems), Readback or Response (receiver acknowledges information)—these are critical areas. All of the other options contain items that are not critical to a shift report.

11. Which action by the nurse has a potential for creating role conflict? a. Arguing that the nurse on the next shift is responsible for weighing a patient b. Failing to discuss differences with a coworker the nurse is angry with c. Placing the nurse's personal achievement over that of coworkers d. Trying to change another nurse's personality

ANS: A Arguing with another nurse about whose responsibility it is to weigh a patient is an example of a role conflict.

14. The nurse manager is giving a presentation on the disadvantages of democratic leadership in group functioning. Which statement shows an understanding of this type of leadership? a. "Requires more time and effort to make decisions and accomplish goals" b. "Discourages participation from quieter members of the group" c. "Increases the possibility of "scapegoating" or argumentative behavior" d. "Is difficult to control the outcomes and decisions of the group"

ANS: A Because of the encouragement of participation in decision making and the democratic leadership's emphasis on group function, decision making becomes more involved with consensus and is less timely. Democratic leadership encourages group participation and works to reduce any type of scapegoating behavior among members because everyone has equal voice. The group democratically makes decisions and determines outcomes that are not controlled by management.

4. On the unit in which you work, one nurse's aide is usually pleasant and helpful; the other is often abrasive and angry. What is the most important basic guideline to be observed by a nurse who must resolve a conflict between the two nurse's aides? a. Deal with issues, not personalities. b. Require the aides to reach a compromise. c. Weigh the consequences of each possible solution. d. Encourage ventilation of anger and use humor to minimize the conflict.

ANS: A Dealing with the issues and not the personalities is one of seven important key behaviors in managing conflict. Whereas issues tend to be more concrete, personalities involve emotional issues. Although weighing the consequences is one of the seven key behaviors, it does not apply to this situation which involves the behaviors of the nurse's aides. Asking parties to compromise may not always be the best approach in resolving the conflict. Although encouraging ventilation of anger and using humor are successful approaches, it is important to always deal with the issue at hand and not the personality of the person.

5. The nurse manager is updating unit staff on findings by The Joint Commission. Which of the following statements shows an understanding of untoward events in the hospital setting? The primary cause of untoward events is a. "unclear, ineffective communication." b. "unclear chain of communication for reporting." c. "ineffective reporting of the untoward event." d. "lack of consistent supervision of nursing staff."

ANS: A Ineffective communication was identified as the root cause for nearly 70% of all sentinel events reported. The majority of those untoward events involved communication failure. The other options were not identified as the majority of all sentinel events.

18. A nurse is working with a nurse aide to care for a group of patients. Which of the following activities would be inappropriate to delegate to the nurse aide? a. Providing discharge instructions to a patient b. Refilling water containers c. Obtaining a lift to help a patient out of a chair d. Feeding a patient who is unable to feed himself

ANS: A It is the nurse's responsibility to provide discharge instructions to patients and to assess their understanding of them. This task cannot be delegated to the nursing assistant. Refilling water containers, obtaining a lift to help a patient out of a chair, and feeding patients are all tasks that can be delegated to the nursing assistant.

25. Which action by the nurse indicates placement in the unfreezing phase of Lewin's Change Theory? a. The nurse reconsiders what has caused themselves to be resistant to change. b. The nurse begins the process of implementing change. c. The change has become routine. d. The change is permanent.

ANS: A Lewin's Change Theory consists of three phases: unfreezing, moving, and refreezing. In the unfreezing phase, the nurse reconsiders what has caused her to be resistant to change. In the moving phase, the nurse begins the process of implementing change. In the refreezing phase, the change has become a permanent, routine part of the nurse's life.

3. What do the responsibilities of the nurse manager include? a. Planning and organizing how nursing care can most effectively be delivered on the nursing unit b. Establishing the nursing care standards to be implemented on the unit c. Developing educational programs to assist staff to meet licensure requirements d. Assisting staff to adhere to organizational policies and procedures

ANS: A Managers must be attentive to both dimensions of their job: the mission and goals of the organization and planning with the staff to meet the nursing care goals of the unit within the overall goals of the institution. Both levels must be addressed—the organization as well as the needs of the individuals. Other options are not as comprehensive and could be included within the first option

18. What types of changes in management can be anticipated with the introduction of generations X and Y to the nursing work force? a. More flexible work time and increased personal responsibility for work outcomes b. Increased loyalty to the institution and the need for a well-defined work environment c. Increased interest in the goals and needs of the institution d. Increased structure within the nursing environment to more effectively predict outcomes

ANS: A Members of generations X and Y are more independent and place higher value on personal time. They are not characteristically team players, but they are very creative and want to be responsible for their work outcomes. Baby Boomers are focused on building careers and are invested in organizational loyalty. The silent or veteran generation places high value on loyalty, discipline, teamwork, and respect for authority

2. The clinical instructor interprets the development of mutual goals and guidelines as a. norming. b. performing. c. storming. d. informing.

ANS: A Norming begins with the development of guidelines and mutual goals. Successful task completion helps to redefine individual behavioral roles in the group. In the performing phase, everyone knows each other, and the group makes changes in a seamless way. The storming phase involves acting out roles normally portrayed in the presence of peers. Informing is not a phase in the group process.

Occupational Safety and Health Administration (OSHA) guidelines protect health care workers from needlesticks by requiring employers to: a. Purchase safety devices b. Provide a safe working environment c. Work with the local health department d. Establish guidelines for safe nursing practice

ANS: A OSHA has established guidelines that employers must follow to protect their workers. The Needlestick Safety and Prevention Act became law in November 2000, requiring the use of safer devices to protect workers from sharps' injuries

After completing a crisis intervention course, the nurse recognizes the signs of escalating violence as: a. Pacing and cursing b. Repeatedly pushing the call bell c. Crying and complaining of no pain relief d. Staring out the window and not responding to questions

ANS: A Signs of escalating violence include pacing, using foul language, cursing, raising of fists, and threats.

9. The charge nurse is assigning patient care activities to the nursing care team. In supervising the team, what is the most effective activity to determine that the nursing care has been completed satisfactorily? a. Have hourly checks with personnel to determine how effectively nursing care is being completed. b. Review with personnel at the end of the shift regarding the status of patients and how care was delivered. c. Discuss with each person the status of their assigned patients and what type of nursing care each will require. d. Schedule routine patient care rounds to evaluate the patients and the nursing care that has been completed.

ANS: A Supervision entails providing direction, evaluation, and follow-up by the nurse regarding the nursing care assigned. The only way the nurse can determine whether the care has been done satisfactorily is to monitor the task (hourly checks with personnel) and evaluate the patient. Waiting until the end of the shift could lead to problems not being assessed early to prevent complications. Discussing with the health care provider about the patient is a good practice, but determining the outcome of the care is what needs to be evaluated not just telling them what type of care is required. Scheduling rounds allows the nurse to evaluate the patient; however, communication with the nursing team is important to determine if care is administered satisfactorily.

