leadership test 2 practice questions

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

3, 1, 4, 5, 2 Planning, organizing, and keeping the group on task are critical in ensuring that meetings are productive and that time is managed well.

High levels of work-related stress affect all but which of the following? (Select all that apply.) a. job satisfaction b. absenteeism and turnover c. nurses' health d. client welfare

a. job satisfaction b. absenteeism and turnover c. nurses' health d. client welfare Many writers and researchers have found that these work-related areas are adversely affected by stress.

Because of the complexity of reimbursement systems and its implications for the services available to patients, the nurse has a key role in: a. advocacy for patients with regard to services required and services utilized b. increasing the volume of services and decreasing the number of patients served c. accomplishing more with each visit and decreasing the volume of services used d. decreasing the volume of services used and the number of return visits

a. advocacy for patients with regard to services required and services utilized The specific strategies employed by organizations and nurses to contain costs and increase revenues depend on the reimbursement system(s) within which the organization operates and therefore on whether the volume of services is increased or whether the volume of services is decreased by placing greater emphasis on efficacy in each visit and reducing the number of return visits. Because of the complexity of the reimbursement environment, the nurse is placed in a position of advocacy in terms of what the patient needs and how those needs can be best met within the funding structures.

What best describes evidence-based practice? a. applying best research evidence to care of patients b. using research-based information to develop practice guidelines c. conducting a randomized control trial to determine the effectiveness of handwashing techniques d. developing standards for practice

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

As a nurse manager and the leader of the unit, you are aware of multiple avenues for learning leadership traits. Which avenues would you pursue for learning leadership traits? (Select all that apply.) a. attending professional conferences b. reading books on leadership c. joining professional organizations d. connecting with other leaders in the organization e. experiences from new nurses

a. attending professional conferences b. reading books on leadership c. joining professional organizations d. connecting with other leaders in the organization We can learn leadership through multiple avenues. For example, attending professional association meetings, reading, and connecting with others at a local, state, or national level allow us to learn from others about their development as a leader.

An RN on the dementia unit, is discussing the treatment of a paitnet who can be agitated and combative at bedtime. The physician orders a strong sedative to "knock the patient out". The nurse questions the order, based on her knowledge of the patient's history and of other medications that the patient has been given. The physician reiterates the order and the nurse refuses to comply. In this instance, the nurse is demonstrating: a. autonomy b. accountability c. authority d. best practice

a. autonomy Participation in decision making regarding one's practice is an appropriate expectation for professional nurses, provides for greater autonomy and authority over practice decisions, contributes to supporting the professional nurse, and is a major component of job satisfaction. Autonomy is encouraged through supportive management and through unit-level support of changes without the need for complex, multilevel approval of changes that can be made locally. In this situation, the nurse is exemplifying autonomy, which is the act of making independent decisions in the best interests of the patient, based on her knowledge and experience. Key to the concept of autonomy is decision making and the level of independence that is given. Accountability refers to achievement of outcomes, and authority refers to the capacity to make decisions.

Mr. Cruiser has been surfing the Web. He is looking for healthcare information on low back pain. He shows the clinic nurse a webpage he thinks is great and tells her that he has been following the exercises recommended by the author. He wants to know what she thinks about the site. When the clinic nurse evaluates this site, she discovers that its author is a personal trainer. No credentials are listed. In several testimonials on the page, people (their pictures are included) say how wonderful they feel after having done these exercises. The exercises all have animated demos when you click on the pertinent highlighted text or icon. They seem easy to follow. The site was posted 5 years earlier and was last updated 3 years before. The clinic nurse advises Mr. Cruiser to: a. avoid this site b. check with his primary healthcare provider c. continue with the exercises d. contact the author for additional exercise and feedback

a. avoid this site Patients need coaching as to how to use and decipher information that is available through the Internet. In this situation, the provider on the site lacks credibility because no credentials are listed, and the information is not current.

