Leadership Final Exam Evolve

An 80-year-old woman has been admitted for diagnostic procedures and then potential surgery for symptoms related to an abdominal mass. Today, she was scheduled for two tests that required that she be NPO. After the first test, the patient was returned to the floor. The patient's assigned nurse was at lunch. Another nurse checked with the radiology department and was told that the test was completed and that the patient could eat. She then provided the patient with a cold cereal until lunch trays were available. Subsequently, it was learned that the second test had not been completed, the test would then be delayed to the next day, and the patient would need to be NPO again. The patient's daughter displayed considerable anger regarding the delay in testing. Which of the following is the most appropriate response? "I am sorry that this caused a delay in your testing. What can we do now to address this?" "The delay in testing won't have an impact on your care since we can schedule the second test for early tomorrow morning." "Your nurse should have done a better job of explaining the situation to the nurse who was covering. We won't let it happen again." "I will call your physician to discuss this and other testing options in more detail with you."

"I am sorry that this caused a delay in your testing. What can we do now to address this?" Apologizing to the patient and daughter without blame and asking for what can be done to provide better service is an axiom of service recovery. Blaming another staff member is counterproductive. Referral to the physician delays the discussion and could be perceived as avoidance. Statements minimizing the impact dismiss the patient and family's concerns.

Which of the following statements by a newly promoted nurse manager indicates the need for follow-up? "I don't need to worry about engaging my workforce because all nurses are naturally engaged." "As a new leader, I should identify and work with a mentor." "I intend to promote shared decision making in my unit." "I will purposefully cultivate a broad follower base in my unit."

"I don't need to worry about engaging my workforce because all nurses are naturally engaged." Option A is true: Mentorship relationships are invaluable to professional growth. Option B is true: Shared decision making results in employee engagement, improved satisfaction, and better patient outcomes. Option C is untrue and indicates the need for follow-up. Engaged workers require cultivation and attention from the manager. Option D is true: Successful leaders require many followers

During bedside rounds, a surgeon turns to you and says, "The poor nursing care has caused this wound to become infected. Can't nurses at this hospital do anything right?" The best response is: "Would you like to change the antibiotic Mrs. Johnson is receiving?" "Let's first decide what to do for Mrs. Johnson and then step into the hall and talk further about your concerns." "It is inappropriate to talk to me that way. I will report this to my supervisor." "The nursing care on this unit has received awards and certainly is not the problem."

"Let's first decide what to do for Mrs. Johnson and then step into the hall and talk further about your concerns." Effective interprofessional communication may necessitate choosing appropriate conflict-handling modes. Collaborating about the health needs of Mrs. Johnson and then talking privately with the surgeon ensures a better setting in which to address the bullying. Although Option D is patient centered, the use of avoidance does not resolve the conflict or address the surgeon's disruptive behavior.

A clinical unit is instituting hourly patient rounding. Nurses are being taught a standardized script to use when making rounds to improve patient satisfaction. One of the nurses objects to using a standardized script. What is the best response by the nurse manager? "You don't have to use the script as long as your patients don't have any complaints about the care that you provide." "The policy requires you to use the script and if you don't, you will receive a warning." "What are your concerns about using a standard script while you make your rounds?" "Why don't you serve as our representative to the nurse council on Quality and Patient Satisfaction?"

"What are your concerns about using a standard script while you make your rounds?" Asking the nurse about concerns involves the nurse in care processes and acknowledges her contributions. This would be an important first step in involving nurses in making decisions about practice. Allowing one nurse to be exempt from a policy is counterproductive to fostering staff morale, as is threatening the nurse with consequences. Having the nurse serve as a representative to a committee might be a solution, but it would not necessarily be the first choice or the most appropriate at this time.

Healthcare organizations that wish to develop a comprehensive workplace violence prevention program should do which of the following? (Select all that apply.) -Conduct a worksite analysis of risk for workplace violence of both physical and psychological nature. -Assign responsibility or accountability for a violence prevention program to individuals or teams with inadequate training and skills in workplace violence. -Withhold adequate resources for this effort from the team responsible for developing workplace violence prevention in health care. -Develop a plan for workplace safety, prevention, and control of violence. -Provide training for staff on conflict management and de-escalation techniques. -Ignore safety concerns identified through reporting of violent incidents. -Address horizontal violence at all levels of the organization. -Collect and analyze data and evaluate the effectiveness of the program. -Commit to a zero tolerance policy for workplace violence and ensure that managers, supervisors, co-workers, clients, patients, and visitors know about this policy.

-Conduct a worksite analysis of risk for workplace violence of both physical and psychological nature. -Develop a plan for workplace safety, prevention, and control of violence. -Provide training for staff on conflict management and de-escalation techniques. -Address horizontal violence at all levels of the organization. -Collect and analyze data and evaluate the effectiveness of the program. -Commit to a zero tolerance policy for workplace violence and ensure that managers, supervisors, co-workers, clients, patients, and visitors know about this policy.

A hospital in a large metropolitan area hopes to obtain magnet status. The following are characteristics of the nursing service in this hospital. Select the areas that must be addressed in order to become a magnet hospital. (Select all that apply.) -Cost reduction at the hospital has resulted in a 50% decrease in the number of staff in the Education Department. -The hospital has a nurse vacancy rate of 20%. -50% of the nurse managers hold a BSN. -The chief nursing officer holds a MSN, with a specialty in nursing administration. -Transforming Care at the Bedside has been implemented in all units.

-Cost reduction at the hospital has resulted in a 50% decrease in the number of staff in the Education Department. Magnet status highlights hospitals that provide a positive work environment for nurses and other staff. A high vacancy rate suggests that nurses are leaving the hospital, in some cases, because the environment does not "hold" them to their job. Similarly, cost reduction in the area of staff development suggests a lack of support for ongoing professional development. Finally, effective January 2014, all nurse managers must hold a BSN. -The hospital has a nurse vacancy rate of 20%. Magnet status highlights hospitals that provide a positive work environment for nurses and other staff. A high vacancy rate suggests that nurses are leaving the hospital, in some cases, because the environment does not "hold" them to their job. Similarly, cost reduction in the area of staff development suggests a lack of support for ongoing professional development. Finally, effective January 2014, all nurse managers must hold a BSN. -50% of the nurse managers hold a BSN. Magnet status highlights hospitals that provide a positive work environment for nurses and other staff. A high vacancy rate suggests that nurses are leaving the hospital, in some cases, because the environment does not "hold" them to their job. Similarly, cost reduction in the area of staff development suggests a lack of support for ongoing professional development. Finally, effective January 2014, all nurse managers must hold a BSN.

Janice is a new graduate nurse working in the intensive care unit of a large medical center. Janice completed her nurse residency and began working full-time on the unit about 6 weeks ago. Janice is the only new graduate nurse on a unit where her colleagues range from 29 to 48 years old. Janice is a member of the American Association of Critical-Care Nurses and is aware that the protocol for sepsis management in patients recently changed. Janice wants the ICU to adopt these best practices but doesn't know how to go about implementing the change. Which of the following is the best approach Janice could take? (Select all that apply.) Adopt the practices herself and become a role model. Post an article reviewing the new sepsis management protocol on the bulletin board in the staff lounge. Ask other nurses on the unit why they are still using old standards of practice. Talk with the nurse manager about the recent protocol change.

-Post an article reviewing the new sepsis management protocol on the bulletin board in the staff lounge -Talk with the nurse manager about the recent protocol change.