11. The nurse manager on a surgical unit receives notification that multiple victims of a plane crash will arrive at the hospital momentarily. What is the most appropriate leadership style to adopt in this situation? a. Authoritarian b. Democratic c. Laissez-faire d. Eclectic

ANS: A The authoritarian style of management has its emphasis on the tasks, which would be effective during an emergency or disaster situation; hence, the autocratic manager may be most effective in a crisis situation. The laissez-faire manager maintains a permissive climate with little direction or control exerted. This manager allows staff members to make and implement decisions independently and relinquishes most of his or her power and responsibility to them. The democratic manager is people oriented and emphasizes effective group functioning. The environment is open, communication is both ways, and staff members are encouraged to participate in decision making. Eclectic is not a specific leadership management style

Ergonomic hazards are a major safety risk for nurses, causing serious musculoskeletal injuries. To reduce the risk, nurses should: a. Use assistive devices b. Take up weight lifting c. Never lift or move clients d. Stretch out after pulling or reaching

ANS: A The current recommendations by the American Nurses Association (ANA) include the use of assistive patient-handling devices for lifting, transferring, and turning patients. According to the ANA, there is no safe way to manually lift or turn a physically dependent person (i.e., proper lifting techniques or good body mechanics) without risking back and shoulder injuries

4. The nursing staff on a busy unit enjoys autonomy and needs minimal direction for patient care. Which leadership style would be most effective on this unit? a. Democratic b. Authoritarian c. Laissez-faire d. Bureaucratic

ANS: A The democratic manager is people oriented and emphasizes effective group functioning. The environment is open, communication is both ways, and staff members are encouraged to participate in decision making. The manager is also willing to take responsibility to make decisions when staff participation is not necessary. An authoritarian leader makes decisions without the input of others. The laissez-faire manager maintains a permissive environment. The bureaucratic leader follows a close set of standards to maintain order.

6. The nurse manager is beginning the process of problem solving. Which action should be taken first? a. Define the problem. b. Gather information. c. Analyze the information. d. Consider the alternatives.

ANS: A The good manager will guide the process of defining or identifying the problem by asking the what, when, and where of the problem. Before the manager can perform any of the other steps of problem solving, the problem must be identified. Importance is placed on management's ability to differentiate between facts and opinions and to attempt to break down the information to its simplest terms.

4. Which term refers to the group member who watches others take the risks and responsibility for group input and agrees with everyone in the group? a. Mouse b. Motor mouth c. Self-server d. Know-it-all

ANS: A The mouse is less confident of his or her abilities and is therefore less aggressive in the group dynamics. The motor mouth often interrupts others to get his or her point across. The self-server does not serve as a functional part of the group unless there is a benefit to them. The know-it-all is not a term used to describe group members.

20. Which statement would be most appropriate for the nurse to make when practicing assertive behavior? a. "I feel upset when Dr. Smith yells at me in front of my patients." b. "I can't believe what a jerk Dr. Smith is; the doctor should be fired!" c. "Dr. Smith was right in her action." d. "I am reporting Dr. Smith to the medical director."

ANS: A The nurse practicing assertive behavior would state: "I feel upset when Dr. Smith yells at me in front of my patients." The statement is direct and uses "I" statements. When the nurse says, "I can't believe what a jerk Dr. Smith is; the doctor should be fired" and "I am reporting Dr. Smith to the medical director," the nurse is using aggressive behavior. Statements such as: "Dr. Smith was right in her action" indicate passive/avoidant behavior.

How does the federal government affect environmental safety in the hospital setting? a. Requires employers to provide a safe working environment b. Identifies those nurses who are not implementing standard precautions c. Works with the state boards of nursing in disciplining nurses d. Requires employers to establish guidelines for safe nursing practice

ANS: A The purpose of the Occupational Safety and Health Administration (OSHA), a federal agency, is to establish safety and health standards in the work environment. OSHA requires employers to provide a safe work environment for employees

1. A newborn has several congenital anomalies incompatible with living beyond 1 month. The newborn cannot retain formula, and the temperature drops when the newborn is removed from the warmer. Two nurses who alternate caring for the baby argue about whether or not to attempt bottle feedings and whether the newborn should be removed from the warmer to be held. What is the origin of the conflict described? a. Ethical values b. Nursing role concerns c. Personal goals for advancement d. Personality differences

ANS: A This situation depicts personal issues based on two separate sets of ethics or values regarding the newborn's care. One nurse places value on nutritional needs and the other on the need for bonding. This conflict is not personality driven among the two nurses. The role of the nurse is to care for the newborn. They both want to care for the newborn, so they are meeting their nursing role; however, the conflict is based on an ethical issue about feeding and bonding.

19. A nurse manager is educating staff on how to give effective presentations. Which statement indicates an understanding of this? a. "To give an effective presentation, you should always maintain a positive attitude." b. "You should avoid planning and should create the presentation as you go." c. "Give the same presentation regardless of the audience." d. "To reduce anxiety, avoid making eye contact with the audience."

ANS: A To give an effective presentation the nurse should always maintain a positive attitude, plan the presentation ahead of time, spice up the presentation and make changes according to the audience, and make eye contact.

13. A nurse is aware that an area of conflict between nurses and patient's families is quality of parental care. Which action would not help the nurse reduce conflict? a. Become frustrated with the parents for lack of participation in care b. Model positive parenting techniques c. Encourage parents to meet other parents d. Give out information about parenting classes

ANS: A To reduce conflict that nurse can model positive parenting techniques, encourage parents to meet other parents and give out information about parenting classes. The nurse should avoid becoming frustrated with parents because this will likely cause conflict.

The staff nurse, in her tenth hour of a 12-hour shift, is told by the house supervisor that her replacement will be 2 hours late and she must work these extra 2 hours. The best option for this nurse, who is tired, is to: a. Talk to the person over the house supervisor b. Refuse and go home on time because she is too tired to work c. Fix some strong coffee and call home to explain the situation d. Ask the supervisor if she could work a double because she needs the money

ANS: A When nurses are concerned that their clients require more care than they can provide, they must report this. If you do not get an adequate direction or answer from your immediate supervisor then you should follow the chain of command and report it to the person above your supervisor

20. A nurse is discharging a patient who primarily speaks German. Which action(s) should the nurse take to communicate effectively with the patient? (Select all that apply.) a. Contact interpreter services to interpret discharge instructions to the patient. b. Provide discharge instructions for the patient that are written in German. c. Ask the patient to repeat the discharge instructions back to the interpreter as he understands them. d. Forego the interpreter because you are just showing him how to change a dressing. e. Give the patient discharge instructions that are written in English.

ANS: A, B, C The nurse should contact interpreter services and request a German-speaking interpreter. The nurse should provide all discharge instructions with the help of the interpreter and ask the patient to repeat back what he has heard. By using a Team STEPPS strategy "check back," the nurse can ensure that the patient understands the discharge instructions what he needs to do for himself when he leaves.

19. What action(s) by the staff nurse is an effective way to deal with a sexual harassment issue in the workplace? (Select all that apply.) a. Tell the person to stop. b. Tell your best friend about the incident. c. File a formal grievance. d. Explain the situation to your spouse. e. Play along with the person and document the activities. f. Threaten the person with a sexual harassment lawsuit.

ANS: A, B, C, D There are two ways to deal with sexual harassment workplace conflict, informally and formally through a grievance procedure. Start with the most direct measure. Ask the person to STOP! Tell the harasser in clear terms that the behavior makes you uncomfortable and that you want it to stop immediately. In addition, put your statement in writing to the person, keeping a copy for yourself. It is also important to tell other people (e.g., family members, friends, your personal physician, your minister) that this is happening and how you are dealing with it.

20. Which of the following are common factors of conflict encountered in nursing? (Select all that apply.) a. Ambiguous boundaries around work responsibilities b. Unclear communication to family members about visiting hours c. Nursing assistant placing personal achievement above everything d. Chief of medicine demanding that the nurse/patient ratio be increased e. Consideration of 26-week termination of pregnancy by a physician because of mother's health f. Vacation schedules posted with new staff members having to work at least one day during all holidays

ANS: A, B, C, D, E, F All of these areas are potential factors that can precipitate conflict in a nursing situation—roles, communication, goals, personalities, and conflicting ethics and values.

26. Which of the following actions is consistent with a manager? (Select all that apply.) a. Planning the agenda for a staff meeting b. Directing nurse assistants in how to divide up patient care assignments c. Organizing a group of nurses to present a topic at a staff meeting d. Giving blood at the local hospital blood drive e. Assume control of the guidelines for how hourly rounding will work on the unit

ANS: A, B, C, E Managers plan, direct, organize. and control activities designated to their staff. Giving blood at the local hospital would not be an action that is consistent with a nurse manager role.

