Chapter 22, 24, 26

16. In the situation described in the Multiple Response Question below, treating the patient with chest pain ahead of the patient with a migraine is a: a. Product aspect. b. Service dimension. c. Compassionate decision. d. Ritual.

ANS: B Service involves interaction between the consumer and the system related to provision of needs, which, in this situation, involved interaction of a patient with a migraine headache.

"The nurse asks the client whether the client has any allergies. This is an example of: A) Health history data B) Biographical information C) History of present illness D) Environmental history data"

A - Known allergies are a part of historical data. Biographical data include age, address, occupation, work status, marital status, course of health care, and insurance. The history of the present illness includes when the symptoms began, whether they began suddenly or gradually, whether they come and go, and other information about the illness. The environmental history includes data about the client's home and working environments.

"The nurse asks a client, ""Ms. Neil, describe for me your typical diet over a 24-hour day. What foods do you prefer? Have you noticed a change in your weight recently?"" This series of questions would likely occur during which phase of a client interview? A) Working B) Orientation C) Termination"

A - The nurse's questions exemplify the working phase of the interview.

"The nursing assessment is which phase of the nursing process? A) First B) Second C) Third D) Fourth"

A - The nursing process cannot proceed unless the nurse first conducts a client assessment. The other phases of the nursing process occur after assessment.

"What techniques encourage a client to tell his or her full story? (Select all that apply.) A) Active listening B) Back channeling C) Use of open-ended questions D) Use of closed-ended questions"

A, B, C - Options 1, 2, and 3 encourage clients to tell their full stories. Closed-ended questions allow clients to answer with one or two words, which makes it more difficult to obtain all the information required for a full story. The other options give clients the opportunity to tell their stories and feel supported. Active listening helps them feel that they, and their stories, are important.

"The nurse gathered the following assessment data. Which of these cues form a pattern? (Select all that apply.) A) Client is restless. B) Respirations are 24/min and irregular. C) Client states feeling short of breath. D) Fluid intake for 8 hours is 800 ml. E) Client has drainage from surgical wound. F) Client reports loss of appetite for over 2 weeks."

A, B, C - The data in items 1, 2, and 3—rapid irregular breathing, complaints of shortness of breath, and restlessness—form a pattern indicating that the client may be experiencing hypoxia, because all are signs and symptoms characteristic of this condition. The other information, although important, is not related to hypoxia.

19. Becky, RN, works as a staff nurse in mental health; Sharon works as a data entry clerk in Admissions; Sarah is an emergency room physician; and Donna is a housekeeper in geriatrics. Which of these four is most at risk for violence and aggression? a. Becky b. Sarah c. Sharon d. Donna

ANS: A Nurses are the primary target of violence in healthcare settings. Hader (2008) found that nurses experienced their colleagues as primary targets of violence 79.7% of the time

5. The nurse manager has to develop a patient satisfaction survey. What is one of the critical elements in selecting a patient satisfaction instrument? a. Being able to use the same instrument for all clinical units b. Including items that are important from the patient's perspective c. Being able to administer the instrument before a patient's discharge from the hospital d. Being sure that the reading level is no higher than third grade

ANS: B Because satisfaction is a measure of service and service is a measure of perception of what matters to the patient, to measure satisfaction, surveys must include items that reflect the perspective of the patient.

17. The patient in the Multiple Response Question eventually receives medication for his headache. Administration of the medication is: a. A product. b. A service. c. A requirement. d. Nursing care.

ANS: A A product is a tangible item with physical characteristics. The administration of medication involves a ritual and certain physical aspects involved in the act, which makes it a product.

20. In Question 19, which of the four is most likely to be a perpetrator of violence? a. Becky b. Sarah c. Sharon d. Donna

ANS: A According to Hader (2008), the perpetrator was a patient 53.2% of the time, a nurse colleague 51.9% of the time, a physician 49% of the time, a visitor 49% of the time, and other healthcare workers 37.7% of the time.