The number of patient days on a 28-bed unit in September is 618. What is the average daily census (ADC)? -22 -20.6 -30 -23.5

20.6 Formula for average daily census is number of patient days divided by the number of days in the time period.

There were 525 patient days accrued in September on a 28-bed unit. There were 100 discharges during this same time period. What is the Average Length of Stay? -6 -5 -3 -7

5 Formula for average length of stay is number of patient days divided by number of discharges.

Which of the following is the most appropriate assignment involving asking a nurse to "float" to another unit? -A nurse 9 months post licensure working on an orthopedic unit is asked to float to a cardiac step-down unit. -An experienced nurse working on a medical-surgical unit is asked to work in a medical-surgical ICU. -An experienced psych nurse is asked to work on a palliative care unit. -A nurse who has worked in the CCU for 2 years is asked to work on a cardiac step-down unit.

A nurse who has worked in the CCU for 2 years is asked to work on a cardiac step-down unit. The nurse who has worked in the CCU will have had the necessary competencies validated for this assignment.

Which of the following describes comparative effectiveness research? A qualitative study that examines family members' experience of being allowed to observe procedures being performed on their children A study designed to determine which of three strategies for teaching self-management works best for adolescents diagnosed with type 1 diabetes Determining whether the implementation of an evidenced-based protocol reduces the rate of catheter-associated bloodstream infection (CLABSI) A meta-analysis that evaluates strategies to prevent delirium in hospitalized patients

A study designed to determine which of three strategies for teaching self-management works best for adolescents diagnosed with type 1 diabetes Comparative effectiveness research is designed to compare the benefits and harms of methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the quality of care. The type of qualitative research described here is phenomenological research and is focused on the experience of the study participants. Examining the impact of an evidence-based protocol for CLABSI would be characterized as quality improvement. A meta-analysis combines the results from different studies in order to test the pooled data for statistical significance.

To maximize the coordination of care, provide seamless transitions, and improve quality of care, organizations are increasingly turning to which organizational structure? -Public health institutions -Accountable care organizations -Proprietary, investor-owned organizations -Academic medical centers

Accountable care organizations Accountable care organizations (ACOs) are designed to coordinate care, provide chronic disease management, and improve the overall quality of care. Proprietary organizations are investor owned, and they operate with the specific intent of earning a profit by providing healthcare services to individuals who can afford to pay for these services. Public health institutions provide health services to individuals under the support and/or direction of the local, state, or federal government. Academic medical centers are focused on providing care while providing education for physicians and other health professionals.

Case management has become a very important role for all acute care organizations. Nurses must partner with case managers in reaching organizational goals. The ideal partnership includes the following contribution(s) by the nursing staff: Ongoing patient and family education regarding discharge planning as well as identifying barriers to discharge -Knowledge of patient goals, expected outcomes, and anticipated discharge date -All of the above -A comprehensive assessment of the patient and family -Appropriate and timely interventions when the patient is not progressing as expected

All of the above Case management has become a very important role for all acute care organizations. Nurses must partner with case managers in reaching organizational goals. The ideal partnership includes the following contributions by the nursing staff: Knowledge of patient goals, expected outcomes, and anticipated discharge date; comprehensive assessment of the patient and family; appropriate and timely interventions when the patient is not progressing as expected; appropriate management of pain, activity, skin integrity, bowel and bladder integrity, and cognition; ongoing patient and family education regarding discharge planning and reducing the risk of readmission; and identifying barriers to discharge (Bower, 2013).

What is the benefit of strategic planning for a healthcare organization? (Select all that apply.) -It allows an organization to set its vision and goals. -It allows an organization to assess its strengths, weaknesses, opportunities, and threats. -It defines the driving forces in the environment. -All of the above

All of the above Options A, B, and C incorporate the components for strategic planning as noted in the literature review.

Group decision making offers the following advantages and disadvantages: -Implementing solutions becomes easier when individuals have been actively involved in the decision-making process. -Groups may be more concerned with maintaining group harmony than engaging in an active discussion on a particular issue. -The time required for making group decisions may not be appropriate, especially in a crisis situation. -More ideas can be generated by groups and they have a synergistic effect -All of the above statements are true.

All of the above statements are true. The advantages of group decision making are numerous. The adage "two heads are better than one" illustrates that when individuals with different knowledge, skills, and resources collaborate to solve a problem or make a decision, the likelihood of a quality outcome is increased. More ideas can be generated by groups and they have a synergistic effect. In addition, when followers are directly involved in the process, they are more apt to accept the decision, because they have an increased sense of ownership and commitment to the decision. Implementing solutions becomes easier when individuals have been actively involved in the decision-making process. Although group decision making and problem solving have distinct advantages, involving groups also carries certain disadvantages and may not be appropriate in all situations. The time required for making group decisions and for achieving consensus may not be appropriate, especially in a crisis situation, which requires making prompt decisions. In addition, some decisions may have been made at the organizational level and discussing the decision as though other options were possible is counterproductive. Groups may be more concerned with maintaining group harmony than engaging in active discussion on the issue and generating creative ideas to address it. Group members who manifest a "groupthink" mentality may be so concerned with avoiding conflict and supporting their leader and other members that important issues or concerns are not raised.

Regulations in most states require that the number of patients a nurse should care for in a particular setting should be determined by a staffing plan developed by registered nurses, some of whom are direct patient caregivers. The rationale for this approach is: (Select all that apply.) -Having nurses who provide direct care involved in developing a staffing plan will prevent cost from being the major influence on determining the number of staff required on a unit. -Mandated staffing ratios may prevent an adequate staffing pattern in some circumstances, when unusual resources are required for a particular patient. -Decisions by staffing committees made up of registered nurses are more likely to be accepted by the nursing staff. -Multiple factors, such as patient acuity and nurse experience, influence the time required to adequately care for the patient. This requires nursing judgment to determine the standard. All of these are correct

All of these are correct

Which one of the following organizations published the Cole of Ethics for Nurses that provides provisions for eliminating discriminatory practices against patients and nurses? -National League for Nurses -American Nurses Association -National Council of State Boards of Nursing -Sigma Theta Tau International Nursing Honor Society

American Nurses Association None of the other organizations has a published Code of Ethics for Nurses.

A newly hired nurse has observed bullying behaviors on her new unit that include gossip, demeaning, criticizing, and intimidation. She also feels other nurses are avoiding her or giving her the silent treatment. The unit manger does little to address these behaviors. The consequences of this toxic culture include all of the following EXCEPT: Increase in anxiety, low self-esteem, and sleep disorders among the staff Loss of productivity and potential for high staff turnover Potential for patient safety errors that may increase the cost of care An increase in teamwork and communication

An increase in teamwork and communication Bullying behaviors negatively impact teamwork and communication and can contribute to all of the other issues listed.

A clinical unit just received its patient satisfaction scores for the last month and the unit's scores are lower than that of other general medical/surgical units in the hospital and much lower than previous scores. Which of the following would be appropriate strategies for addressing the low patient satisfaction scores at this time? (Select all that apply). Institute an hourly rounding program. Ask for volunteers for a committee to make recommendations to investigate and address the problem. Examine nurse turnover data from the unit in comparison to other units. Ask staff members what they think might be the cause of the decline. Institute a training program on how to improve patient satisfaction.

Ask for volunteers for a committee to make recommendations to investigate and address the problem. Examine nurse turnover data from the unit in comparison to other units. Ask staff members what they think might be the cause of the decline.