22. A nurse manager is delegating a task to another nurse. Which of the following action(s) would help the manager effectively communication with the nurse? (Select all that apply.) a. Get the full attention of the nurse. b. Ask the nurse to repeat back what he or she heard. c. Give directions to the nurse as the nurse is walking away. d. Give clear, simple instructions. e. Give instructions while multitasking.

ANS: A, B, D The nurse manager should first get the full attention of the nurse before the nurse manager begins to communicate with the nurse. The nurse manager should give clear, simple instructions and ask the nurse to repeat back what he or she heard.

28. Which of the following statement by the nurse reflect transformational leaders? (Select all that apply.) a. Lifelong learners b. Courageous change agents c. Slow to change d. Value-driven visionaries e. Hesitant to follow

ANS: A, B, D Transformational leaders are lifelong learners, courageous change agents, and value driven visionaries. They are not slow to change or hesitant to follow.

25. The nurse manager is in charge of a busy nursing unit. Today the nurse manager is planning to evaluate the work of nurses on the unit. Which of the following actions would help complete this task in an effective manner? (Select all that apply.) a. Provide feedback as necessary to staff. b. Verify the tasks are being performed according to standards of practice. c. Allow nurses to complete all tasks, even if performed incorrectly. d. Provide directions with clear expectations of how the task is to be performed. e. Evaluate the performance of the task by the staff.

ANS: A, B, D, E The nurse manager should provide directions with clear expectations, intervene if the task is being performed incorrectly, verify that the tasks are being performed according to standards of practice, evaluate the performance of the task, and provide feedback as necessary. Following these steps will help the nurse manager effectively evaluate staff.

21. Which of the following actions can the nurse take to communicate with the supervisor? (Select all that apply.) a. Keep the supervisor informed. b. Focus on problem solving. c. Use "you" statements. d. Calm down before speaking. e. Choose words wisely.

ANS: A, B, D, E To communicate openly and effectively with the nursing supervisor, the nurse should keep the supervisor informed, focus on problem solving, use "I" statements, calm down before speaking, and choose words wisely.

27. A nurse manager is in the planning phase in a new job. Which action shows this? (Select all that apply.) a. Developing goals that reflect the mission and vision of the organization b. Defining strategies to meet the mission and vision of the organization c. Providing direction for staff to perform the work of the organization d. Retaining accountability for all work completed by the staff e. Planning for contingencies which may interfere with the work of the organization

ANS: A, B, E In the planning phase, the nurse manager will develop goals, define strategies, and plan for contingencies that may interfere with the work. The next phase of management is providing direction to staff and retaining accountability for all work completed by the staff.

25. A nurse notices that a coworker has been taking longer lunch breaks. The nurse is frustrated by this and wants to use assertive communicate techniques to effectively handle the situation. Which statement(s) would be the most beneficial? (Select all that apply.) a. "I feel frustrated about the length of your breaks because I am really busy with my patient assignment today." b. "You need to stop taking such long lunch breaks while the rest of us pick up your slack!" c. "I am willing to compromise so that we can both get the breaks and help that we need." d. "I am having a hard time keeping up with both of our assignments today." e. "You are putting my nursing license in jeopardy."

ANS: A, C, D To effectively communicate, the nurse should use "I" statements and compromise with her coworker. Statements that would be the most beneficial include "I feel frustrated about the length of your breaks because I am really busy with my patient assignment today," "I am willing to compromise so that we can both get the breaks and help that we need," and "I am having a hard time keeping up with both of our assignments today."

22. Which action(s) can the nurse take during report to ensure patient safety? (Select all that apply.) a. Give report at the bedside. b. Give report while the nurse is finishing up charting on another patient, so that the new nurse doesn't have to wait. c. Use I-SBAR-R during shift change report. d. Focus on giving report, not on answering telephones. e. Be prepared for report.

ANS: A, C, D, E To ensure patient safety during change of shift the nurse should be prepared, give report at the bedside if possible, use I-SBAR-R, and focus on giving report and not on other distractions such as answering the telephone. The nurse should not multitask because this increases the incidence of errors.

25. What actions can a nurse implement into daily practice to reduce conflict? (Select all that apply.) a. Deal with issues and not personalities. b. Worry about themselves and no one else. c. Communicate openly. d. Listen actively. e. Sort out issues.

ANS: A, C, D, E To reduce conflict, nurses can implement the following actions into their daily practice: deal with issues and not personalities, communicate openly, listen actively, and sort out issues.

12. Which of the following scenarios shows an ethical conflict? a. A nurse who consistently speaks poorly of another nurse for always being "grumpy" b. A nurse who has a hard time respecting 'no codes' on young patients c. A nurse who refuses to run a systems check on the glucometers because "it's night shift's duty" d. A nurse who forgets to alert family members to a change in visiting hours

ANS: B A nurse who has a hard time respecting "no codes" on young patients is experiencing an ethical conflict. A nurse who speaks poorly of another nurse has a personality conflict. A nurse who refuses to run controls on a glucometer has a role conflict. A nurse who forgets to alert family members to a change in visiting hours has a communication conflict.

3. What is the best strategy for resolving the conflict in a situation in which two staff nurses request the same vacation weeks? a. Accommodation b. Collaboration c. Competition d. Avoidance

ANS: B Collaboration is the strategy that involves confrontation and problem solving. Needs, feelings, and desires of both parties are considered to create a win-win outcome. Avoidance is a lose-lose strategy for conflict resolution, which is unassertive and uncooperative. Competition is a win-lose situation in which the use of force or the use of power occurs. Accommodation is the lose-win situation in which one person accommodates the other at his or her own expense but often ends up feeling resentful and angry.

1. Which action shows the cyclical phase of forming? a. A group dissolving b. Individuals coming together with a common bond c. Developing mutual goals d. A group completing tasks together

ANS: B Forming is the beginning development of a group with well-defined reasons and common directions. In the storming phase, the nurse begins to act out the roles they normally portrays in the presence of peers. Norming occurs during the development of mutual goals and guidelines that help to redefine the nurse's behavioral roles in the group. During the performing phase, everyone knows one another, is able to work together, and trusts one another.

13. The nurse is reviewing I-SBAR-R with a coworker at the end of the shift. Which statement indicates that they are discussing the Situation component? a. The nurse states the patient's name using two identifiers. b. The nurse states that the patient was hospitalized for a broken tibia and that surgery is scheduled for later today. c. The oncoming nurse acknowledges the info that has been received. d. The nurse states an opinion on what is happening with the patient.

ANS: B In the Situation component of I-SBAR-R, the nurse states what is going on with the patient. In this situation, the patient was hospitalized with a broken tibia, and surgery is planned for later today. The Identification component involves stating the patient's name, the Assessment component involves the nurse discussing what the nurse thinks is happening with the patient, and the Read-Back or Response component involves that the oncoming nurse repeating what the nurse has heard from the nurse who is reporting at the end of the shift.

3. A nurse is assigned to care for five patients. The nurse is concerned about the ability to care for this many patients. The nurse needs to a. delegate one of the patients to someone else. b. prioritize the needs of the patients and determine the sickest patient. c. procrastinate and hope that someone will offer assistance. d. do the easiest patients first to allow more time for sicker patients.

ANS: B It is important to determine the least stable patient when planning care for multiple patients. Plan and complete the care for the patient who requires multiple treatments or complex nursing care. This patient is most likely to experience physiological problems if the nurse does not address his or her needs. The others are cared for in the priority order determined by their stability and needs. Procrastination and caring for the easiest patient first are not reflective of assessing patient needs and administering patient care management effectively.

