N402
When making a decision about using a prn pool for added staffing, what can the nurse manager do to make the best decision?
Make a decision with all of the facts.
Which of the following is a decision-making tool often used by today's nurse leaders/managers for program/unit evaluation?
Flow charts
A new nurse is working in the operating room suite. The nurse notices that the surgeon uses inappropriate humor concerning the patient while the patient is under anesthesia. What is the nurse experiencing?
Moral outrage
Which statement is true about an incident report? (Select all that apply.)
- A disclosed incidence report can be subpoenaed in court. - The document is generally considered confidential. - The chart should contain all the variables related to the incident.
What is the term used to identify the omission of doing something that a reasonable person would do, guided by the considerations that ordinarily regulate human affairs?
Negligence
A 94-year-old patient with end-stage renal disease is refusing to take any prescribed medications, saying, "They make me feel sick, and I want to enjoy the rest of my short life." Which of the following responses by the nurse is best?
You can certainly decide not to take these medications, but first I want to make sure you know why they were prescribed.
A nurse is determining whether the outcomes were met for a patient preparing for discharge with an open abdominal wound and reassessing if not met. What phase of the nursing process is the nurse performing?
Evaluating
What is the role of the nurse manager in assuring ethical nursing practice on the unit? Select all that apply.
Implementing the best decision with attention to cost Identifying desired outcomes Expert problem solver Primary decision make
Which of the following strategies should nurse leaders use to promote evidence-based practice?
Staying current with professional issues
The nurse manager has an obligation to act as advocate for which entities? (Select all that apply.)
The staff The patient The profession Themselves
Which situations are necessary components for malpractice to occur? (Select all that apply.)
- A direct connection between care given and injury must be present. - A standard of care must be in place whereby the provider has accepted duty for the patient. - The practitioner has failed to meet a standard of care, also called a "breach of duty." - Foreseeability of harm must exist.
A nurse explains the informed consent form to a patient who is scheduled for heart bypass surgery. Which elements are considered essential to the effective establishment of informed consent? (Select all that apply.)
- Competence of the patient must be determined prior to consent - Comprehension of the information by the patient or guardian - Full disclosure of information regarding the procedure
One of the first actions a new nurse manager must address is the unit practice of posting photographs on social media of staff with favorite patients without the patient's permission. When planning communication about this topic, the nurse manager intends to use which communication techniques? (Select all that apply.)
- Differentiating between information and communication, ensuring that the unit staff receive both types of communication - Ensuring congruence in verbal and nonverbal communication with the staff - Preparing written communication with clear and specific language
Staff development activities on a nursing unit occur for a variety of reasons, including to establish or improve competence in an area, or to provide annual training for mandatory competencies. Which topics would be covered in an annual in-service of the mandatory child abuse reporting process for all nursing staff? (Select all that apply.)
- Discussion of actual case studies of child abuse to review obvious and concealed circumstances. - Demonstration of the electronic Child Protective Services (CPS) form that must be completed by a CPS staff member on every report made. - Review of the state statute on mandatory child abuse reporting. - Review and discussion of recent journal articles on child abuse detection and prevention.
What must a person giving informed consent for surgery or a procedure fully comprehend in order to give informed consent? Select all that apply
- Expected complications or potential side effects that may occur as a result of the treatment. - The risks involved - Expected or desired outcomes - The procedure to be performed
The Health Insurance Portability and Accountability Act ensures strong privacy protections for the patient without threatening access to which areas of care? (Select all that apply.)
- Health care plans - Health care clearinghouses - Exchange of patient information among appropriate health care providers
Which steps will help the nurse minimize the risk of nursing malpractice? (Select all that apply.)
- Periodically reviewing the scope of practice for nurses - Observing all facility policies and procedures when providing care - Maintaining liability insurance independent of that provided by the facility - Attending relevant continuing education programs to upgrade clinical skills
Which behaviors by a nurse can result in the suspension or revocation of the nursing license? (Select all that apply.)
- Practicing on an expired nursing license - Failing to report an incident of substandard nursing care - A felony conviction for drug use - Being convicted of professional negligence
Which statement is true regarding the Good Samaritan law? Select all that apply.