Susan discovers that the first CNA refused to help her co-worker ambulate a very obese, high-risk pregnant patient to the bathroom. Susan should: Ask questions about the safety of the patient. Give them a lecture on working together as a team. Describe the anger and upset as inappropriate behavior.

Ask questions about the safety of the patient. When the conversation refocuses onto the patient, this can also de-escalate the situation and help the staff members look more critically at their behavior.

The two CNAs have a history of problems with each other and usually don't work the same shift. Working together today is a fluke. The nurse should: Ask questions about what triggered the upset. Separate the two and send each to a different area on the unit. Ask them not to talk to each other for the remainder of the shift.

Ask questions about what triggered the upset. Again, having each person share her perspective often de-escalates and informs the situation. In addition, suggestions for a resolution of the incident may emerge.

How can a leader deal fairly with employees who fail to meet established standards of care? First, determine if the employee issue is a will or skill issue. Ask questions of the employee that can reflect the employee's knowledge base. Conduct a chart review that reflects the care issue.

Ask questions of the employee that can reflect the employee's knowledge base. It is appropriate to obtain more information and questions regarding the employee's knowledge base of both the standards of care and the evidence. Policies and procedures help add to this information so that the leader can make the best assessment possible. The leader could also use scenarios.

When the leader observes the employee has a significant increase in errors and may have some emotional problems, the most appropriate response is: Schedule a series of meetings with the employee to support and assist the employee in addressing the problem. Put the employee on the first steps of disciplinary action. Ask the employee some questions ending with a suggestion that Employee Assistance might be an option.

Ask the employee some questions ending with a suggestion that Employee Assistance might be an option. The leader is not a psychotherapist and should not attempt to address an employee's possible depression. Most organizations have Employee Assistance as a part of the benefit package. A limited number of visits are at no cost to the employee and could be of great benefit.

After providing the unit staff with an in-service class on shared governance models, the manager knows the education was effective if staff do which of the following? (Select all that apply.) Assemble a subgroup of staff to develop new unit policy. Boast openly about the quality of their direct involvement through shared governance to their colleagues from other units. Develop a peer recognition program. Ask the manager to determine policy for the unit. Request a team be assembled to implement a clinical ladder. Search the literature together for best practice articles regarding a clinical question.

Assemble a subgroup of staff to develop new unit policy. Boast openly about the quality of their direct involvement through shared governance to their colleagues from other units. Develop a peer recognition program. Request a team be assembled to implement a clinical ladder. Search the literature together for best practice articles regarding a clinical question.

Managers may or may not be leaders; however, managers do all of the following EXCEPT: -Avoid addressing complexity so that the staff does not worry and change may occur anyway. -Collaborate and translate direction into action, warning the team of potential barriers to the vision. -Build a culture of teamwork. -Organize, plan, control, and solve problems

Avoid addressing complexity so that the staff does not worry and change may occur anyway. Managers must address complexity and facilitate change. They must communicate and encourage the dissemination of information to allow staff to be a part of the change process and be engaged in solutions. They must be fully transparent with their team to obtain the appropriate buy-in to change

Which of the generations is challenged by sharing leadership with other generations? -Generation Y -Baby Boomers -Generation Z -Generation X

Baby Boomers Baby Boomers are more likely to want to do the work themselves than to rely on someone else who may not have the same work ethic as they have. They tend to see the younger generations as less dedicated to excellence and less willing to work as hard as they do.

Janice wants to be a change agent. Which action listed below would be the most appropriate for Janice to take? Seek help from her nurse manager. Become an early adopter. Wait until a more experienced nurse vocalizes support. Talk to a peer on another unit about the problems with more experienced nurses.

Become an early adopter. Any nurse can be an early adopter by championing and promoting a change. Early adopters often help motivate other nurses to make the change.

Which observation by the charge nurse indicates the new nurse needs additional education regarding the safe use of the electronic health record? -The care assistant needs to document and asks to use the nurse's computer; before the care assistant begins documentation, the nurse logs out of the system. -The nurse using a computer outside of the patient room minimizes the screen when a family member approaches. -The nurse logs off the computer before walking away. -Before leaving the patient's room, the nurse minimizes her documentation on the computer screen.

Before leaving the patient's room, the nurse minimizes her documentation on the computer screen. While minimizing the documentation removes it from immediate view, it is not a secure method to lock down patient information. Logging off or password-locking the system is the best process for securing patient information.

Being able to think systematically involves: -Refusing to come to staff meetings on your day off. -Focusing on the number of patients each nurse is assigned, unrelated to patient acuity. -Being able to consider the "Big Picture," beyond the needs of your unit. -Considering what nursing tasks need to be completed before the next medication pass.

Being able to consider the "Big Picture," beyond the needs of your unit. A systems thinker has the big picture by looking beyond what is going on during a shift or the events of the nursing unit. The other options demonstrate a focus on short-term objectives and lack of flexibility.

Upon entering a patient's room, the Emergency Department nurse observes a visitor attempting to choke the patient. The visitor appears agitated and is screaming at the patient. The patient is gasping and looks cyanotic. What should the nurse do first? Call security for help. Attempt to remove the visitor from the room. Assess the patient for injuries. Attempt to reason with the visitor and calm him or her down.

Call security for help. The nurse should not attempt to intervene in this situation with a clearly agitated and aggressive visitor. In this situation, the safety of the nurse is the primary concern. Assistance is needed to first control the situation, remove the aggressor, and then assess the patient and provide appropriate care.

When administering medications to a patient utilizing bar-code technology, what is the most important first step? -Scan medication. -Scan patient's identification band. -Check 5 Rights. -Administer medication.

Check 5 Rights. While all steps are imperative in the medication administration process, it is most important to remember technology does not replace standard nursing practice (5 Rights) and safely caring for the patient

Ms. Viola questioned if her staffing ratios demand the use of high-level delegation strategies. What "delegation right" is she assessing? Person Circumstances Task Communication/Direction

Circumstances Ms. Viola is assessing the circumstances (environment) on the unit to determine if she needs to use high-level delegation strategies to provide high-quality patient care.

Which of the following statements is true? -Although decision making and problem solving are similar, only problem solving requires critical thinking. -Decision making and problem solving are similar. -Although decision making and problem solving are similar, only problem solving can improve the practice of nursing. -Decision making and problem solving are synonymous.

Decision making and problem solving are similar. Decision making and problem solving are not synonymous terms. However, the processes for engaging in decision making and problem solving are similar. Both skills require critical thinking, which is a high-level cognitive process, and both can be improved with practice.

Delegation, a multifaceted decision-making process, is implemented for all of the following reasons EXCEPT to: Achieve nursing goals. Improve the work performance of staff. Decrease the registered nurses' accountability. Improve patient care outcomes.

Decrease the registered nurses' accountability. Delegation is a multifaceted decision-making process implemented to improve the work performance of staff, improve nursing care, and achieve nursing goals. The registered nurses maintain accountability for delegation decisions.

Managers can effectively reduce workplace stress, improve job satisfaction, and promote a positive work environment by doing all of the following EXCEPT: -Bringing in food for all shifts and encouraging social support among the team. -Eliciting support, communicating to the team that deadlines are quickly approaching and that the department is performing poorly. -Building strong relationships within the leadership team as well as other peers. -Encouraging autonomy in the workplace.