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

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

During times of nursing shortages and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny? a. case method b. team nursing c. functional nursing d. nurse case management

a. case method The case method may involve total patient care provided by a registered nurse, which, in today's costly healthcare economy, is very expensive. In times of nursing shortages, there may not be enough resources or nurses to use this model. This model is especially useful in the care of complex patients who need active symptom management provided by an RN, such as the care of the patient in a hospice setting or an intensive care unit. This method would be justifiable delivery in the pediatric intensive care unit, where the status of patients can change rapidly and where complex functions of care involve both patients and families.

During times of nursing shortages and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny? a. case method b. team nursing c. functional nursing d. nurse case management

a. case method The case method may involve total patient care provided by a registered nurse, which, in today's costly healthcare economy, is very expensive. In times of nursing shortages, there may not be enough resources or nurses to use this model. This model is especially useful in the care of complex patients who need active symptom management provided by an RN, such as the care of the patient in a hospice setting or an intensive care unit. This method would be justifiable delivery in the pediatric intensive care unit, where the status of patients can change rapidly and where complex functions of care involve both patients and families.

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

a. consciously evaluate invisible mental models -see above

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

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

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

a. consciously evaluate invisible mental models Senge theory on change suggests that each individual or organization bases activities on a set of assumptions, or a set of beliefs, or mental pictures about the way that the world should work. When these invisible models are uncovered and consciously evaluated, it is possible to determine their influences on work accomplishment. Senge theory on change has 5 organizational disciplines (box, og 329): shared vision - the process of creating a common view about where the organization is going mental models - the practice of helping individuals become aware of how they think, what they value, and how that affects organizational performance personal mastery - the fostering of openness in the face of change by managing self-awareness and using reflection team learning - the promotion of teams thinking together, collaborating, and sharing ideas, knowledge and perspective systems thinking - the development of frameworks that see the organization as a complex entity whose many parts affect outcomes

What is the first step to gather evidence for guiding practice? a. develop the clinical question b. identify the databases to be used c. appraise the evidence d. integrate available evidence with unit expertise

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

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

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

The nurse manager is working with a group of new nurses. The new nurses ask questions about leadership and the role of a manager in leading nursing. The manager shares the desire to have engaged staff nurses who participate in a team environment. What is the manager describing? a. effective follower b. effective leader c. ineffective follower d. ineffective leader

a. effective follower The manger has described the role of an effective follower on the unit. The effective follower identifies and engages and participates as member of the team to work to achieve the team goals.

What are the positive factors influencing healthcare consumers and their relationship with healthcare organizations? a. increased engagement of patients with their healthcare b. inadequate healthcare professionals discussing legislation bills related to healthcare c. healthcare professionals are held more accountable for patient outcomes e. delivery of cost-effective quality care is achieved by preparing nurses with a higher level of education in the ever-changing healthcare environment f. giving people a voice for changes they desire to achieive in healthcare f. patients use non-professional websites to research pathology and treatments g. management may place gaining approval and certification by deeming authorities above staff needs h. recognition and certification provides status and feedback for healthcare institutions on needed improvements and maintenance

a. increased engagement of patients with their healthcare c. healthcare professionals are held more accountable for patient outcomes e. giving people a voice for changes they desire to achieve in healthcare h. recognition and certification provides status and feedback for healthcare institutions on needed improvements and maintenance -see above

What are the positive factors influencing healthcare consumers and their relationship with healthcare organizations? a. increased engagement of patients with their healthcare b. inadequate healthcare professionals discussing legislation bills related to healthcare c. healthcare professionals are held more accountable for patient outcomes d. delivery of cost-effective quality care if achieved by preparing nurses with a higher level of education in the ever changing healthcare environment e. giving people a voice for changes they desire to achieve in healthcare f. patients use non-professional websites to research pathology and treatments g. management may place gaining approval and certification by deeming authorities above staff needs h. recognition and certification provides status and feedback for healthcare institutions on needed improvements and maintenance