9. Which of the following actions by the nurse leader is most likely to lead to an effective meeting? a. Creating an atmosphere in which people say very little b. Sending out an agenda ahead of time c. Creating well-designed overhead transparencies d. Completing all the tasks of the group

ANS: B It is the leader's responsibility to send out an agenda ahead of time and to indicate any preparations members need to make or materials they need to bring. It is important to have a meeting atmosphere where people feel as though they can respond and ask questions in a cooperative and collaborative setting. It is not necessary to have well-designed handouts for the meeting or for the leader to complete all the tasks of the group because this would indicate a lack of participation from the group members.

5. Which statement best describes effective leadership by the nurse manager? a. Directs a staff nurse to modify his or her communication skills b. Fosters behavior changes in one staff member that have positive effects on the nurse manager and his or her peers c. Encourages behavior changes through the annual evaluation process d. Uses the group process to determine what behavior is distressing to staff

ANS: B Leadership in groups is democratic; the members feel positive about their participation and the outcomes of the group process. The other options are not examples of effective leadership. This person should be flexible enough to adapt to the changing roles of nursing staff. The nurse manager/leader should be willing and able to share power with the same people that he or she will supervise. It is important to understand that the most effective leadership style for one situation is not necessarily the most effective for another. Research indicates that the effectiveness of the leader is influenced by the situation itself. As leadership theories continue to develop, emphasis is more on what the leader does rather than on the traits the leader possesses. Effective leadership revolves around the leader focusing a group's efforts on identifying goals and carrying out the activities needed to reach those goals, not necessarily on individual issues, such as an annual evaluation processes or working with a staff to change communication skills.

2. The instructor has suggested that the student nurse could improve organizational skills and manage time better by scheduling selected nursing activities in the daily assignment. Which activity should be scheduled? a. Suctioning the tracheostomy tube of a patient b. Administering medications c. Assessing patient knowledge of colostomy care d. Assisting a patient with personal hygiene

ANS: B Medications are the most time sensitive issues in nursing care delivery. Scheduling is predetermined by the physician's order. Assessment of a patient's understanding of colostomy care can be done at any time. Personal hygiene needs can be met around non-time-sensitive issues (medications, treatments) in managing the patient care. Suctioning a tracheostomy should be performed when the patient needs it; it is not scheduled.

15. Staff nurse 1: "You're stomping around and glaring at me. I'm wondering what's going on." Staff nurse 2: "I'm sick of you always going to lunch first. You don't care about anyone but yourself." What assessment can best be made about this exchange? a. Staff nurse 1's remark is challenging and obstructive. b. Staff nurse 1's remark invites clarification of the meaning of the specific behaviors of staff nurse 2. c. Staff nurse 2's remark will facilitate effective problem solving. d. Staff nurse 2's remark will keep anger at a minimum and give incentive for meeting the other's needs.

ANS: B Nurse 1 was assertive in her approach by giving direct descriptive feedback reflecting nurse 2's actions with a question seeking information to explain nurse 2's actions. Asking about what is going on allows nurse 2 to make some comment about what is bothering her. Nurse 2's comment does not promote effective problem solving as it is judgmental (You don't care about anyone but yourself.).

19. The nurse understands that having a stand-up meeting versus the traditional (sitting at a conference table) meeting takes less time to come to a decision based on which of the following ideas? a. Contingency-style leadership b. Evidence-based management protocols and interventions c. Autocratic management style d. Presence of a clinical nurse leader (CNL)

ANS: B Nurses are expected to practice using evidence-based protocols and interventions for clinical decision making, and managers are expected to use those management practices that are not simply based on conventional wisdom but on demonstrated outcomes. Evidence indicates that stand-up meetings took 34% less time to make decisions (Pfeffer & Sutton, 2006). Using this model could save an organization many hours a year that can be put to another productive use or could be eliminated from the payroll. However, very few organizations use this model for meetings even in the face of the clear evidence of the impact it would have on the organization. The CNL is a highly prepared individual in the clinical setting whose role is to positively impact patient safety issues by identifying and managing risk while meeting standards of quality clinical care. Autocratic management style is authoritative. Contingency leadership style is a style of leading that is flexible to adapt to the situation.

16. The nurse wants to anticipate patient needs in order to increase patient satisfaction and decrease the use of call bells in the assigned section. What actions can be taken to achieve this? a. Tell patients to turn on their call bells if they need something. b. Perform hourly rounding on each patient. c. Check on the patient every 2 to 3 hours. d. Check on the patient only when medication needs to be administered.

ANS: B Performing hourly rounding encourages the nurse to anticipate the patient's needs, thereby increasing patient satisfaction and decreasing call bell usage. Although checking on the patients every 2 to 3 hours is appropriate, it is not the best answer because hourly rounding provides increased patient satisfaction and reduction of call bells. The nurse needs to check more frequently on the patient rather than wait until the nurse sees the patient when medications are administered.

1. During clinical experience, the student nurse is assigned a patient scheduled to undergo numerous treatments. The student decides it is not possible to complete all the needed treatments in the time scheduled for this clinical day. The student nurse consults with the clinical instructor to... a. delegate b. prioritize c. procrastinate d. do the easiest treatment first

ANS: B Plan your care of a patient who requires multiple treatments or complex nursing care by determining the priority of the patient's problems or needs so that you can provide care to the patient's highest priority needs first. Delegation would not be the most logical or appropriate choice as the student is not working over anyone. It is not always wise to do the easiest treatment first because difficult treatments may have unexpected outcomes that may challenge time management. Procrastination is never a good approach in managing patient care.

10. Considering the following terms used to label different styles of handling anger—the Sherman tank, the sniper, the constant complainer, and the clam. Which of the following comments would you expect a Sherman tank to make? a. "That sure sounded like a put-down to me." b. "How dare you accuse me of not putting away the linen!" c. "So, you think you know everything, eh?" d. "Why do we always have to rotate shifts?"

ANS: B Sherman tanks attack individuals and have a strong need to prove to themselves and to others that their view of a situation is right. Their comments are abusive and abrupt and can be intimidating. Snipers take "potshots" at others and are not as openly aggressive as Sherman tanks. Constant complainers do just that—they complain but offer no solution. Clams also behave like their name—they clam up and refuse to respond when you need an answer or want to talk.

23. Which of the following actions by the nurse manager would indicate an autocratic management style? a. Allows staff members to make most of the decisions b. Makes most of the decisions without input from the staff members c. Exerts little control over staff d. Emphasizes effective group functioning

ANS: B The autocratic manager uses an authoritarian approach to direct the activities of others. This manager would make most of the decisions without input from the staff members. Allowing staff members to make most of the decisions and exerting little control over staff is a laissez-faire management style. Emphasizing effective group functioning is common for a democratic management style.

13. Which statement by the staff nurse shows adequate understanding of the nurse manager role? The nurse manager: a. "is given information and power through an official position." b. "coordinates group activities toward a common goal." c. "is responsible for developing goals to be accomplished." d. "selects and assumes a role among a group of peers."

ANS: B The manager coordinates the activities of the group to maintain balance and direction. There are generally four functions the manager performs: planning (what is to be done), organizing (how it is to be done), directing (who is to do it), and controlling (when and how it is done). Good leaders carefully balance job-centered and employee-centered behaviors to meet both staff and patient needs effectively and often have information and power through an official position. A good leader works toward developing goals and has a sense of purpose and direction. A good leader must also be aware of how her or his behavior impacts the workplace. Emotions, moods, and patterns of behavior displayed by the leader will create a lasting impression on the behavior of the team involved. A team member is a person who assumes a role among a group of peers.

12. A nurse is working on a busy orthopedic floor and is on the phone with the floor manager when a physician comes up and gives a verbal order for pain medications on an assigned patient. The physician then leaves the unit. Which action by the nurse would be the most appropriate? a. Write down the order and administer the medication. b. Put the nurse manager on hold and ask the physician to write the order. c. Ignore the physician and continue the conversation with the nurse manager. d. Write down the order and document it as a telephone order.