Eliciting support, communicating to the team that deadlines are quickly approaching and that the department is performing poorly. The manager's role is to encourage and facilitate job satisfaction, while focusing on social supports that are intended to reduce stress. Autonomy and maintaining a positive work environment are paramount to ensuring a healthy workforce. Demoralizing the department by pressuring them and demeaning them is not motivating to a team.

"The tendency of an individual or group to impose values, beliefs, and practices on another culture for varied reasons" is which of the following? -Transculturalism -Cross-culturalism -Ethnocentrism -Acculturation

Ethnocentrism The correct answer "ethnocentrism" is defined in the chapter as stated. The other terms are also defined within the chapter.

Healthcare prices are set using the same economic equilibrium found in all major industries. True or False -False -True

False Prices in health care are not set by the same economic equilibrium found in all major industries. For the most part, healthcare pricing is highly influenced by the government and the reimbursement plans. For example, both Medicare and Medicaid impose pricing on hospitals and there is no room for negotiation

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented on children returning from surgery. According to total quality improvement (TQI), to correct the problem, the educator, in consultation with the patient care manager, would do which of the following? Have a group of staff nurses review the established standards of care for postoperative patients. Call a meeting of all staff to discuss this issue. Talk to the staff individually to determine why this is occurring. Document which staff members are not recording vital signs and write them up.

Have a group of staff nurses review the established standards of care for postoperative patients. The educator should request the manager provide time for select unit staff to participate in quality improvement measures, including reviewing the established standards of care for postoperative patients. Having the entire unit involved is inefficient and premature

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented on children returning from surgery. According to total quality improvement (TQI), to correct the problem, the educator, in consultation with the patient care manager, would do which of the following? -Have a group of staff nurses review the established standards of care for postoperative patients. -Call a meeting of all staff to discuss this issue. -Talk to the staff individually to determine why this is occurring. -Document which staff members are not recording vital signs and write them up.

Have a group of staff nurses review the established standards of care for postoperative patients. The educator should request the manager provide time for select unit staff to participate in quality improvement measures, including reviewing the established standards of care for postoperative patients. Having the entire unit involved is inefficient and premature.

A new graduate is asked to serve on the hospital's Quality Improvement Committee. The nurse understands that the first step in quality improvement is to: -Collect data to determine if standards are met. -Implement a plan to correct the problem. -Identify the standard. -Determine if the findings warrant correction.

Identify the standard. The first step in the quality improvement (QI) process is to identify the needs most important to the consumer of healthcare services, which includes identifying the standard to be measured. See Box 20-3 for the six steps of the QI process

A new graduate is asked to serve on the hospital's Quality Improvement Committee. The nurse understands that the first step in quality improvement is to: Collect data to determine if standards are met. Implement a plan to correct the problem. Identify the standard. Determine if the findings warrant correction.

Identify the standard. The first step in the quality improvement (QI) process is to identify the needs most important to the consumer of healthcare services, which includes identifying the standard to be measured. See Box 20-3 for the six steps of the QI process.

When entering the postoperative care unit, the nurse manager notices that the temporary agency nurse has incorrectly entered the rate of infusion for the patient's vasopressor medication and that the arterial line is indicating a blood pressure of 76/40. Discontinuing the intravenous infusion, the nurse manager's next most appropriate action is to determine which of the following? -The nurse in charge of the unit -If there are standing orders for interventions for hypotension -If the temporary nurse has had an orientation to the unit -If there is an assigned resource nurse to serve as mentor for the temporary nurse

If there are standing orders for interventions for hypotension Patient safety is always the first concern, and attention must first center on ensuring the patient's welfare. To prevent such an occurrence in the future, the nurse manager should next determine who is in charge of the unit. Questions to ask the charge nurse include asking about the temporary nurse's qualifications and experiences caring for critical postoperative patients, if a resource nurse was assigned to the temporary nurse so that the temporary nurse had a mentor and could ask questions if needed. Finally, the nurse manager should ask about the orientation to the unit and whether the temporary nurse was informed about the types of intravenous pumps used in this facility, how to set the appropriate drip rate, and the necessary monitoring of patients who are receiving vasopressor agents.

For years, a small community hospital had a wound/ostomy nurse who took all photographs of pressure ulcers and uploaded a picture to the patient's medical record. The nurse retired and now nursing administration is expecting that registered nurses should assume this responsibility. Which of the following should be included in planning to use evidence for this approach? (Select all that apply.) Include staff members in planning for this policy change. Demonstrate that the literature indicates that taking photographs of pressure ulcers is inappropriate unless the photographer is a wound/ostomy nurse. Organize a meeting with nursing administration to recommend that a wound/ostomy nurse be hired. Perform a literature search for the evidence for best practice for taking photographs of pressure ulcers. Determine whether the evidence demonstrates that staff nurses are reliable in taking photographs of pressure ulcers.

Include staff members in planning for this policy change. Perform a literature search for the evidence for best practice for taking photographs of pressure ulcers. Determine whether the evidence demonstrates that staff nurses are reliable in taking photographs of pressure ulcers.

The nurse manager on a skilled nursing unit notices that the number of patient falls in his unit has escalated over the past year, resulting in a fall rate that is below the target projected for this unit. The best evidence-based approach to reducing the number of falls is to: -Place patients at risk for falls close to the nursing station. -Institute a safety restraint policy. -Increase the number of total nursing hours on the unit. -Purchase side rails that are easy to raise and lower.

Increase the number of total nursing hours on the unit. Research supports the idea that patient falls increase when there is insufficient staffing on a unit. While putting patients who are at risk for falls close to the nursing station is often appropriate, it is not the most effective strategy. Restraints are a poor nursing strategy for preventing falls, and although side rails may be helpful, they do not stop patients from falling when getting out of bed or in other situations

Which of the following represents outcomes of transformational leadership? -Increased job satisfaction -Pay tends to be higher. -Work is completed according to the rules. -Deadlines are met.

Increased job satisfaction People tend to have higher satisfaction when they are motivated and intellectually stimulated, as are hallmarks of the transformational leader. Regimented, deadline-oriented leadership does not tend to promote higher job satisfaction.

An 83-year-old Caucasian man is admitted to a large suburban nursing home. Today, an African-American nurse's aide is assigned to care for the patient and assist him with a shower. The patient refuses to go with the nurse's aide for the shower. Later in the day, the patient's son arrives and insists that no African Americans be allowed to participate in the patient's care. Only a few nurse's aides and professional staff members in this setting are African American. Which of the following is the best strategy for addressing this issue? Since this will be the patient's home, plan the care to accommodate the family's wishes. Indicate that it is not within the institution's practice to restrict who provides care to patients. Refer the patient and his son to the administration. Offer to have someone else bathe the patient today until someone in administration can talk with the patient.

Indicate that it is not within the institution's practice to restrict who provides care to patients. Acceding to the patient and family's demands about restricting caregivers is discriminatory and makes it difficult to appropriately staff the facility. Hospitals, nursing homes, and other healthcare facilities should disclose their nondiscriminatory practices to patients and train staff on how to deal with such requests. Patients have a right to refuse treatment, but they do not have the right to demand that treatment only be provided by certain people. This is disruptive to the usual workflow and could be a safety issue for all patients in the facility.