a. increased engagement of patients with their healthcare c. healthcare professionals are held more accountable for patient outcomes e. giving people a voice for changes they desire to achieve in healthcare h. recognition and certification provides status and feedback for healthcare institutions on needed improvements and maintenance Social - positive factors - increased engagement of patients with their healthcare; healthcare professionals are held more accountable for patient outcomes negative factors - patients use unofficial/non-professional websites to research pathology; disgruntled patients can still accuse healthcare professionals on social media with incorrect narrative Economic positive factors - redesigned roles in healthcare and restructure of healthcare; access to care and quality management are essential components of cost control negative factors - delivery of cost effective quality care is achieved by preparing nurses with a higher level of education in the ever-changing healthcare environment Political - positive factors - giving people a voice for changes they desire to achieve in healthcare negative factors - not having adequate healthcare professionals discussing legislation bills related to healthcare; uninsured, underinsured Regulatory - positive factors - education to provide knowledge and healthcare competency for patients and staff; EBP to provide safe and competent patient care; recognition and certification provides status and feedback for healthcare institutions on needed improvements and maintenance negative factors - difficulty in implementing cost-effective changes; management may place gaining approval and certification by deeming authorities above staff needs

A staff nurse is taking leadership classes in an advanced degree program with a goal to become a nurse manager. The nurse is studying the leader-follower relationship. What has the nurse discovered as accurate part of the leader-follower relationship? a, leaders are also followers b. followers need hierarchical structures c. followers are submissive in nature d. leaders should dictate to the group

a. leaders are also followers In the leader-follower relationship, it is important to be aware the leaders are also followers. In reality, a core part of leadership is being an effective follower as well. There is no linear structure any longer and followers have as much input in decision making as is needed based on the topic. The older days of dictatorship as leadership are antiquated and no longer valid in true leader-follower relationships.

An example of an initiative that may reduce total healthcare costs would be: a. offering nurse-practitioner led clinics that educate parents about non-pharmacologic strategies for managing ear infections b. educating seniors about the comparative costs of medications that are prescribed to them c. lowering copayments for prescription drugs for seniors d. advocating for more readily available MRI services to ensure early diagnosis

a. offering nurse-practitioner led clinics that educate parents about non-pharmacologic strategies for managing ear infections Total healthcare costs are a function of prices that are established for various services and the volume or quantity of services used. Utilization of high-tech diagnostic services and lowering of copayments have been implicated in increasing total healthcare costs (thus C and D would not be correct), as well as attitudes and behaviors of consumers of health care. In general, consumers prefer to "be fixed" when something goes wrong rather than to practice prevention. Many consumers still believe that the physician knows best, so they do not seek much information related to costs and effectiveness of different healthcare options. When information is sought, it is not readily available or understandable. Also, consumers are not accustomed to using other, less costly healthcare providers, such as nurse practitioners.

A client requires an appendectomy. The surgeon explains the procedure and asks the client to sign the consent. The patient speaks very little English and looks worried. What is the appropriate action by the nurse? a. suggest that an interpreter explain the procedure to the client and answer any questions b. ask the client if they have any questions c. draw a picture to show the incision d. not intervene

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

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

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

As a new manager, you are shocked to learn that your unit is still using heparin in heparin locks. You are aware of evidence related to this practice and want to change this practice as quickly as possible on your unit. You are in which stage of Lewin's stages of change? a. unfreezing b. experiencing the change c. moving d. refreezing

a. unfreezing Although you may be at a higher level of change in relation to your individual practice and knowledge of the use of change, in this situation, you are recognizing the need for change in relation to practice on the unit that you are managing. This phase is the initial phase in first-order change and will involve listening to staff to see if they perceive a similar problem.