ANS: B The most appropriate action would be for the nurse to put the nurse manager on hold and ask the physician to write the order. The Joint Commission states that there is a big difference between verbal and telephone orders. Verbal orders should never be accepted unless there is an emergency or the physician is in a sterile environment because there is too much opportunity for a transcribing error.

14. A nurse has received report on assigned patients and is prioritizing their care. Which of the following patients should the nurse assess first? a. A female patient who is complaining of a headache b. A patient who has just returned from surgery and has saturated his dressing c. A patient with a femur fracture that is requesting pain medications d. A male patient who needs to use the bathroom

ANS: B The nurse should assess patients using Maslow's hierarchy of needs or the ABCD system. In the situation, the patient who has saturated his postoperative dressing should be seen first because an issue with the circulatory system makes the patient a priority over the others.

1. What is the most consistent concern of the nurse as manager? a. To develop long-range career goals b. To coordinate patient care while meeting the agency goals c. To maintain harmony within the agency d. To organize the subordinates to meet agency goals

ANS: B The role of the nurse as manager has evolved into a complex one that includes organizing patient care, directing personnel to achieve agency goals, and allocating resources. The most consistent concern of the nurse as manager is not to develop long-range career goals, maintain harmony within the agency, or organize subordinates to meet agency goals. Although having long-range career goals is a good idea for the nurse manager, it is not a day-to-day concern. Organizing subordinates in not a role of the nurse manager, but instead it is directing or supervising them to achieve patient care needs.

6. A staff nurse who has worked on the unit for 6 months voices the following concerns to another nurse: "The clinical nurse leader of the unit often follows me into the supply room and stands blocking the doorway and chats. The nurse leader makes opportunities to mention my good looks, muscular physique, or strength in the context of daily work, saying things like: 'You're so handsome; no wonder your patients like you.' The nurse leader frequently touches me on the arm, the shoulder, chest, or the hair, and if I'm sitting, touches my leg. Yesterday, the nurse leader patted my arm and said, 'You know, if we were dating, I might be able to give you lighter assignments.' I don't want to date the nurse leader. I just want to be left alone! What should I do?" What is the best reply? a. "Don't be quite so honorable. Go on a date and see if you get better assignments." b. "Confront the nurse leader with a description of the behavior and state that you want the behavior to stop." c. "Go directly to the human relations office at the agency and tell them what you just told me." d. "Contact your lawyer and get advice ASAP in case the nurse leader decides to turn the tables and accuse you of advances."

ANS: B There are two ways to deal with sexual harassment in the workplace: informally by confrontation and formally through a grievance procedure, keeping a record of all confrontations and statements in writing. The best first step is to confront the person directly. Then, if there is no stopping of the behavior, go to the human relations office and explain the situation. At this point, there is no need to contact a lawyer because the human relations office can handle the sexual harassment issue.

7. To resolve a scheduling conflict, a nurse manager is using employment seniority. The nurse manager interprets this as a. a win-win strategy. b. a win-lose strategy. c. a lose-lose strategy. d. a compromise.

ANS: B This is an example of a win-lose strategy, which underpins competition as the method of resolving the conflict. The person with the more seniority wins, and the one with the lesser seniority loses the scheduling issue. Compromise or bargaining is a modified win-lose strategy. In this instance, there is no compromise as the nurse manager uses seniority to resolve the conflict. Avoidance is a lose-lose strategy for conflict resolution, which is unassertive and uncooperative. Win-win strategies involve collaboration and problem solving, which lead to cooperation and objectivity.

18. A nurse is caring for a Latino patient. The nurse is aware of the importance of cultural competency and providing the patient with culturally competent care. What can be done to enhance communication with this patient? a. Use jargon or slang. b. Obtain an interpreter if needed. c. Give longer explanations to enhance understanding. d. Speak loudly to the patient.

ANS: B To communicate effectively with this patient, the nurse may need to obtain an interpreter. The nurse should also avoid jargon or slang, give shorter explanations, and speak in a normal volume and tone to the patient.

14. Your team leader reminds you that you have forgotten to complete an assigned task. What is an assertive response? a. "Not now; I'm busy." b. "You're right. I did forget. I'll do it now." c. "It's not my fault. You should have reminded me sooner." d. "I'm so sorry I've disappointed you. It won't happen again."

ANS: B When using assertive communication, a person would respond to criticism by acknowledging the issue and taking direct action to correct the problem. An apologetic response is not assertively taking responsibility for the forgotten task. Telling the person "you should have reminded you sooner" is placing the responsibility of the forgotten task onto another person. Telling the person you are busy is denying the issue.

Violence in the health care setting: a. Is a new problem b. Can occur anytime and anywhere c. Is a problem in the acute care setting d. Occurs mostly in mental health settings

ANS: B Workplace violence is a growing risk and the second leading cause of occupational death in the United States. Health care workers are at risk for harm from coworkers, clients, families, and visitors

19. A nurse is working on a medical-surgical unit and receives phone call from a physician who would like to give orders for a new patient. What should the nurse do to make the telephone order safer for the patient? (Select all that apply.) a. Refuse to accept the telephone order and request that the physician come to the unit to write the order. b. Accept the order and perform a "read back." c. Write down the telephone order as it is being given. d. Accept the telephone order, but write it down later. e. Ask another nurse to accept the telephone order.

ANS: B, C The nurse should accept the order, write it down and perform a read back. According to the Institute for Healthcare Improvement (2005), 50% of all medication errors have been directly attributed to the failure to communicate information at the point of transition.

21. A nurse has received an abnormal result on a critical test for an assigned patient. The nurse has been trying to reach the resident for 20 minutes but has been unsuccessful. What should be done to ensure the best care for the patient? (Select all that apply.) a. Page the resident once and document this in the chart; he will make rounds soon. b. Page the attending physician. c. Continue to provide care for the patient and document all actions in the medical record. d. Wait until the resident makes rounds to review the test results with him. e. Begin treating the patient for the test result because the nurse knows what the resident will likely order.

ANS: B, C Upon receiving the critical test result, the nurse should page the resident. The nurse should document all attempts to reach the resident and all care provided to the patient. If the resident does not call the nurse back, the nurse should page the attending physician to ensure adequate care for the patient. The nurse should not withhold the test results until the resident makes rounds or begin treating the patient without a physician's order.

24. Which of the following statements by the nurse about unresolved conflict is true? (Select all that apply.) a. "Conflict makes nursing staff more productive." b. "Conflict reduces productivity among staff." c. "Conflicts wastes time." d. "Conflict waste energy." e. "Conflict increases teamwork."

ANS: B, C, D, Unresolved conflict reduces productivity, decreases teamwork, and wastes time and energy. Nursing staff are not more productive with unresolved conflict, and this type of conflict does not increase team work.

21. What is important for the nurse manager to understand about resolving conflict in the workplace? (Select all that apply.) a. Realize that most new graduates use competition as a form of conflict response. b. Effective role socialization reduces negative conflict behaviors among nursing staff. c. Use of collaboration to solve conflict issues is an important strategy to encourage. d. Thinking like a nurse promotes role socialization and reduces conflict. e. Nurse managers need to create working environments that facilitate professional practice. f. High self-esteem fosters entitlement-type behavior that promotes conflict.

ANS: B, C, D, E New graduates use compromise and avoidance as primary means of conflict resolution based on current research. High self-esteem is often found in empowering workplace environments where successful positive conflict resolution occurs. Effective role socialization, positive professional practice environments, using collaboration, and thinking like a nurse are noted in effective conflict resolution situations.

24. A nurse has noticed that a coworker consistently has a negative attitude, criticizes others, and even shows aggression toward other members of the healthcare team. Which action(s) by the nurse would help to limit time with this individual? (Select all that apply.) a. Try to help the coworker deal with personal problems during work. b. Steer clear of the coworker. c. Use assertive communication. d. Learn to say "no." e. Set clear boundaries with the coworker.