An Iranian woman is admitted with a tentative diagnosis of pneumocystis carinii. She is being tested for HIV. The patient has limited English proficiency and her 21-year-old daughter has been translating for her. The daughter asked the nurse why blood tests are being done and when the results can be expected. The nurse indicates she wants to speak to the mother alone. However, both mother and daughter indicate that the nurse should proceed with the explanation. Which of the following is the best response? Refer the patient to the healthcare provider. Proceed with the explanation. Insist that a telephone language translation service be used. Provide the patient with a Farsi language pamphlet on HIV and AIDS.

Insist that a telephone language translation service be used. Sharing sensitive information with the daughter present violates the patient's right to privacy. In addition, in this instance, it may have serious consequences for the patient if others in the family learn about the tentative diagnosis and plans for HIV testing. Using a telephone language translation service is consistent with the National Standards on Culturally and Linguistically Appropriate Services. Providing a pamphlet does not provide the patient with the opportunity to ask questions. Referring to the healthcare provider does not address the problem of providing the patient with appropriate healthcare information.

The ICU soon implements the new evidence-based nursing practice for early identification and management of sepsis. Janice is concerned that the nurses with more experience will not want to adopt a new protocol or change practice patterns. This is an example of which of the following? External barrier Internal facilitator Internal barrier Change strategy

Internal barrier Internal barriers are restraining factors that are found within the organization or unit where the change is occurring.

Inherent characteristics of culture are often identified by the following. Which one is NOT true? -Members learn to share it. -It changes with ease. -It develops over time. -It is essential for survival and acceptance.

It changes with ease. Options B, C, and D are true statements. Option A is not true: culture does not change with ease but rather changes with difficulty.

You are the nurse manager for a busy intensive care unit (ICU). Two patients are awaiting admission to the ICU; one is a 42-year-old bank president admitted through the emergency center with a diagnosis of an acute myocardial infarction, and the other is an elderly woman who experienced a cardiac arrest on the general medical unit. After reviewing the charts of all the patients already in the ICU, you contact the physician about a patient who can safely be discharged to a general medical unit so that two beds will be available for the two people awaiting admission. The ethical principle that you have most closely applied is that of: -Respect for others -Beneficence -Fidelity -Justice

Justice Justice concerns treating people equally and fairly. Both patients awaiting admission to the ICU are equally in need of the medical and nursing care available in this unit. The next best choice is respect for others, transcending culture differences, gender issues, racial concerns, and, in this instance, age differences. Though one of the patients is much younger and seemingly more affluent in the local society, both are deserving of the highest quality care. Beneficence could also be said to be applied in this instance; doing good by assuring that both patients are admitted to the unit. Fidelity is the least applicable principle in this instance as it pertains to keeping one promises and commitments and, given the facts of the scenario, there is no indication of any promise being made to either of the patients to be admitted.

A long-term acute-care hospital adopted an evidence-based protocol to reduce the rate of catheter-associated urinary tract infections. One year after the protocol was adopted with moderate success, a senior staff nurse continues to insist on calling the healthcare provider for an order to insert a urinary catheter. Which of the following characterizes the behavior of this individual in relation to the adoption of innovation? Early majority Late majority Laggard Early adopter

Laggard Laggards, according to Rogers (2003), are most secure in holding on to the past. They are most comfortable when an idea cannot fail.

Managers need to address all but which of the following when effectively implementing organizational change that promotes patient safety? -Actively manage the change process. -Involve the staff in decision making in the redesign of the workflow. -Create and sustain trust -Learn quickly as you must complete all tasks before the end of the shift.

Learn quickly as you must complete all tasks before the end of the shift. Managers need to view themselves as a change coach, enabling a positive work environment for the staff. While managers must learn and create a positive learning environment, this environment does not occur by the end of a shift or day. The environment is transformed over time

The ability to transfer selected nursing activities in a given situation to a competent individual is known as: Responsibility. Accountability. Legal authority. Supervision.

Legal authority. Legal authority is the ability to transfer selected nursing activities in a given situation to a competent individual. Responsibility is the reliability, dependability, and obligation to accomplish work. Accountability determines if the actions taken were appropriate and provides a detailed explanation of what occurred. Supervision is the oversight of delegated work.

Which of the following is not a rule of leadership? -Maintain balance -Listen to people. -Maintain a positive attitude. -Maintain likeability.

Maintain likeability. Although likeability may derive from effective leadership, it may not always be the case when leaders strive hard to do the right thing

Susan, a new nurse, discovers two of the certified nursing assistants (CNAs) in the utility room speaking loudly and pointing at each other. The most appropriate action is to: Continue walking down the hall, believing they will work it out. Make an observation about their behavior and ask what's going on. Walk into the utility room and tell them to stop or they will be reported to HR.

Make an observation about their behavior and ask what's going on. Effective communication requires staying calm, focused, and centered. Being in "reaction" with people demonstrating negative behavior does not solve the problem and usually inflames it. The leader needs more information in these situations.

What type of performance appraisal is based on the employee and manager jointly setting goals? -Behaviorally anchored rating scales -Critical incidents -Narrative method -Management by objective

Management by objective No other answer option has the employee and manager jointly setting goals.

In the delegation process, all of the following factors need to be assessed EXCEPT: Predictability of outcomes. Patient's condition. Medical insurance of the patient. Complexity of the task to be performed.

Medical insurance of the patient. In the delegation process, the three major factors that need to be assessed are the patient's condition, complexity of the task to be performed, and the predictability of outcomes. The patient's medical insurance is not a factor in the delegation process.

Two employees disagree about who should work Christmas Day. The bottom line is that one employee will have to work and the schedule must be posted tomorrow. As the nurse manager, how can you best help them resolve the conflict? Use your position of power to resolve the conflict. You decide who will work Christmas Day. Meet with both employees at the same time. Engage them in the problem-solving process. Rely on centralized staffing to resolve the issue. Try to arrange a compromise. Have one employee work the first half of the shift and have the other work the second half.

Meet with both employees at the same time. Engage them in the problem-solving process. Effective leadership involves guiding and coaching followers to resolve conflict versus employing an autocratic conflict-handling approach to unit management. Being present during the discussion facilitates and promotes conflict resolution strategies that are comfortable and effective for the individuals involved. This approach also strengthens the problem-solving skills of followers and allows each nurse to receive guidance as appropriate.

The chief nursing officer (CNO) of a large metropolitan hospital is preparing to defend her request for more staffing in certain units during budget development. Research has illustrated that a number of outcomes are improved when there is sufficient staffing on the unit. To make her case for more nursing staff, the CNO should gather data on which outcomes associated with staffing patterns and highlighted in the research? -Number of errors in patient care identified over time on a unit -Average length of stay of patients on a unit -Unit revenue generated -Number of physicians who regularly admit patients to a unit

Number of errors in patient care identified over time on a unit Inadequate staffing has been linked to an increase in the number of patient care errors.

Which of the following statements is true regarding complexity theory? -Nurses can understand the dynamic nature of health care processes using complexity theory -The need for additional staff can be justified based on complexity theory. -Complexity theory is used to explain the relationships among leading, managing, and following -Complexity theory is used to predict the health and illness trajectory of critically ill patients

Nurses can understand the dynamic nature of health care processes using complexity theory. The complex nature of health systems and related processes can be best understood using complexity theory. Option A is incorrect because complexity theory does not project medical outcomes. Staffing is not directly tied to complexity theory; therefore, option C is incorrect. Leading, managing, and following are concepts related to management, but their interrelationships are not explained by complexity theory.