Which of the following would be most effective in implementing the findings to staff nurses regarding a new clinical treatment for an identified problem? a. presentation by physician b. an interactive in-service for the nurses that involves discussion of sample case studies and application of evidence c. presentation of the findings on a poster in the staff break room/lounge d. discussing the evidence presented in the studies with the informal leaders of each unit

b. an interactive in-service for the nurses that involves discussion of sample case studies and application of evidence Current research suggests that translation of research into practice is best facilitated through interactive learning such as workshops. Least effective strategies included didactic learning and distribution of learning materials.

Within a healthcare environment, where the gap between revenues and costs can mean the difference between sustainability of an organization and nonsustainability of an organization or services, it is critical for nurse managers to: a. maintain a clear vision of how to trim healthcare costs b. balance value-added services against costs and revenues c. consistently delete programs that are of high cost d. implement programs that bring in additional revenues

b. balance value-added services against costs and revenues To achieve and maintain financial viability, nurse managers must be able to think strategically financially and in terms of nursing care. Cutting costs by deleting programs and bringing in additional revenue through new programs and services are not in themselves strategic unless the decisions made lead to quality care, have positive outcomes, and are efficient in terms of cost.

A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. What would BEST support the capital request? a. number of patient care hours anticipated for the year b. cost comparisons; how much and how often infusion pumps are used; condition of existing pumps c. outline of cost for each pump d. estimation of total cost; no further details

b. cost comparisons; how much and how often infusion pumps are used; condition of existing pumps Complete well-documented justifications are needed because the competition for limited resources is stiff. Justifications should be developed using the principle of any business case and should include, at minimum, projected amount of use; services duplicated or replaced; safety considerations; need for space, personnel, or building renovation; effect on operational revenues and expenses; and contribution to the strategic plan.

Workplace Advocacy is designed to assist nurses working in an emergency department by: a. creating professional practice climates in their institutions b. equipping them to practice in a rapidly changing environment c. negotiating employment contracts d. representing them in labor-management disputes

b. equipping them to practice in a rapidly changing environment Workplace advocacy encompasses a number of activities that enable nurses to control the practice of nursing and to address challenges that they face in the practice setting. These activities include career development, employment rights, employment opportunities, and the labor-management relationship. The aim of workplace advocacy is to proactively equip nurses to practice within a rapidly changing environment, rather than to negotiate contracts or provide representation in employment disputes.

Data, information, and knowledge are core concepts in: a. database b. informatics c. biomedical technology d. communication technology

b. informatics Informatics is the application of technology to all fields of nursing to facilitate and extend nurses' decision-making abilities and to support nurses in the use, storage, and linkage of clinical information to provide effective and efficient patient care. The three core concepts are data, information and knowledge.

The chief nursing office of a Magnet® hospital has conducted a study of ways to improve healthcare services. Healthcare services that add value for clients: a. accomplish healthcare goals b. minimize costs c. decrease the number of services used d. use high-technology treatments

b. minimize costs Models of reimbursement affect which services and approaches (e.g., decreasing the number of services used) might be financially viable and add value for clients. It is critical to determine and advertise the value of nursing care. Services that add value are of high quality, affect health outcomes positively, and minimize costs.

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

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

Before beginning a continuous quality improvement project, a nurse should determine the minimal safety level of care by referring to the: a. procedure manual b. nursing care standards c. litigation rate of unsafe practice d. job descriptions of the organization

b. nursing care standards Standards establish the minimal safety level of care. Procedure manuals provide information about how standards are to be achieved.

A nurse manager wants to decrease the number of medication errors that occur in her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a total quality management philosophy by: a. explaining to the staff that disciplinary action will be taken in cases of additional errors b. recommending that a multidisciplinary team should assess the root cause of errors in medication c. suggesting that the pharmacy department should explore its role in the problem d. changing the unit policy to allow a certain number of medication errors per year without penalty

b. recommending that a multidisciplinary team should assess the root cause of errors in medication Quality management stresses improving the system, and the detection of staff errors is not stressed. If errors occur, reeducation of staff is emphasized rather than imposition of punitive measures such as disciplinary action or blaming. Leadership must identify safety shortcomings and must locate resources at patient care levels to identify and reduce risks. One method of doing this is to invite all staff into a discussion related to solutions to an identified concern. This approach encourages teamwork.