ANS: B, C, D, E To limit time with this coworker, the nurse should steer clear of this coworker, use assertive communication, learn to say "no," and set clear boundaries. It would not be appropriate to help the coworker deal with personal problems during work.

22. What are some positive results that can come from conflict? (Select all that apply.) a. Disturbing issues are brought out, which may lead to more serious conflict. b. Groups cohesiveness may increase as individuals resolve issues. c. Results of conflict can be constructive. d. Groups can learn from each other. e. Talking about issues can avert serious conflict.

ANS: B, C, D, EP Positive aspects of conflict include group cohesiveness may increase as individuals resolve issues, results of conflict can be constructive, and groups can learn from each other and talking about issues can avert serious conflict.

24. Which of the following statements about listening indicate the nurse's adequate understanding? (Select all that apply.) a. "Listening is the hearing of words." b. "Listening requires most of our communication time." c. "We pay most attention to our listening skills." d. "People remember 1/3 of the messages that they have heard." e. "Listening requires a lot of energy."

ANS: B, D, E The nurse has an adequate understanding of listening when the nurse states: "Listening is not just the hearing of words," "Listening requires most of our communication time," "We pay least attention to our listening skills," "People remember 1/3 of the messages that they have heard" and "Listening requires a lot of energy."

23. A new nurse understands that organization is key to providing safe, effective care. Which of the following actions would help to achieve this? (Select all that apply.) a. Memorize her assignment and patient reports. b. Create a work organization sheet. c. Keep info about each patient on separate sheets of paper. d. Write down all pertinent patient info. e. Minimize distractions during report.

ANS: B, D, E To provide safe, effective care, the nurse should create a work organization sheet and write down all pertinent information regarding the patient, and minimize distractions during report. The nurse should keep all information on one sheet, so that the information does not get lost. It is unrealistic to memorize assignment and patient reports. Having patient information on separate sheets of paper can become overwhelming and is not effective work organization.

11. The nurse interprets assertive behavior as a. apologetic. b. coercive. c. direct. d. self-denying.

ANS: C A person exhibiting assertive behavior would express his or her true feelings in an honest, direct manner. An assertive person's behavior respects others and is not coercive or self-denying or self-depreciating in any manner. Assertive persons accept compliments and criticism and are not excessively apologetic but have self-respect for their thoughts and actions.

15. A nurse is frustrated about being scheduled on a holiday that had been requested off, but a new nurse with less seniority was given the holiday off. Which action by the nurse shows accommodation? a. The nurse works out a schedule change with the new nurse. b. The nurse doesn't bring the issue to the attention of the new nurse but feels angry and frustrated. c. The nurse works the holiday while the new nurse has the day off. d. The nurse requests to have the day before the holiday off.

ANS: C Accommodation occurs when the nurse decides to work the holiday while the new nurse has the holiday off. Collaboration occurs when the nurses work out a schedule change. Avoidance occurs when the nurse doesn't bring the issue to the attention of the new nurse but feels angry and frustrated. Compromise occurs when the nurse requests to have the day before the holiday off.

9. A nurse is interested in moving into a management position. Which action would assist with accomplishing this? a. Use of reward power b. Use of coercive power c. Use of expert power d. Use of legitimate power

ANS: C An expert refers to someone who is knowledgeable, experienced, and respected in his or her area of nursing. This type of expert power would assist the nurse to advance to higher positions in nursing. Reward power is closely linked with legitimate power in that it comes about because the individual has the power to provide or withhold rewards. Legitimate power is power connected to a position of authority. Coercive power is power derived from fear of consequences

12. The nurse manager tells the patient that he must eat his breakfast before getting out of bed. What type of power is the nurse manager using? a. Legitimate power b. Expert power c. Coercive power d. Referent power

ANS: C Coercive power is power derived from fear of consequences. Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others. Reward power is closely linked with legitimate power in that it comes about because the individual has the power to provide or withhold rewards. Legitimate power is power connected to a position of authority. Referent power is power that a person has because others closely identify with that person's personal characteristics; the person is liked and admired by others.

7. A nurse is using the decision-making process. Which action should be taken first? a. Evaluate the outcome. b. Identify and evaluate options. c. Set the objective. d. Implement the options.

ANS: C Decision making requires the definition of a clear objective to guide the process. The nurse must set the objective before proceeding to the other steps in the decision-making process. The second step is to identify and evaluate alternate decisions. The third step is to make the decision and implement, and the last step is to evaluate the outcome.

2. What action would be an appropriate first step for the nurse to take toward becoming an effective manager? a. Learn how to effect and direct the change process. b. Assess individuals' sources of power. c. Develop communication and interpersonal skills. d. Implement effective nursing care plans.

ANS: C Effective managers have a balanced mix of management skills and leadership qualities. There are generally four functions the manager performs: planning (what is to be done), organizing (how it is to be done), directing (who is to do it), and controlling (when and how it is done). To be effective in performing these functions, a manager must develop communication and interpersonal skills.

16. A nurse wants to implement a change in the work environment. Which of the following actions would be the most important thing to do? a. Ask for suggestions from peers working in other institutions. b. Explain to coworkers how a different plan would work better. c. Seek input from coworkers from the beginning. d. Incorporate all suggestions into the plan before implementing.

ANS: C Seeing the input from coworkers from the beginning is an important component of initiating change in the work environment. In the unfreezing phase, all of the factors that may cause resistance to change are considered. Others who may be affected by the change are sought out to determine whether they recognize that a change is needed and to determine their interest in participating in the process. It will be important to determine whether the environment of the institution is receptive to change and then convince others to work with the group initiating the change.

3. A member of a nursing committee frequently disregards the rules of the group and feels that the rules do not apply to the member personally. The president of the committee recognizes the term that best describe this person a. critical conservative. b. motor mouth. c. self-server. d. mouse.

ANS: C Self-servers are not willing to serve as a functioning part of the group, although they may appear to be group members when they perceive a personal benefit by the interaction. The critical conservatives typically have criticism for any suggestion other than their own. Motor mouths often interrupt others to get their points across. The mouse is known as a silent observer.

The Needlestick Safety and Prevention Act of 2000 was implemented to prevent healthcare workers from experiencing needle stick injuries. Which of the following is required documentation regarding a needle stick injury? a. Notify the client's physician b. Advise the hospital risk management department c. Document the department or work area in which the exposure occurred d. Send the injured staff person to the emergency room for documentation of the incident

ANS: C The Act requires documentation of the department and work area in which the needlestick injury occurred. It also requires employers to maintain a sharps injury log to document the type and brand of device involved and an explanation of how the incident occurred. The information is to be recorded and maintained in a way that protects the confidentiality of injured employees

Hospitals are granted Magnet status by the: a. National League of Nursing b. American Nurses Association c. American Nurses Credentialing Center d. National Council of State Boards of Nursing

ANS: C The American Nurses Credentialing Center is responsible for judging whether hospitals achieve Magnet status.

4. Which statement by the nurse manager shows understanding of what initiated the development of the team Strategies and Tools to Enhance Performance and Patient Safety (STEPPS)? a. "The increased need for health care coverage" b. "The need for more qualified nurses" c. "A need for a teamwork system focused on improving communication and teamwork" d. "The increased cost of health care"

ANS: C The Department of Defense (DoD) Patient Safety Program, in collaboration with the Agency for Healthcare Research and Quality (AHRQ), developed an evidence-based teamwork system focused on improving communication and teamwork skills in the health care industry to improve patient outcomes. The team was not created to solve health care coverage concerns, search for more qualified nurses or to decrease the cost of health care.

8. The nurse manager is attempting to resolve an interpersonal conflict between two nurses. Which action below should be done first? a. Determine the facts related to the situation. b. Schedule a meeting time for resolution. c. Have an accurate understanding of the problem or conflict. d. Have the determination to resolve the conflict.