An incident report of the incident described in Question 1 needs to be completed. The most appropriate wording to be included in the incident report is: -Nurse MJ started the vasopressor medication; the patient subsequently was noted to have a blood pressure reading of 76/40, the medication was discontinued, and the physician notified -Patient receiving vasopressor medication intravenously; blood pressure fell to 76/40 and intravenous infusion discontinued; physician notified and the patient given 500 mL of IV fluid over 15 minutes. -Patient was noted to have a low arterial blood pressure (76/40) and the vasopressor medication was discontinued. -Patient's vasopressor medication was infusing at a higher rate than ordered and the medication was discontinued when the patient's blood pressure dropped to 76/40.

Patient receiving vasopressor medication intravenously; blood pressure fell to 76/40 and intravenous infusion discontinued; physician notified and the patient given 500 mL of IV fluid over 15 minutes. The most complete incident report note is Option D because it states what was happening, why an intervention was needed, and the follow-up care for the patient. Option A is also correct but is less desirable as there is no mention of what follow-up measures were done to ensure the patient's welfare. Options B and C are incorrect; there should never be a mention or indication, however slight, of liability in the incident report, as it could later be used in a court of law to show liability against the healthcare providers and the institution.

A rural, critical access hospital has used a total patient care model to deliver nursing care to patients because of the hospital's commitment to individualized care to patients in the community. Environmental factors such as a nursing shortage in the area and limited profitability of the hospital have forced the nursing administration to consider another, less expensive model of nursing care delivery. They want to continue their commitment to individualized care to the extent possible. Which model of care would be most appropriate in this situation? -Primary care -Team nursing -Functional nursing -Patient-centered care

Patient-centered care The patient-centered care model of care maintains the commitment to individualized care; however, it uses less expensive unlicensed assistive personnel to extend the practice of the registered nurse.

The nurse manager in ICU develops a plan to implement the new sepsis management protocol. The plan includes education, focused sessions to discuss concerns with the staff, and sepsis warning signs in various places on the unit. This is an example of which of the following? Planned change Complexity management Unplanned change Open Systems

Planned change Planned change is deliberate and organized and has the goal of improvement.

What should an applicant review before attending a job interview? -Relocation expenses -Salary ranges for position -Position description -Corrective action processes

Position description It is vital that the applicant have a clear understanding of the job description and what is expected of them in the position. Salary ranges and relocation expenses are a discussion to be held if offered the position. Corrective action processes are not critical for the applicant to know prior to the interview.

In order to maximize authority and accountability for all aspects of the nursing practice in the nurses responsible for the delivery of care, the most effective strategy an organization can take is to: -Position management and administrative levels to coordinate and facilitate the work of the practicing nurses. -Define in specific detail the daily activities of frontline nurses. -Have nurses report directly to physicians. -Develop multidisciplinary teams of care providers.

Position management and administrative levels to coordinate and facilitate the work of the practicing nurses. With a focus on shared governance, effective organizations design structures to provide nurses maximum autonomy over the decisions that impact the care they deliver.

Which of the following best demonstrates the concept of followership? -Assessing a clinical situation and following a set of guidelines in order to delegate tasks to unlicensed personnel -Preparing for a committee meeting by reviewing the agenda and supplemental materials, so that you can be an active participant in the meeting -Completing the tasks associated with your patient assignment without deviation with the intent of receiving praise from your manager -Administering medications to patients in conjunction with other nursing actions in order to make effective use of your time

Preparing for a committee meeting by reviewing the agenda and supplemental materials, so that you can be an active participant in the meeting A follower would prepare for a meeting so that he or she can be an active participant, rather than arriving to the meeting unprepared to contribute to the group activities. Options A and C are examples of activities associated with managing. Option D is an example of time management and does not reflect followership.

A nurse manager wants to highlight the accomplishments of the nurses who are providing high-quality care on a medical unit in a tertiary care medical center. Which of the following is an example of a nurse-sensitive outcome that could be used for this project? Percentage of patients with heart failure who are prescribed an ACE inhibitor on hospital discharge Pressure ulcer rate compared to a national benchmark rate Patient satisfaction scores compared to other hospitals Nurse satisfaction scores compared to other hospitals

Pressure ulcer rate compared to a national benchmark rate Nurse-sensitive outcomes are patient outcomes that are primarily dependent on the quality of nursing care rather than a multidisciplinary team effort. Although patient satisfaction is an important measure, it may not necessarily be linked to the quality of care. The prescription of an ACE inhibitor is an outcome measure dependent on medical care.

A new graduate nurse is considering employment opportunities. He wants to make sure he works for an organization that has similar beliefs as he does about nursing. Which of these documents would NOT provide him information to help him make his decision? -Product line -Organizational chart -Nursing philosophy -Organizational mission

Product line An organization's culture is reflected in its mission statement. A philosophy of nursing describes the organization's beliefs about nursing, health, and patients. A review of the organizational chart typically demonstrates the level of empowerment and independence of nurses within the organization. A product or service line describes an integrated organizational structure focused on a specific service.

A nurse manager wants to decrease the number of medication errors that occur within her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a total quality management philosophy by: Suggesting that the pharmacy department explore their role in the problem. Changing the unit policy to allow a certain number of medication errors per year without penalty. Recommending that a multidisciplinary team assess the root cause of the medication errors. Explaining to the staff that disciplinary action will be taken for further errors.

Recommending that a multidisciplinary team assess the root cause of the medication errors. The goal of quality management is to improve systems and processes, not to assign blame. Assembling an interprofessional team to assess the root cause of medication errors allows an avenue to comprehensively explore a systems problem and collectively identify a course of action firmly grounded in data that can be embraced by all involved disciplines. See Box 20-1.

A nurse manager wants to decrease the number of medication errors that occur within her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a total quality management philosophy by: -Suggesting that the pharmacy department explore their role in the problem. -Changing the unit policy to allow a certain number of medication errors per year without penalty. -Recommending that a multidisciplinary team assess the root cause of the medication errors. -Explaining to the staff that disciplinary action will be taken for further errors.

Recommending that a multidisciplinary team assess the root cause of the medication errors. The goal of quality management is to improve systems and processes, not to assign blame. Assembling an interprofessional team to assess the root cause of medication errors allows an avenue to comprehensively explore a systems problem and collectively identify a course of action firmly grounded in data that can be embraced by all involved disciplines. See Box 20-1.

Mr. Grandion was admitted to a rehabilitation center after discharge from a hospital. He has not walked in 5 days while he was hospitalized and is provided a wheelchair. Dining with other residents is expected, and staffing is limited on a holiday weekend. What is the best strategy to be sure Mr. Grandion has sufficient nutrition and exercise? -Request help from another unit before dinner and indicate the nature of help needed -Tell Mr. Grandion to stay in bed and someone will bring a tray to his room because the staff can't get him to the dining room in time for dinner -Order a lift device to transfer Mr. Grandion from his bed to the wheelchair -Assist Mr. Grandion into his wheelchair and remind him that in 2 hours he must be in the dining room if he wished to eat.

Request help from another unit before dinner and indicate the nature of help needed. Leaving Mr. Grandion in bed fails to provide any exercise. Assisting him to the wheelchair 2 hours in advance of when he needs to eat may pose physical discomfort and the potential for skin breakdown. Ordering a lift device might be useful, but it might not be timely. Requesting help to prevent personal injury and aiding Mr. Grandion into a wheelchair in a timely manner provides some activity and helps him gain appropriate nutrition.