- Protection provided is generally limited to emergency situations. -The provider may not exceed scope of practice limits.
A nurse manager must be aware of what is happening on the unit to prevent injury to the patient and exposing the staff to a potential malpractice situation. What steps would the nurse manager take to accomplish this? (Select all that apply.)
- Providing disciplining those who provide inappropriate care - Assuring adequate staffing - Regularly checking the credentials of current nursing staff - Arranging for relevant staff in-services regarding the operation of equipment
What rights do patients have? (Select all that apply.)
- The right to protection of their privacy - The right to end treatment without physician consent -- The right to informed consent -The right to respectful care free of discrimination
What information is accurate when describing the Nurse Practice Acts? (Select all that apply.)
- They need to be consistent with applicable federal statures - They identify actions that fall outside of the nurse's scope of practice - When considering the law, they are an example of a statute - They focus on the practice of the professional nurse
A nurse manager is making a decision based on a problem with a staff member. What would be the optimal end product of the decision?
A chosen course of action
What best describes someone who is an informal nursing leader
A well-respected nurse with years of experience on the unit becomes a team leader.
Which of the following competencies are important for the nurse leader to develop?
Ability to diagnose a situation, adapt, and communicate
When considering the MORAL decision-making model, what step is the nurse engaging in when developing the plan of care?
Affirming
Which document addresses the role of the nurse in taking appropriate action regarding instances of illegal, unethical, and/or inappropriate behavior when caring for a patient population of any age
American Nurses Association (ANA) Scope and Standards of Practice
When the care required of a patient comes into conflict with the nurse's personal beliefs, what situation exists?
An ethical dilemma
A nurse manager is holding a meeting to discuss a sensitive issue with the staff. A previous meeting was held regarding the same issue and it ended in a negative manner. What action can the manager take in order to minimize the impact of leader/group style mismatch?
Appoint a leader as a participant.
Samantha's assessment of Mary reveals that Physician Orders for Life-Sustaining Treatment (POLST) would be beneficial. How should Samantha best address Mary's need for POLST?
Assess Mary's ability to have an informed dialogue about POLST.
The nurse is admitting a new patient and is collecting data through obtaining a health history and physical assessment. What phase of the problem-solving process is the nurse focusing on with the patient?
Assessing
The nurse engages in actions to promote the good of the patient. The nurse is engaging in fulfillment of which ethical principle?
Beneficence
A nurse educator determines that the present classroom environment is ineffective in promoting critical thinking. What methods could the educator employ in the classroom to improve critical thinking? (Select all that apply.)
Case studies Problem-based learning exercises Simulation
Which type of law regulates the practice of nursing?
Civil law
What is the nurse's best safeguard against legal prosecution?
Competent practice
A nursing staff is presently using disposable biopsy forceps in the endoscopy suite, and the nurse manager is questioning the cost-effectiveness of this practice. What would be an appropriate decision-making model to find a cost-efficient solution?
Decision grid
A nurse manager is mentoring a new facilitator. What decision-making models can the manager suggest to the facilitator that will help minimize the impact of an unskilled facilitator?
Decision tree Consequence table Decision grid Payoff table
An experienced nurse using contingency theory is orienting a new graduate to the unit. What needs will the nurse meet with the new graduate using this theory? (Select all that apply.)
Counseling Developing Coaching
How can the nurse manager best minimize the personal risk for legal liability?
Creating a work environment that prioritizes patient needs
A nurse is arrested for possession of illegal drugs. What kind of law governs this type of activity?
Criminal
According to Marquis and Huston (2021), there are other critical elements that nurse managers/leaders use to complete the decision-making process. From the following choices, select those that are considered crucial to problem solving and decision making.
Develop realistic timeline Carefully gather pertinent data Think logically Objectives clearly define
Samantha has approached Dr. Gonzalez in an effort to discuss Mary's care, and it is clear that they disagree about the necessary approach. What should Samantha do in order to promote a collaborative approach to conflict management?
Discuss Mary's situation with Dr. Gonzalez and try to agree on a common goal for her care.