9. In the Emergency Department waiting room, you notice a patient sitting, with his head in his hands, who has been waiting for about 5 hours for relief of his headache. When you approach him to ask him how he is doing, he says "I can't believe that I have to wait this long for help! Do you know what it is like to be in pain for 10 hours?" Your response to him would be: a. "It is frustrating to wait when you are in pain and when you are expecting to receive relief right away." b. "Don't talk to me. If you are going to be rude, then you will not receive treatment here." c. "We are very busy and don't have enough staff to deal with problems such as yours." d. "Perhaps you should go elsewhere. We do not have time for you here, as many more sick patients are waiting."

ANS: A Empathizing helps the other person to know and feel that he has been understood and is powerful in de-escalating a situation that has potential for aggression and violence

11. In designing a Web-based program for seniors with Parkinson's disease, it is important to understand that: a. The program will not be used by half of the target population. b. Parkinson's disease affects younger patients as well. c. The program should include graphics as well as text. d. Seniors find it difficult to read computer screens.

ANS: A Half of the population over 65 does not use the Web, and 56% of those who do not use the Web have no education beyond high school.

16. The CEO of Bow Valley Hospital makes the following statement: "The reason we can't hire any more staff is the lack of government funding." This is a good example of which of the following conditions that propel a situation toward conflict? a. Incompatible goals b. Role conflicts c. Structural conflict d. Competition for resources

ANS: A Healthcare providers want to maximize the quality of care, whereas payers are concerned with minimizing healthcare costs; this exemplifies a conflict between goals

5. Sarah, a staff nurse on your unit, witnesses another nurse striking a patient. Sarah wants to remain friends with her colleague and worries that confrontation with her colleague or reporting her colleague will destroy their relationship. Sarah is experiencing which type of conflict? a. Intrapersonal b. Interpersonal c. Organizational d. Professional

ANS: A Intrapersonal conflict occurs within a person when confronted with the need to think or act in a way that seems at odds with one's sense of self. Questions often arise that create a conflict over priorities, ethical standards, and values. Some issues present a conflict over comfortably maintaining the status quo and taking risks to confront people when needed, which can lead to interpersonal conflict.

3. The nurse manager understands that the three Ps associated with client education include philosophy, priority, and performance. Effective client education programs start with a shared philosophy that such programs are worth the investment. Evidence of a philosophic commitment to client teaching is best represented by: a. Investing time and energy in teaching clients. b. Developing teaching skills among the nursing staff. c. Assuming that clients lack the knowledge they need. d. Having a teaching checklist on clients' charts.

ANS: A Investment of time and energy in teaching translates vision into action and communicates commitment to service.

8. Based on data from the patient satisfaction survey, the nurse manager decides that a change should be made in communication with family members. What would be important for a nurse manager to consider when instituting a change to improve customer service? a. Assess the perceptions of the nursing staff regarding the particular service problem. b. Include community representatives on a planning committee to address the change. c. Involve physicians, other healthcare professionals, and ancillary staff. d. Review all patient complaints with the nursing staff.

ANS: A Nurses, who are in the most continuous interaction with patients, are in an opportune position to understand the issues, structures, and processes that affect patients. The involvement of staff in sharing perceptions and solutions is empowering to the staff.

3. The nurse manager is aware that conflict is occurring on her unit; however, she is focused on preparing for a state health department visit, so she ignores the problem. A factor that can increase stress and escalate conflict is: a. The use of avoidance. b. An enhanced nursing workforce. c. Accepting that some conflict is normal. d. Managing the effects of fatigue and error.

ANS: A Purposeful avoiding is an appropriate strategy when the conflict is interpersonal and the individuals involved in the conflict have the necessary skills and insight to be able to own the problem and solve it themselves. When these conditions are not present and avoidance is not purposeful, then avoidance can increase stress and escalate conflict.