ANS: C The first step is to make sure that the nurse manager has an accurate understanding of the problem of conflict. The quality of the outcome of resolving a problem depends on proper recognition and identification of the problem or issue. This assessment is best addressed by determining the nature of the differences and the reasons for them. After this has been achieved, the next steps would be identifying the conflicting facts and developing ways to implement a plan for resolution.

17. Which statement by the nurse is true regarding sexual harassment? a. "Sexual harassment no longer occurs in the workplace." b. "Sexual harassment is only caused by men." c. "The most common sexual harassment complaint is inappropriate remarks and touching." d. "Nothing can be done to prove sexual harassment."

ANS: C The most common sexual harassment complaint is inappropriate remarks and touching. The statements that "sexual harassment no longer occurs in the workplace," "sexual harassment is only caused by men," and "nothing can be done to prove sexual harassment" are false.

15. A nurse is unhappy about the way medications are being administered on the unit. What does the nurse need to do first to facilitate a change in the process? a. Initiate a new method starting with assigned patients. b. Discuss concerns with fellow nurses. c. Develop a better method to administer the medications. d. Inform the charge nurse of how it can be done better.

ANS: C The nurse needs to shift into the moving phase, which incorporates taking the lead by being responsible and willing to implement change by sorting out what must be done and by facilitating an appropriate and effective approach. Whenever one is not happy with a situation or procedure, it is important that providing suggestions for change be incorporated into the process. Discussing concerns with fellow nurses does not actively involve the change process. For change to be effective, it must have "buy-in" from other staff and not merely inform the staff or change nurse of how there is a better way to administer the medications on the unit.

16. A nurse feels angry over a patient assignment and feels that assignments always include the "bad ones." What is the best way to control this anger? a. Ignore the negative feelings. b. Talk about other coworkers behind their backs. c. Face this anger and determine what is being felt. d. Refuse to speak to any coworkers for fear of lashing out.

ANS: C The nurse should face the anger and determine what is being felt. Ignoring angry feelings, talking about coworkers behind their backs, and ignoring others will not help to resolve the anger.

18. A female nurse is experiencing sexual harassment in the workplace by a male nurse. Which action should this nurse take to stop the sexual harassment? a. Ignore the comments made by the male nurse. b. Laugh about the comments. c. Tell the male nurse to stop. d. Begin to sexually harass the male nurse.

ANS: C The nurse should take the most direct route and tell the male nurse to stop. Ignoring the comments, laughing at them, or sexually harassing the male nurse will not stop the harassment.

17. Which statement made the by the nurse indicates understanding of how to control the grapevine? a. "Grapevine rumors are generally true." b. "Avoid face-to-face communication." c. "Avoid spreading rumors." d. "Keep rumors circulating."

ANS: C To control the grapevine, the nurse should avoid spreading rumors. The nurse should also promote face-to-face communication, obtain information from the source, and stop the circulating of rumors by not engaging in gossip.

15. A nurse has been assigned the following patients. Which patient is a priority to assess first? a. A patient with abdominal pain b. A patient who has been NPO all morning and wants to eat c. A patient with pneumonia and O2 saturation of 88% d. A patient complaining of ear pain

ANS: C Using Maslow's hierarchy of needs or the ABCD system, the nurse should see the patient with pneumonia and low O2 saturation first. Issues involving the airway are a priority, and these patients must be seen first. Next, the nurse should see the patient with abdominal pain followed by the patient with ear pain and then the patient who is NPO and wants to eat.

10. What would be a good assignment for an experienced nursing assistant? a. Help teach patients newly diagnosed with diabetes to give themselves injections. b. Report on the quality and quantity of urine on a continuous bladder irrigation. c. Obtain a clean-catch urine specimen from a patient. d. Chart a diet for a patient with an eating disorder.

ANS: C The nursing assistant can be assigned activities that involve standard, unchanging procedures such as helping to obtain a clean-catch urine specimen from a patient. Charting, teaching, and assessing are not assigned to the nursing assistant.

23. A nurse is caring for an older adult patient when conflict regarding treatment arises between the family and the health care provider. What can the nurse do to resolve this conflict? (Select all that apply.) a. Defend the health care provider's treatment and try to explain it to the family. b. Try to convince the family that the health care provider knows what is best for the patient. c. Allow the family to participate in the decision-making process for their loved one. d. Encourage the family to speak directly to the health care provider regarding treatments. e. Clarify the health care provider's order with the family.

ANS: C, D, E The nurse should avoid defending the health care provider's treatment and convincing the family that the health care provider knows what is best. Instead the nurse should allow the family to participate in the decision-making process, encourage the family to speak directly to the health care provider regarding treatments, and clarify orders with the family.

11. The nurse calls a physician to come to the unit to assess a patient. Which of the following is the most effective telephone communication by the nurse? a. "This is the 4100 unit troublemaker again. You probably ought to come to the unit to see Mr. Samuels. His condition doesn't seem right." b. "This is Ann Allen on 4100. I don't quite know what to think about Mr. Samuels. I think his condition is deteriorating, and I'd like to have you see him." c. "Sorry to bother you. This may not be important, but I'm not completely comfortable with Mr. Samuel's response to care. His blood pressure has dropped, and his pulse is elevated." d. "This is Sheila Ryan on 4100 calling regarding your patient, Mr. Samuels. His BP has dropped from 130/90 at 8 am to 100/70 at 10 am. His pulse has risen from 80 to 100, and he seems restless. He received his 8 am Cardizem."

ANS: D A detailed, objective response is effective when communicating not only in person but also by telephone. Try organizing your conversation in the I-SBAR-R communication format. The other responses are subjective in nature with no descriptive assessment data to provide to the physician.

9. During a staff meeting, an upset nursing assistant tells the group that the other nursing assistants are given easier patient assignments and are always given their choice of days off. What approach by the nurse manager would be effective to resolve this conflict? a. Attempt to persuade the upset nursing assistant to calm down. b. Tell the group that this type of conversation needs to be handled privately. c. Consider transferring the upset nursing assistant to another unit. d. Acknowledge the feelings of the upset nursing assistant and make a plan to meet with her.

ANS: D Acknowledging the nursing assistant's feelings is the first step in conflict resolution. This process requires dealing with issues, not personalities, by communicating openly, listening actively to the complaints, sorting out the issues, identifying key themes of the discussion, and weighing the consequences and options to resolve the conflict. Transferring the upset person avoids dealing with the conflict.

10. A nurse is respected by peers for clinical skills and effective interpersonal relationships. The nurse has studied diabetic patient educational needs and consults with several units. What type of power does this nurse possess? a. Informational b. Legitimate c. Reward d. Expert

ANS: D Expert power is based on specialized knowledge, skills, or abilities that are recognized and respected by others. Those who have information that others need to perform their duties have informational power. Legitimate power is based on the person's position within an organization. Reward power occurs when an individual has the power to give or withhold rewards.

13. Dr. Jones asks you to give a medication to one of the patients, and you know the patient is allergic to it. When you point this out, Dr. Jones says, "Give the medication or I'll report this to your supervisor." What is the best assertive response? a. Agree to give the medication and hope no one finds out. b. Say, "I won't give the medication, and I don't care who you talk to about it." c. Walk away and ignore Dr. Jones. d. Say, "Perhaps you and I could talk this over with my supervisor together."

ANS: D Expressing to the physician that both of you should discuss the issue with the supervisor is an assertive response. As nurses gain experience, their judgment improves, and they are able to recognize ways to communicate needs and feelings with the goal of improving the processes and procedures used in the work setting. The patient's safety always comes first, so you would not go ahead and give the medication. When you walk away and ignore the comment, you are denying the feelings and not dealing assertively with the situation. Not giving the medication and stating that you don't care who the physician talks to about the issue is a threatening, aggressive response.