A nurse is travelling to work on the highway. The nurse sees a car get hit from the rear. The car spins out of control and hits the median. The nurse stops to help at the scene. Legally, the nurse may do this based on the Good Samaritan Law. What ethical framework is the Good Samaritan Law based upon?
Duty based
A nurse educator in a college setting has developed leadership skills as a result of attaining further education and sharing positive change within the department. What transformational leadership characteristic is this nurse educator demonstrating?
Empowering others
A nurse leader is considering using transformational leadership. What information would the nurse leader need to keep in mind?
Empowerment of both the leader and follower occurs
Which of the options below correctly correlate the decision-making model to the nursing process?
Evaluate: Evaluate decision-making steps Implement: Choose alternative, implement alternative
TRUE OR FALSE: Decision-making tools such as decision trees or consequence tables are in place to prevent errors in the decision-making process.
FALSE
TRUE OR FALSE: Rationales and justification for decisions need to be communicated to stakeholders only when there is lack of clarity.
FALSE
TRUE OR FALSE: The American Nurses Association Code of Ethics is legally binding.
FALSE
TRUE OR FALSE: The HIPAA Privacy Rule provides protection for individually identifiable health information on a state level and may differ state by state
FALSE
TRUE OR FALSE:A patient can give informed consent by verbalizing understanding prior to receiving a complete explanation of medical-surgical treatment options.
FALSE
TRUE OR FALSE:The person who generates the lawsuit is the defendant.
FALSE
The nurse manager on the unit where Mary is receiving care is applying Crisham's (1985) MORAL decision-making model to Mary's care planning. What is the nurse manager's best initial action?
Gather as much specific information about Mary's status and circumstances as possible.
As a new graduate nurse is transitioning into her first pediatric nursing job, which statement suggests that this new nurse needs additional training, as identified by her preceptor and nurse manager?
I'm so glad we have a CPS case worker in our hospital to deal with all this. I could never do that job!
A nurse has a difficult decision to make regarding patient care. What should the nurse due to influence a positive outcome? (Select all that apply.)
Identify a number of different options. Gather data and input from a variety of sources. Slow down the thinking process Understand the repercussions of each option
Which step in the problem-solving process assists the nurse leader to prioritize the problem or issue?
Identifying the problem
A nurse is educating a patient who is scheduled to undergo an open cholecystectomy how to turn, cough, and deep breathe in order to prevent complications after the procedure. What phase of the nursing process is the nurse providing
Implementation
A nurse determines that action is justified for a patient with limited mobility after an injury. After a plan for a solution has been identified, what is the next step in the problem-solving process?
Implementing
A nurse is caring for a patient that suddenly becomes short of breath and has a decrease in oxygen saturation to 86%. The nurse places the patient on 4 L of oxygen via nasal cannula and elevates the head of the bed. What decision tree would the nurse have used in this situation?
Intuitive judgment
The registered nurse is planning assignments for patients on a short-stay observation unit. Which activity should be assigned to the licensed practical nurse/licensed vocational nurse (LPN/LVN)?
Irrigate and apply a sterile dressing to a leg wound
For which reasons does the nurse manager understand that frequent individual and group communication is critical to employee satisfaction? (Select all that apply.)
It motivates all staff to do their jobs well and go "above and beyond." It provides a shared vision for all staff to work towards. It gives the opportunity for the manager to clarify policies and organizational changes.
A nursing instructor is discussing ways to improve critical thinking during a clinical rotation with a student. The student asks the nurse what critical thinking is. What is the best response by the nursing instructor
It requires reasoning and creative analysis.
An elderly patient is admitted to the cardiac floor for worsening congestive heart failure. As the nurse is obtaining baseline vital signs, the patient states, "My neighbor is in the ICU on one of those machines that keep people breathing forever. I never want to end up like that." Which response by the nurse is best?
It sounds likes you have given this a lot of thought. Would you like me to arrange for you to complete an advance directive and share this with your family?
The director of a busy outpatient department is meeting with staff to ask input and make decisions about the feasibility of a freestanding unit. What issue by the nurse manager can stop the entire process if not rectified?