An example of one strategy used to improve participation in the change process by staff fitting the behavioral description of innovators and early adopters is to: a. repeat the benefits of change b. share change experiences early in the process c. initiate frequent interactions among staff d. provide select information to the staff

b. share change experiences early in the process Connecting innovators and early adopters to new ideas and with new peers keeps them at the cutting edge.

In a nurse managers' meeting, the chief nursing officer encourages the managers to brainstorm ways to reduce costs. Nurse managers have the greatest impact on reducing costs by managing: a. supplies b. staffing c. fixed costs d. medication costs

b. staffing Because staffing constitutes the largest portion of any healthcare budget, managing the mix and numbers of staff required for patient care to meet identified outcomes will have the largest impact on budgets.

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

b. two part-time staff members are hired to work in a unit, but the job expectations for them are unclear, and the head nurse expresses disappointment in their performance Role stress is an additional stressor for nurses. Viewed as the incongruence between perceived role expectations and achievement, role stress is particularly acute for new graduates. Failure to comply with expectations can lead to role conflict. Role conflict and role ambiguity are major sources of conflict for nurses.

The clinical coordinator expects the position description of the new wound care specialist to change nurses' responsibilities in caring for clients with skin integrity problems. The best approach to address this need for change, yet to have the best outcomes for clients, staff nurses, and the organization, is to: a. select one of the change models b. use Lewin's model and principles of change c. apply both planned and complexity theory approaches d. form a task force of nursing staff and wound care specialists

c. apply both planned and complexity theory approaches In the second stage, the moving or changing stage of Lewin theory, planned interventions and strategies, such as education, vision building, and incremental steps towards the change, are executed to support the implementation of the change. This situation potentially also involves complexity theories that recognize that change involves engagement of individuals and subsystems throughout the unit and organization.

To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must: a. be able to effectively communicate with patients b. build relationships with physicians c. be able to adapt to daily changes in staffing d. adapt in communicating information to her supervisor

c. be able to adapt to daily changes in staffing A particular challenge in team nursing is that staff mixes and staff may change daily because of individual schedules and shortages. Team nursing delivers care to a small group of patients, using a mix of licensed and unlicensed personnel. Team nursing uses the strengths of each caregiver.

To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must: a. be able to effectively communicate with patients b. build relationships with physicians c. be able to adapt to daily changes in staffing d. adapt in communicating information to her supervisor

c. be able to adapt to daily changes in staffing A particular challenge in team nursing is that staff mixes and staff may change daily because of individual schedules and shortages. Team nursing delivers care to a small group of patients, using a mix of licensed and unlicensed personnel. Team nursing uses the strengths of each caregiver.

Nurses need to know how to operate a computer, compare data across time, and look for patterns in client responses to treatments. These are examples of: a. competencies for knowledge technology b. competencies for data knowledge c. competencies for informatics d. competencies for EBP

c. competencies for informatics The Quality and Safety Education for Nurses (QSEN) project identified informatics competency as a necessary component of the knowledge, skills, and attitudes for quality patient care. Nurses are anticipated to be able to use information and technology to communicate, manage knowledge, mitigate error, and support decision making. Nurses must utilize hospital database management, decision support, and expert system programs to access information and analyze data from disparate sources for use in planning for patient care processes and systems.

A nurse manager questions the true difference between primary nursing and total patient care. After careful consideration of both models, the nurse manager concludes that primary nursing differs significantly from total patient care in: a. breadth of nursing knowledge and expertise required b. intention to provide holistic nursing c. degree of task orientation d. levels and types of assessment

c. degree of task orientation Significant overlap can be seen between primary nursing and total patient care in terms of breadth of assessment and knowledge required to provide holistic care. A primary difference is that nurses in the total care model assume accountability while on shift, whereas primary nurses assume responsibility from time of admission to discharge and 24 hours a day.