6. In considering the overall task of the team, what issues should be considered in the care of the patient? a. Nursing care plan, religious preference, and financial base b. Physician's orders, nursing actions, and religious preference c. Family needs, physician's orders, nursing diagnosis, and religious preference d. Physician's treatment plan, nursing plan of care, and needs of the patient and family

ANS: D Nurses as individuals and as team members are advocates of the patient with a focus on the best and safest delivery of quality health care.

8. The graduate nurse has an adequate understanding of effective listening when stating which of the following? a. "Limited level of vocabulary often affects listening skills," b. "Underdeveloped attention span affects listening skills." c. "External noise distractions affect listening skills." d. "Emotional reactions interfere with the actual message."

ANS: D One of the most problematic reasons for ineffective listening is that people allow their emotions to dictate what they hear or do not hear. Limited vocabulary, underdeveloped attention span, and external noise distractions are not the most problematic reason for ineffective listening.

6. The nurse is receiving a phone order from a health care provider. How will the nurse make sure that the provider's order is received without error? a. Advise the health care provider that the order must be written on the chart within the next 24 hours. b. Ask the nurse in charge to come to the phone to take the order. c. Write the order without using any unclear or unapproved abbreviations. d. Repeat the order, write the order verbatim, and read it back to the provider.

ANS: D Repeat the order, write the order verbatim, and read it back to the provider are the steps recommended to confirm that the order was understood correctly, as well as communicated correctly. The question is in regard to the receiving of the order, not specifically how it is written. The nurse will write the phone order on the chart, and later the health care provider will co-sign the order. The charge nurse does not have to take the phone order; any licensed nurse can take the phone order.

Which of the following agencies oversees environmental hazards at ambulatory care centers? a. National Council of State Boards of Nursing b. American Nurses Credentialing Center c. Ambulatory Care Nursing Administration and Practice d. Occupational Safety and Health Administration

ANS: D The purpose of the Occupational Safety and Health Administration (OSHA) and the state health department is to establish safety and health standards in the work environment. OSHA requires employers to provide a safe work environment for employees. The other options refer to agencies that regulate professional nursing practice (NCSBN) and provide credentialing (ANCC).

14. What can staff nurses do to reduce conflict with patients and families? a. Allow nurses to enforce what they feel comfortable with. b. Keep treatment decisions between the patient and health care team only. c. Do not allow family to participate in patient care. d. Maintain consistency in enforcing rules and policies.

ANS: D To reduce conflict with patients and families, the nurse can maintain consistency in enforcing rules and policies. Allowing each nurse to enforce rules they are comfortable with, keeping treatment decisions between the patient and the health care team, and not allowing family to participate in care may increase conflict.

16. A nurse is meeting with the nurse supervisor to discuss an issue with a coworker. Which of the following statements would help the nurse effectively communicate with the supervisor? a. "This is all my coworker's fault. I never do anything wrong." b. "My coworker always makes 100 excuses to get out of work." c. "I knew you would be on their side." d. "I feel upset that my coworker seems to have less work than I do."

ANS: D When communicating with a nurse supervisor, the nurse should avoid blaming others and exaggeration. The nurse should instead focus on using "I" statements to express themselves.

5. One of your peers, a staff nurse, is a "potshot artist." This nurse often makes you the butt of innuendo or teasing digs. You are fed up and decide to take action the next time it happens. What strategy should be considered as an effective way of dealing with a "sniper?" a. Clam up and allow the individual to fully ventilate her concern. b. Confront and tell the individual he or she is wrong. c. Coldly withdraw from the individual. d. Obtain group confirmation or denial of criticism raised by the individual.

ANS: D When confronting the sniper, it is important to involve the rest of the staff to get a group consensus of denial or confirmation. Remember to always expose the sniper's attack by saying, "That sounded like a put-down to me." Clams tend to withdraw from the individual. Confronting the individual and telling them they are wrong is how a Sherman tank would approach the situation because they have a strong need to be right.

8. Which statement by the nurse shows understanding of the primary advantage in using the group process in decision making? The process a. "increases the time spent discussing alternatives." b. "eliminates opposition to decisions by administrators." c. "allows additional time for the planning process." d. "promotes acceptance of the decision by the group."

ANS: D When the group has input in the decision-making process, there is more acceptance of the group's decision. Groups can be beneficial to the decision-making process. Groups generally offer the benefits of a broader knowledge base for defining objectives and more creativity in identifying alternatives. The effectiveness of the group decision-making process is dependent on the dynamics of the group. When a group is involved in the decision-making process, there may be additional time spent discussing alternatives, and more time may be allowed for planning; however, this is not a specific advantage. It may not necessarily eliminate opposition to the decision by administration, but when the group makes a decision, it may be easier to deal with administrative opposition

20. A nurse manager has an adequate understanding of their nursing role when making which of the following statements? a. "A manager selects or assumes a role." b. "I have the same function as a floor nurse." c. "I have the same authority as the director of the hospital." d. "I was appointed to my role."

ANS: D Whereas a manager is assigned or appointed to a role, a leader selects or assume a role. The nurse manager functions differently than a floor nurses, and although the nurse manager has some authority, it is less than the director of the hospital.

7. The nurse receives report on an assigned group of patients. Which patient would the nurse assess first? a. A patient 2 days postoperative who is complaining of pain b. An older adult patient reported to have increasing lethargy and confusion c. A newly admitted patient with a serum blood urea nitrogen (BUN) of 32 mg/dL d. A hypertensive patient complaining of severe mid-sternum pain

ANS: D The patient with chest pain is at greatest risk of experiencing urgent problems and needs to be evaluated immediately. This does not mean that the nurse will not address the needs of the other patients, but the safety of the hypertensive patient is at risk if the nurse does not see him first.

21. Which of the following actions is consistent with a nurse leader? a. A nurse who encourages staff to give excellent patient care b. A nurse who performs chart audits on her staff c. A nurse who writes yearly staff evaluations d. A nurse who gives pain medication to an assigned patient

ANS: A A nurse leader is someone who influences others, such as a nurse who encourages staff to give excellent patient care. A nurse who performs chart audits and writes staff evaluations is functioning as a nurse manager. Giving pain medications is a function of the staff or bedside nurse.

10. Which action by the nurse shows a major characteristic of aggressive behavior? a. Achievement of personal goals at the expense of others b. Indirect expression of personal feelings c. Communication of personal needs d. Ability to restrict personal rights

ANS: A All of us have a style of communication that reflects our own personality and self-concept. Achievement of the nurse's goals at the expense of others shows an aggressive behavior. Indirect expression of one's feelings describes passive behavior. Being able to communicate one's own needs describes an assertive behavior. Restricting one's own rights does not describe an assertive style of communication. Aggression is not an indirect expression of one's feelings but a very direct expression. Aggressive communication is angry and dominating where the person attempts to humiliate or "put down" other people.

2. Of the following common areas of conflict between nurses and their patients and families, which does the nurse interpret as the most easily resolved? a. Issues of concern about quality of care b. Issues surrounding treatment decisions c. Issues of family involvement d. Issues about quality of parental care

ANS: A Families typically are concerned with how well their loved one is being attended to. Conflict often arises out of concerns related to quality of care. Whereas this is something that the nurse can directly address, issues of treatment decisions, family involvement, and quality of parental care often require more discussion and intervention.

7. How can the "grapevine" best be controlled? a. Providing factual information in anticipation of employees' questions b. Using an authoritarian communication style c. Putting everything in writing d. Having a strong union to represent employees

ANS: A Providing factual information in anticipation of employees' questions is an effective way to reduce the "grapevine." Most employees get secondhand information, and few employees get enough of the factual information that they need. Even if information is put in writing, it is important to communicate verbally to employees by answering their questions. A strong union does not necessarily reduce the grapevine.