2. You need to terminate Gregory, who has had a long-standing history of conflict with you and the staff, and who recently was charged with theft of patient belongings. You consult Human Resources, and together, you develop a plan, which includes: a. A private meeting with Gregory, a Human Resources representative, and you to deliver the news and deliver the termination notice and all other documents that are related. b. Planning an opportunity for Gregory to return and be recognized at a staff farewell. c. Calling Gregory at home to tell him that he is fired, and that his paperwork will be sent to him at a future date. d. Calling him into a meeting in your office on the ward, where assistance is available, should he become upset or agitated.

ANS: A Termination requires careful planning as to timing, privacy, safety, and how to preserve the employee's dignity and avoid humiliation. Choosing a private location where colleagues are not present, and organizing all documentation that is required to be given to Gregory, achieves these goals and prevents his having to come to the organization at a future date

10. At 3 AM, a man walks into your emergency department. He paces back and forth in the waiting area before he approaches staff to ask if he can see his wife, who is a patient on another floor. He speaks rapidly, his face is flushed, he glances around often, and he keeps his hand in his jacket pocket. A best initial response would be to: a. Assess your situation and your surroundings. b. Ask two or three staff to assist in confronting the individual. c. Ask what floor his wife is on and remind him that visiting hours are closed. d. Remain calm as there is no potential for violence here.

ANS: A The behavior of the individual (flushed appearance, furtive glances, speed of speech) and the hand in his pocket suggest the potential for violence or aggression. The first step is to quickly assess your surroundings for others who might assist and for safety alarms.

20. As a nurse manager, you see an opportunity for patients to be well-serviced through the medical home concept. You recognize that the concept of medical homes: a. Currently does not include nurses in its vision of multifaceted primary care. b. Includes nurses as part of an interdisciplinary and multidisciplinary team. c. Restricts nurses to services related to direct care and procedures. d. Cannot encompass nurses within this framework.

ANS: A The concept of medical homes encompasses the idea of multifaceted medical homes that provide a usual source of health care. Current discussions have focused on physician-directed care.

9. The chief nursing officer is pleased with the nurse manager's strategy of improving patient satisfaction in the pediatric intensive care unit. She decides to implement these changes throughout the hospital. What would be important to consider in implementing a new program focused on improving relationships with consumers? a. Recognition of the nursing staff for excellence in promoting consumer relationships b. Holding the staff accountable for resolving patient complaints c. Selecting a staff nurse leader to implement the program d. Identifying key staff members who have already demonstrated excellence in consumer relationships

ANS: A The nurse leader should accomplish objectives through persuasion, should celebrate successes and accomplishments, and should communicate a shared vision.

7. After using a mediator to resolve a conflict between the nurse manager and two staff nurses, the chief nursing officer decides to: a. Observe to make sure the conflict has been resolved. b. Fire both staff nurses. c. Reassign both staff nurses. d. Reassign the nurse manager.

ANS: A The nurse leader should critically analyze organizational issues after a review of the evidence. Following up is important and necessary to maintain conflict resolution.

14. A nurse educator is giving a workshop on conflict. During the sessions, he makes various statements regarding conflict. All of the statements are true except: a. Conflict can decrease creativity, thus acting as a deterrent for the development of new ideas. b. Conflict can arise over the most trivial issues. c. A variety of definitions of conflict are known. d. All conflicts involve some level of disagreement.

ANS: A The opposite is true because research has shown that conflict, like change, increases creativity and allows for the development of new ideas.

6. In writing the patient satisfaction survey, the nurse manager is aware of the education levels of the families. What is the most critical element in the concept of health literacy? a. Providing instructional materials at appropriate reading levels b. Facilitating access to translators for persons with language barriers c. Obtaining, processing, and understanding basic health information so appropriate decisions can be made d. Knowing that most people have limited health literacy skills

ANS: A Unless health materials are written at a level that makes the material accessible to patients, then patients are unable to make sense of what has been written.