Which of the following is the most effective method an organization to ensuring that EBP is incorporated into nursing care? a. formation of nursing-only implementation teams b. restriction of evidence to RCTs c. formation of a network of individuals doing research and/or interested in research utilization d. avoidance of partnership with experienced researchers

c. formation of a network of individuals doing research and/or interested in research utilization Collaboration, partnerships, and consideration of a variety of evidence appropriate to the clinical questions are important in ensuring translation of evidence into practice. Collaboration is considered particularly critical and can occur through practice-based networks. Journal clubs provide opportunities for engagement in reading research and considering how it might be applied to clinical practice problems, which is considered very effective in behavioral change.

A patient complains to the charge nurse that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." The nursing care delivery model most likely employed in this situation is: a. differentiated practice b. team nursing c. functional nursing d. case management

c. functional nursing Functional team nursing involves licensed and unlicensed personnel who perform specific tasks for a large number of patients. A disadvantage of functional team nursing is the fragmentation of care. The physical and technical aspects of care may be met, but the psychological and spiritual needs may be overlooked. Patients become confused with so many different care providers per shift. These different staff members may be so busy with their assigned tasks that they may not have time to communicate with each other about the patient's progress. Although repetition of tasks increases confidence and competence, it can also lead to boredom. Rotation of tasks can assist specifically in this model to reduce the boredom that is a potential disadvantage of this model.

A patient complains to the charge nurse that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." The nursing care delivery model most likely employed in this situation is: a. differentiated practice b. team nursing c. functional nursing d. case management

c. functional nursing Functional team nursing involves licensed and unlicensed personnel who perform specific tasks for a large number of patients. A disadvantage of functional team nursing is the fragmentation of care. The physical and technical aspects of care may be met, but the psychological and spiritual needs may be overlooked. Patients become confused with so many different care providers per shift. These different staff members may be so busy with their assigned tasks that they may not have time to communicate with each other about the patient's progress. Although repetition of tasks increases confidence and competence, it can also lead to boredom. Rotation of tasks can assist specifically in this model to reduce the boredom that is a potential disadvantage of this model.

To effectively achieve a change goal/outcome in a change situation, the wound care specialist will: a. preserve the status quo b. diminish facilitators and reinforce barriers c. weigh the strength of forces d. strengthen facilitating forces

d. strengthen facilitating forces For change to be effective, the facilitators must exceed the force of the barriers; thus, strengthening the facilitating forces would achieve this aim.

An older adult couple with limited means and on Medicare is considering options after the hospitalization of Mrs. A. with a fractured hip. Mrs. A. is stable but requires assistance with bathing, transfer, and mobility, and this will present stress for Mr. A., who was hospitalized with a mild myocardial infarction last year. Considering their means and health concerns, which of the following might be the best option? a. hospice care b. custodial nursing home care c. home care d. hospital care

c. home care Custodial nursing care is not covered under Medicare and therefore, the financial burden of this option may cause further stress for the couple. Medicare Part A is an insurance plan for hospital, hospice, home health, and skilled nursing care that is paid for through Social Security. Because Mrs. A. is stable and not terminal, she does not require hospice care. The assistance provided through home care is covered under Medicare and provides assistance for needs such as those of Mrs. A.

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

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

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

c. integrating the change This particular initiative assesses the success with which the change has been integrated into everyday practice after it has been experienced, or the degree to which staff members have accepted using the new infusion equipment.