Keeping the objective and expectations for the group undefined.
A nurse manager schedules a meeting with the staff to discuss policy changes. What does the manager hope to achieve by having some upper left-brain dominant staff members lend their input?
Logical and rational analysis
The pediatric nurse is admitting an 8-year-old child with cellulitis of both hands and arms from multiple infected bug bites in various stages of healing. The child has not received care for these infected bug bites. The nurse is upset and angry when she becomes aware that other unit staff have previously made several referrals to the local CPS agency about this family for issues related to neglect of care. Which ethical issue may be used to describe this situation
Moral outrage
A nurse does not assist with ambulation for a postoperative patient on the first day after surgery. The patient falls and fractures a hip. What charge might be brought against the nurse?
Negligence
A staff nurse is having difficulty with problem solving in patient care and the nurse manager is counseling the nurse. What suggestions by the nurse manager may assist the staff nurse in improving problem solving skills? (Select all that apply.)
Override bias Systematize data collection Slow down thinking
Samantha is applying the American Nurses Association Code of Ethics for Nurses when planning the next steps of Mary's care. When applying the principles of the Code, Samantha should prioritize what factor?
Protecting and promoting Mary's rights, dignity, and well-being
Which legal act gives patients the right to determine their desired end-of-life care?
Patient Self-Determination Act
Which of the following are behaviors associated with effective leaders?
Priority setting, critical thinking, skillful communication
When discussing the role of mandated reporting for suspected child abuse, the student nurse understands that not reporting suspected abuse could result in which legal action?
Professional negligence
A 12-year-old child visits the school nurse about tiredness. While assessing the child, the nurse notices a black eye, which the child says occurred during a fall on the playground. This is the third school nurse visit in one month for vague, nonspecific complaints. What is the school nurse's priority action?
Report suspicion of abuse to the local Child Protective Services (CPS) agency.
In a leadership class discussing the role of advocacy in nursing, the student nurse learns that these are patient advocacy nursing values when caring for a pediatric patient who may be a victim of child abuse? (Select all that apply.)
Respect Empowerment Autonomy Caring
The nurse is caring for a patient whose vital signs are not stable and who seems to be nearing the end of life. The provider orders the patient to be placed on life-sustaining treatments, but the nurse questions this order. The nurse is operating within which type of ethical framework?
Rights based—deontological
A new nurse manager is interested in a transformational leadership style. Which statement best describes this type of leadership?
Seeks input from all staff for joint problem solving with a focus on team building
A nurse educator determines that the present classroom environment is ineffective in promoting critical thinking. What methods could the educator employ in the classroom to improve critical thinking? (Select all that apply.)
Simulation Case studies Problem-based learning exercises
A nurse has a difficult decision to make regarding patient care. What should the nurse due to influence a positive outcome? (Select all that apply.)
Slow down the thinking process Identify a number of different options. Understand the repercussions of each option. Gather data and input from a variety of sources.
During a staff meeting, a nurse manager identifies interpersonal conflict occurring between two RNs about how best to schedule new graduate nurses. The manager responds, "You both agree that the schedule for the new graduates is critical to their success, so let's start there." Which conflict resolution strategy is the manager using?
Smoothing
A nurse manager is using the decision-making model "SWOT" to determine whether it is feasible to add another on-call team in perioperative services. What words does the acronym "SWOT" represent?
Strengths, Weaknesses, Opportunities, Threats
A staff nurse is having difficulty with problem solving in patient care and the nurse manager is counseling the nurse. What suggestions by the nurse manager may assist the staff nurse in improving problem solving skills? (Select all that apply.
Systematize data collection Slow down thinking Override bias
TRUE OR FALSE: A nurse can have his or her license revoked if he or she is providing patient care while under the influence of drugs or alcohol.
TRUE
TRUE OR FALSE: A wrong committed against another person or property is a tort
TRUE
TRUE OR FALSE: Adults learn differently than children; therefore, nurse leaders need to be familiar with teaching and learning styles to effectively educate staff members.