The nurses at a community hospital are selecting research articles to use for the development of a new protocol for the removal of indwelling urinary catheters in surgical patients. This would be characterized as which of the following? Review of the literature Implementation science Evidence-based practice Research

Review of the literature A review of the literature includes seeking and analyzing information by identifying and selecting articles for review. Research involves the generation of new knowledge. Evidence-based practice involves the synthesis of best available evidence along with patient preferences. Implementation science involves identifying scientifically based strategies for implementing a practice change.

In reviewing staffing patterns on a unit, the nurse manager finds that in the last 2-week pay period, one of the nurses has worked seven 12-hour shifts. Two of these shifts were 7 AM to 7 PM; the remainder were 7 PM to 7 AM. The nurse manager should have an individual discussion with the nurse to: -Ask her to share her work schedule, since other staff may complain about a lack of opportunity to work overtime. -Review the research regarding the relationship between patient errors and fatigued nurses. -Put her on "warning" for putting patients' safety at risk.

Review the research regarding the relationship between patient errors and fatigued nurses. Beginning evidence is emerging that working more than 12 hours and rotating shifts can lead to errors that compromise patient safety (Kane et al., 2007).

Role theory provides an appreciable framework for development and evaluation of staff. What term describes when employees are unwilling or unable to meet requirements? -Role clarity -Role conflict -Role ambiguity -Role acquisition

Role conflict Role conflict is the term used to describe the unwillingness or inability to meet the requirements of a particular role. Role ambiguity is lack of understanding of the role. Role acquisition is the ability to clearly take on the role. Role clarity is focused on the individual having a clear concept of the role they are expected to perform.

When caring for a patient who had a hip replacement that morning, a nurse is providing what level of care? -Tertiary -Secondary -Primary -Essential

Secondary Secondary care involves disease-focused or restorative care. Primary care describes preventive care while tertiary care refers to specialized or consultative health care.

Providing information involving an order for Foley catheter insertion for a patient of a different culture and language requires appropriate interpretation. Which one of the following actions should the nurse follow for the best outcome? -Assume the process of translating "word for word" is sufficient when a treatment is ordered for a culturally diverse patient. -Create or maintain a cross-cultural semantic/word equivalency vocabulary list for the nursing unit. -Request an English-speaking family member to provide the translation to the patient about the treatment. -Seek a healthcare professional translator to transfer verbally the source language to the target language with the patient about the anticipated treatment.

Seek a healthcare professional translator to transfer verbally the source language to the target language with the patient about the anticipated treatment. "Word for word" equivalency cannot be guaranteed; a family member may not provide the correct translation based on decoding of words or omission of important words about a treatment; when possible, if a healthcare professional translator is available, creating a cross-cultural semantic equivalency vocabulary list would be a benefit

The most important role of the nurse case manager is to: -Serve as a communication link between all providers of care. -Provide supportive therapy during the grieving process. -Provide education to patients regarding upcoming surgery. -Perform a psycho-social assessment of the patient and his family.

Serve as a communication link between all providers of care. The primary role of the case manager, according to the Case Management Society of America, is to increase the involvement of individual and caregivers in the decision-making process.

The nurse has received her assignment for the day and notices that her peer has a much lighter assignment in both number and acuity of patients. This is not the first time the nurse has noticed this inequity in assignments. She also has seen her peer and the charge nurse go to lunch together and knows that they spend time outside of work socializing. The nurse feels that this constant inequity in assignment is not fair. What is the best course of action for the nurse to address this problem? Confront the charge nurse about the inequity in the assignment. Avoid the issue and say nothing but remain angry about the situation. Share concerns with the charge nurse and find a mutually acceptable compromise for the situation. Approach the peer and ask to switch assignments.

Share concerns with the charge nurse and find a mutually acceptable compromise for the situation. Avoiding the situation creates feelings of powerlessness and frustration that can lead to the nurse feeling that she may not want to work in this environment, or may cause lack of focus that could result in patient safety concerns. Confrontation creates a power struggle and may escalate bad feelings for both parties. It may also affect the ongoing relationship between the charge nurse and the bedside nurse. Attempting to switch assignments without the charge nurse's involvement is unacceptable. The best solution to the problem is to initiate a dialogue with the charge nurse. This may shed light on the rationale behind the assignment and allows the charge nurse to acknowledge the nurse's concerns and negotiate an acceptable solution. It also allows the charge nurse to work on developing a better team environment.

James and Susan are new graduates employed in a small community hospital. They see that practices seem to be very physician driven and that patients have little input into their care. Families are seen as a nuisance rather than as partners in potential care provision. What is the best approach James and Susan might use to improve care in this setting? -Do nothing. They are too new to the organization to make change -Report the team members to the chief nursing officer who is unlikely to know the lack of details on this unit. -Share with their team members what they know about the aims of providing health care -Share with the physician the recommendations from various IOM reports

Share with their team members what they know about the aims of providing health care. As accountable professionals, doing nothing is not an option. The chief nursing officer (CNO) is likely to know the standard of care on every unit in a small community hospital and bypassing the unit manager violates a "chain of command" approach. Similarly, going to the physician fails to engage the nursing chain of command. Sharing with team members what the aims of providing health care are provides the opportunity to discuss patient-centered care.

Recently, a medical center surveyed its patients who smoked about their desire to quit. A high percentage were "motivated smokers," interested in quitting in the next 30 days, but were not offered resources to help with quitting. The nursing research council at a large medical center wants to introduce an evidence-based protocol for smoking cessation. Which of the following would be an appropriate initial action? Start a journal club to review the protocol. Survey nurses to determine barriers and facilitators to using smoking cessation interventions. Collaborate with physicians to develop a standard set of orders to be implemented for all patients. Distribute the protocol to all staff nurses.

Survey nurses to determine barriers and facilitators to using smoking cessation interventions. Advance planning should include a thorough and frank discussion of barriers and facilitators. Surveying the nurses would provide the opportunity to involve key stakeholders—in this instance, nurses—to understand the challenges they face in providing care related to smoking cessation. The other strategies may be employed later in the process.

You are caring for a 15-year-old female who has been admitted to the Emergency Department (ED) with severe abdominal pain. The teen's mother is present in the patient's room and does not let the teen really answer any questions. Which of the following is an appropriate strategy in continuing with the history and physical exam? Thank the mother for her concerns, indicating that some time will be spent examining the teen alone. Allow the mother to remain in the room for the entire history and physical exam. Insist that the mother remain outside the room during the patient's ED visit. Have the nurse manager explain the policy for treatment of adolescents.

Thank the mother for her concerns, indicating that some time will be spent examining the teen alone. Responding to the adolescent as a developing adult would include providing an opportunity for a private examination and confidential discussion of concerns. Being respectful of the mother while addressing the needs of the adolescent is the most appropriate strategy. The nurse should be familiar with local and state laws regarding care for adolescents. Nurses need to be sensitive to the teaching needs of different populations as well as developmental needs.

A cost-based system consists of: -A method in which the cost associated with the service is attributed in advance by a third party. -A method of reimbursement based on outcomes. -The cost of providing a service plus a mark-up for profit.

The cost of providing a service plus a mark-up for profit. Response option B describes a prospective payment system defined as a method in which the third-party payer decides in advance what will be paid for a service or episode of care. Response option C describes a pay for performance system that reimburses hospitals and eventually providers based on performance and outcomes and not on the cost associated with providing the care.