Despite the implementation of bar-code medication administration (BCMA) on your busy medical unit, you notice that the number of medication errors has not significantly decreased. Which of the following reasons might explain the lack of change in errors? a. a number of new medications have been introduced into the hospital pharmacy that are not yet recognized in the CDS b. there have been an unusually high number of patients on the unit who have been unable to confirm their identity at the time of medication administration c. lack of staff understanding and support for BCMA has led to overrides or failures to scan bar codes during busy times d. clinical data that have been entered into the system to guide administration of the medications are outdated

c. lack of staff understanding and support for BCMA has led to overrides or failures to scan bar codes during busy times Most errors related to technology involve mislabeled bar codes on medications, mistakes at order entry because of confusing computer screens, or issues with management of information. Errors also are related to dispensing devices and human factors, such as failure to scan bar codes or overrides of bar-code warnings.

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

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

A nurse manager approves two staff nurses to attend a national conference. When reviewing the budget, the nurse manager looks at which line item? a. cash budget b. capital budget c. operating budget d. supply and expense budget

c. operating budget The operating budget includes a personnel budget, which takes into account productive and non-productive paid work hours. Education hours are covered under nonproductive paid work hours in the operating budget.

What is the primary purpose of QI programs? a. evaluation of the performance of staff b. determine if standards are appropriate c. patient outcomes improvement d. national accreditation preparation

c. patient outcome improvement The primary purpose of QI is improvement of patient outcomes, which relates to prevention of error, quality patient care, and patient satisfaction.

Sarah, RN, is one of your most enthusiastic staff members and has been to a workshop on preparing educational materials for patients. On the basis of this workshop, she would like to develop an information website for patients who are being admitted to the ward. An appropriate response to Sarah's suggestion would be: a. "that is a great suggestion, but we have no resources for such an expensive undertaking right now." b. "perhaps you can keep that in mind as we redesign our charting system." c. "we have too many seniors as patients, and you know that they don't use technology." d. "there is a great group here that meets to look at technology pilots. Let's see if you can join them and discuss your idea further."

d. "there is a great group here that meets to look at technology pilots. Let's see if you can join them and discuss your idea further." Involving Sarah with others who enjoy new ideas and who are able to try out new ideas in pilot projects enables her to remain on the cutting edge and to try out innovative solutions with the least amount of disruption.

A home health nurse has been assigned to cover a 300-square-mile area of remote Montana. Mrs. Baker has just been discharged home following bowel surgery and has a new colostomy. She will need daily contacts for at least 2 weeks and then regular weekly contact following that week. Because it is not possible to visit Mrs. Baker in person every day and see all of the other clients, the nurse gives her a laptop computer with net meeting software installed. Each morning, both dial in at an agreed-upon time and discuss her progress. The home health nurse assesses whether or not the client needs to be seen that day and is able to view the colostomy site. This type of technology is called: a. distance learning b. knowledge software c. telecommunications d. biomedical technology

c. telecommunications Telecommunications and systems technology facilitate clinical oversight of health care via telephone or cable lines, remote monitoring, information links, and the Internet. Patients sitting in front of the teleconferencing camera can be diagnosed, treated, monitored, and educated by nurses and physicians. EKGs and radiographs can be viewed and transmitted.

A new graduate nurse has accepted a position in an intensive care unit. The nurse is assigned a preceptor with several years of experience. The new nurse also notices the other staff seek this nurse out for answers to questions and as a resource to the unit. What does the new nurse consider the role of the mentor nurse? a. a formal leader b. a positional leader c. an official leader d. an informal leader

d. an informal leader Formal leaders, positional leaders, and official leaders hold positions of leadership or titles. In this scenario, the nurse is the formal leader of the unit. The nurse is noted to be an informal leader is one who does not hold an actual leadership title, but leads from an informal position based on experience and behavior.

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

d. applying strategies that aid in adoption of research in practice The science of how research is adopted is known as translation science, the science of translating research into practice (TRIP). The primary aim of research utilization is to activate the change process to move research findings into practice to improve patient outcomes. The National Institutes of Health identified translational research or getting research into the hands of practitioners to improve patient care, as a priority.

A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. This item would typically be included in which budget? a. operating b. strategic c. unit of service d. capital

d. capital Items that have a useful life of longer than a year, which is likely with the pumps, and that have a cost that usually exceeds $300 to $1000 (specific amount is set by the organization) are considered capital items. Operating budget items include what is used on a day-to-day basis, such as staffing.