TRUE
TRUE OR FALSE: An organization's culture can affect the decision-making process.
TRUE
TRUE OR FALSE: Effective decision making is a learned behavior
TRUE
TRUE OR FALSE: Effective nurse leaders have developed critical thinking and decision-making skills that assist with collaborative leadership.
TRUE
TRUE OR FALSE: HIPAA gives the nurse leader a platform in which the nurse leader can prevent conflicts resulting from ineffective communication among staff members and patients.
TRUE
TRUE OR FALSE: If you become aware of the elements of the decision-making process, you will develop effective decision-making skills.
TRUE
TRUE OR FALSE: It is important that the nurse understands the difference between controlling a patient's decision and assisting the patient with an informed decision
TRUE
TRUE OR FALSE: Litigation is the process of bringing forth and trying a lawsuit.
TRUE
TRUE OR FALSE: Nurses should be concerned with the various laws and statutes that govern health care.
TRUE
TRUE OR FALSE: The "nursing process" provides a model for ethical decision making.
TRUE
TRUE OR FALSE: The key role that a nurse leader plays in regard to ethics in the workplace is to create an ethical working environment.
TRUE
TRUE OR FALSE: The nurse acts as the patient advocate with regard to informed consent.
TRUE
TRUE OR FALSE: Using first impressions to guide the decision-making process is a common flaw and considered a pitfall in using decision-making tools.
TRUE
According to the ANA Code of Ethics for Nurses, what is the nurse's primary commitment?
The application of ethical standards to the delivery of patient care
While focusing on preparing for an upcoming accreditation visit, a new charge nurse becomes aware of an interpersonal conflict between two nurses occurring on her shift. Given the pending accreditation visit, she decides to disregard the conflict. The nurse manager explains that which outcome may result from this avoidance approach?
The conflict will remain and reemerge at a later time in a more exaggerated way
During a home visit to a family of three—a mother, father, and child—the mother shares with the community health nurse that the father (who is not present) has hit the child on several occasions when he was drinking. The mother further explains that she has talked her husband into attending Alcoholics Anonymous and asks the nurse not to interfere, so her husband won't get angry and refuse treatment. What is the best response by the nurse?
The nurse commends the mother's efforts and also contacts Child Protective Services.
Leadership succession planning is defined as:
The organization has ensured that there are competent, qualified, well-prepared people available for future positions
Why should nurses be aware of the rights and duties of legal matters?
They are better able to protect themselves
A nurse is using the nursing process to plan the care of a newly admitted patient that has had a stroke. What is the benefit of using the nursing process to devise a care plan?
This method of problem solving can be transferrable to non-patient problems.
What term is used to identify the type of law that covers most incidences of malpractice?
Tort laws
The manager of several related departments brings the team together to inform them that they will all be cross training to other units for the purpose of increasing productivity. What form of leadership does this manager demonstrate?
Transactional
A nurse in a leadership role is committed to a vision for retention in the medical-surgical unit and is able to empower others with this vision. What form of leadership is this nurse demonstrating
Transformational
Choose one of the following words to complete this statement: "Effective leadership in nursing requires the individual to be self-aware in order to ________ the motivation of others."
Understand
A new nurse manager recognizes the importance of promoting a positive organizational culture on the unit. Which behavior indicates that this has occurred?
Unit staff meet weekly to share positive events, identify concerns, and review shared goals.
A nurse makes a decision using intuitive judgment regarding a patient's rapid change in condition. What action should the nurse take after the decision?
Use evidence-based data to validate decision
A nurse manager is having a difficult time in making a decision about reprimanding a staff nurse who has exceeded the absentee policy. Why would the manager's values cause personal conflict in making this decision?
Values often collide with one another
The nurse must get a consent signed by the patient regarding their upcoming surgery. She notes in the chart that the patient was medicated for pain one hour ago with hydromorphone. Ethically, what should the nurse do?
Withhold the consent until another time.
Samantha recognizes the need to adhere to the ethical principle of beneficence when addressing this challenge in Mary's care. Samantha can best promote beneficence in Mary's care by:
ensuring that Mary's best interests inform any decisions that are made.