The nurse manager responsible for two units has one vacancy on each unit for one shift. Unit A is a well-functioning unit, although the acuity level of half of the patients is very high. Unit B has a lesser acuity but a less experienced staff. There are two nurses in the PRN pool who are available to work. The first nurse is 6 months from graduation with a BSN; the second RN holds an ADN, is currently in an RN to MSN program, and has 10 years experience as an ER nurse. Fill in the blank with the number of the nurse that should be assigned to unit A.

The first nurse Although Unit A has a high acuity level, the unit functions very well and can provide effective support for the inexperienced registered nurse

In a landmark study regarding nursing staffing, Aiken, Clarke, Cheung, Sloane, and Silber found that: -The greater the proportion of BSN-prepared nurses or higher employed by a hospital, the lower the risk-adjusted mortality. -There is no difference in the care delivery by RNs regardless of their educational or experience level. -The greater the proportion of RNs with 5 years' experience or more employed by a hospital, the lower the risk-adjusted mortality. -BSN-prepared nurses provide safer care than nurses prepared at other educational levels.

The greater the proportion of BSN-prepared nurses or higher employed by a hospital, the lower the risk-adjusted mortality. Aiken and her colleagues found, using a Pennsylvania nurse survey and patient discharge data from 1999 and 2006, that a 10-point increase in the percentage of nurses holding a baccalaureate degree in nursing within a hospital was associated with an average reduction of 2.12 deaths for every 1000 patients—and for a subset of patients with complications, an average reduction of 7.47 deaths per 1000 patients.

The California staffing law requires that a nurse should care for no more than a certain number of patients in specific units at any one time. The correct ratio of patients to unit type is: -Three patients in a labor and delivery unit. -Six or seven patients in a medical-surgical unit. -Ten patients in a psychiatric unit. -Three patients in the intensive care unit.

Three patients in a labor and delivery unit. Correct ratios: Two patients in an intensive care unit Five patients in a medical-surgical unit Four patients in a psychiatric unit

The main purpose(s) of collective action in nursing is/are which of the following? (Select all that apply.) To facilitate the orientation and competency of newly licensed registered nurses To establish and maintain standards of care To facilitate formation of a recognized bargaining unit (union) To create satisfaction and support in the practice environment To promote the practice of professional nursing To allocate resources effectively and efficiently

To establish and maintain standards of care To create satisfaction and support in the practice environment To promote the practice of professional nursing To allocate resources effectively and efficiently

Which objective best reflects the SMART objectives? -To successfully work as a team and gather all evidence to obtain the Beacon Award by December 2015 -To conduct a gap analysis for the Beacon Award -To obtain the Beacon Award -To think about applying for the Beacon Award

To successfully work as a team and gather all evidence to obtain the Beacon Award by December 2015 Option B contains all the components of the SMART objective: S-Specific M-Measurable A-Agreed on R-Realistic T-Time bound

There are three types of decision-making style: paternalistic, informative, and shared decision making. A shared decision model has been shown to increase productivity and work performance because: -The managers decide what is best for the team since the managers have more experience and have the competency to make decisions for their respective teams. -Just like the paternalistic model, it values the input of others and the staff may express and discuss options and preferences. -It is identical to the informative model. -Unlike the paternalistic model, decisions are made through an interactive, deliberate process and the staff may express and discuss options and preferences.

Unlike the paternalistic model, decisions are made through an interactive, deliberate process and the staff may express and discuss options and preferences. The decision-making style of a nurse manager can be conceptualized using three distinct models: paternalistic, informative, and shared decision making (Moreau, 2012). In the paternalistic model, the managers decide what is best for their team. The informative model offers the staff the ability to make a decision after the information has been shared and without the active involvement of the manager. In a shared decision model, the decisions are made through an interactive, deliberate process, and the staff may express and discuss options and preferences. The shared decision model has been shown to increase work performance and productivity, decrease employee turnover, and enhance employee satisfaction.

Which strategy can be used with nurses who are in the late majority group for the adoption of an evidence-based innovation to increase breast-feeding rates? Use of informal networks to foster positive attitudes Assigning the late majority nurses to patients who have already been successful with breast-feeding Incorporating an assessment of breast-feeding implementation into annual performance reviews Seeking and analyzing reviews that demonstrate the effectiveness of breast-feeding

Use of informal networks to foster positive attitudes Informal communication networks can be used to foster the development of positive attitudes for the implementation of a change. Gathering data about the breast-feeding would have occurred in the early phases of planning the project. Incorporating practices into performance reviews may have negative consequences and backfire. Selective assignment of patients does not address the problem.

A shared governance council has approved a new protocol for a delirium prevention program that is based on the latest evidence. Which of the following strategies might be included to enhance the effectiveness of this program? (Select all that apply.) Using academic detailing or educational outreach visits Disseminating evidence about the protocol in a journal club Distributing education materials on the clinical units Assessment of nurses' attitudes about caring for elderly patients Selecting individuals to serve as protocol champions Including only the early adopters in planning for the rollout of the program

Using academic detailing or educational outreach visits Disseminating evidence about the protocol in a journal club Assessment of nurses' attitudes about caring for elderly patients Selecting individuals to serve as protocol champions

Which one of the following behaviors is NOT an indicator of body movement used during a staff confrontation? -Gestures -Eye Contact -Word Choice -Physical closeness

Word choice "Word choice" is not a body movement. The other items are listed in the chapter as "body movements."

By creating a powerful image: -a nurse communicates self-confidence, competence, and a positive attitude toward nursing. -others, including patients, may be intimidated -others view a nurse as demanding and aloof. -a nurse indicates that direct patient care is demeaning to one's level of nursing knowledge.

a nurse communicates self-confidence, competence, and a positive attitude toward nursing. Being powerful is a positive professional attribute for nurses. It is the abuse of power that creates conflict and results in mistreatment of nursing peers and others.

Nurses were long viewed by physicians, legislators, the media, and others as powerless because nurses: -declined to participate in political activities in the earliest years of the profession in the United States. -as women were subject to control by medicine and other groups because women had limited legal rights in late 19th-century America -and nursing leaders in the mid-20th century did not wish to be viewed by those outside of nursing as pushy or demanding. -were subject to nursing practice acts that limited their ability to take political action.

as women were subject to control by medicine and other groups because women had limited legal rights in late 19th-century America. In nursing's earliest decades in the late 19th and early 20th centuries, society considered assertiveness, political involvement, and even peaceful protests to be unladylike. Women in most states could not vote (until passage of the Nineteenth Amendment to the U.S. Constitution in 1920); women could not own property or claim the incomes they earned in some states.

A patient's family asks the nurse why a clinical pathway is being used to determine her care. The best answer is "Clinical pathways: -help everyone caring for you to provide effective care based on research findings." -help us to give you care without spending too much money." -make sure you meet the criteria for improvement." -keep your doctors and nurses from giving care that is not appropriate."

help everyone caring for you to provide effective care based on research findings." Clinical pathways are designed to integrate research and best practices into the care

"Power in nursing" refers to the nurse's ability to: -demonstrate knowledge about organizational behavior. -use one's influence to create change in pursuit of goals. -act on issues that influence nursing licensure but not patient care. -protest unfair working conditions through walkouts and strikes.

use one's influence to create change in pursuit of goals. Power is the use of one's influence. Nurses use power to create change related to their goals for patient care, organizational effectiveness, development of the profession of nursing, access to health care for the nation, and other arenas/issues that involve nurses.