As the unit manager, you spend a day performing direct patient care and work with a new system that is designed to capture patient documentation at the bedside. During discussions with staff while giving care, you discover that the number of screens that need to be opened during documentation makes charting more complex and time consuming than traditional manual charting approaches. On the basis of this feedback, you: a. assume that the system is doing what it needs to do b. provide reassurance to staff that the unit has achieved its goals in implementation of the system c. ask some of the staff if they have had similar experiences with the system d. consult chart audit data and end user consultation reports to determine if errors and problems are occurring

d. consult chart audit data and end user consultation reports to determine if errors and problems are occurring In Kotter eight-step change model, removing obstacles means keeping alert for barriers in structure and processes that limit the ability to change and then removing those barriers once they have been found.

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

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

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

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

The chief nursing officer works with her nurse managers by helping them understand how to develop and implement a budget. A nurse manager can best describe a budget as a: a. day-to-day plan for operations b. unit of service c. statement of revenues and services d. financial plan

d. financial plan The budget is an overall financial plan that reflects organizational assumptions, objectives, and standards, and various types of budget planning, including operational and capital budgets, which, in turn, reflect revenues and costs.

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

d. have good information literacy skills Time can be saved by using information technology effectively, as it assists with effective data retrieval and information gathering and with communication related to a variety of needs in the management setting.

The definition of follower has historically referred to a person who is subservient and submissive. The new principles of followership offer a different perspective. What is NOT considered an attribute of followership in nursing? a. independent decision making b. critical thinking c. patient advocate d. no influence over leaders

d. no influence over leaders A followership in nursing does have influence over the leaders in an organization. The followers are an integral part of the healthcare team in nursing and provide support, patient care, critical thinking, and decision-making skills.

The wound care nurse decided to involve those to be affected by change early in the change management process. This can positively result in: a. coordination b. resistance c. anticipation d. participation

d. participation Successful change means persistence and advancement of the change, which requires the undivided focus of all team members. Early involvement and participation are critical to capturing the undivided focus of team members.

In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager's main responsibility is the needs of the: a. department b. unit c. staff d. patient

d. patient The functional model of nursing is a method of providing patient care by which each licensed and unlicensed staff member performs specific tasks for a large group of patients. In a functional nursing model, where other team members are focused on performing specific tasks, the nurse manager assumes primary responsibility for patient outcomes.

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

d. political astuteness Political involvement/astutenss is a professional responsibility and nurses' perspectives of the critical issues for improving the healthcare system can shape the policy agenda of the nation's political leadership. This nurse exemplifies several of the skills associated with political astuteness. Collaboration refers to working with others for a common goal; while this collaboration can and does occur when working in professional organizations and committees, the example is specifically referring to being involved politically within and on behalf of the nursing profession. The same refers to power sharing and empowerment.

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

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

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

d. stressors that are identical do not necessarily have similar effects on each individual Stressors may be unique to certain environments, situations, and persons or groups, and individuals may respond to the same stressor in different ways.

Which of the following are considered variable costs? (Select all that apply.) a. salaries for the minimum number of staff b. utilities and rent c. managed care d. supplies e. medication and treatment supplies

d. supplies e. medication and treatment supplies The total fixed costs in a unit are those costs that do not change as the volume of patients changes. In other words, with either a high or a low patient census, expenses related to rent, utilities, loan payments, administrative salaries, and salaries of the minimum number of staff to keep a unit open must be paid. Variable costs are costs that vary in direct proportion to patient volume or acuity. Examples include nursing personnel, supplies, and medications.

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

d. they are closest to the front line of health care and see how it affects clients and families Nurses can no longer be passive observers of the political world. Political involvement is a professional responsibility. Nurses' perspectives of the critical issues for improving the healthcare system can shape the policy agenda of the nation's political leadership.

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

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