8. You are part of a multidisciplinary team that is charged with designing a workplace safety plan for your healthcare organization. This team has been established in response to increases in reports of violence and aggression. You begin by: a. Surveying staff about levels of satisfaction with the workplace and management, collegial, and patient relations. b. Offering training sessions in self-defense. c. Developing a policy that outlines zero tolerance for bullying. d. Offering education sessions on recognizing behaviors with potential for violence.

ANS: A Violence and aggression and a toxic workplace can lead to staff dissatisfaction and high staff turnover rates. Surveying staff provides a useful starting place in identifying problems such as employee dissatisfaction, bullying, and other forms of violence.

18. Joe and Carol, two of the RNs on Unit 22, are discussing recent incidents on the unit that have involved patients and visitors uttering threats or making demeaning remarks to staff during evening hours. Joe observes that unless someone shoots at him, he is not concerned because "words can't hurt you." Joe's remarks: a. Illustrate common misperceptions about the nature of violence. b. Accurately depict the difference between violence and aggression. c. Are partially correct because verbal remarks do not cause injury. d. Reveal possible issues that Joe relates to violence in his personal life.

ANS: A Violence and aggression involve verbal and nonverbal and covert and overt behaviors, and all forms are capable of producing short- and long-term injury that may have an impact on productivity, work performance, work attendance, and patient care.

1. In designing a new healthcare facility, it is particularly important to pay close attention to safety elements related to violence and aggression in which of the following settings? (Select all that apply.) a. Emergency b. Psychiatry c. Gerontology d. Maternal-child

ANS: A, B, C Although the potential for violence and aggression exists in all healthcare settings, emergency, psychiatric, and geriatric settings are at particular risk for violence.

1. Nurses entering into the workforce today are faced with which of the following relationships that could create organizational conflict? (Select all that apply.) a. Nurse-physician relationship b. Nurse-nurse relationship c. Nurse-patient relationship d. Nurse-chief nursing officer relationship e. Nurse-auxiliary personnel relationships

ANS: A, B, C, D, E By nature, conflict is potentially present in all interpersonal situations. The nurse manager should create an environment that recognizes and values differences in staff, physicians, patients, and communities.

7. Caroline asks family members to leave while she cares for the 16-year-old victim of a recent car accident. The father screams at her and tells her that she has no right to ask his family to leave, and that if she continues to do so, he will "throw her out of the room." Caroline is shaken and tells her head nurse, who tells her that this kind of thing is just part of the job. The guidance of the head nurse: a. Is reasonable. No physical violence was involved. b. Is related to why statistics on violence in health care are likely underreported. c. Acknowledges the deep distress and fear of the family. d. Acknowledges the concern of the nurse.

ANS: B A common perception is that incidences such as these, which do not involve physical injury or harm, but rather threats, are part of the job. Because of underreporting, data related to violence and aggression in the workplace may not be reflective of its true incidence

2. Two staff nurses are arguing about working on holidays. In trying to resolve this conflict, the nurse manager understands that interpersonal conflict arises when: a. Risk taking seems to be unavoidable. b. People see events differently. c. Personal and professional priorities do not match. d. The ways in which people should act do not match the ways in which they do act.

ANS: B By definition, conflict involves a difference in perception between two or more individuals.

10. In orienting new staff nurses to a pediatric intensive care unit, the nurse manager asks the staff nurses to answer the following question: "What is an important consideration in providing information to parents of a critically ill child?" a. Making sure that they receive complete information during each encounter with a member of the nursing staff b. Assessing parents' preferences for the amount of information desired c. Allowing parents to observe key aspects of their child's nursing care d. Making sure that patient education brochures explaining ICU protocols are readily available

ANS: B Consultation with the parents regarding the amount of information that they desire reflects a service orientation, in which preferences and needs of the consumer are placed first. The other answers reflect nurse-directed decisions in which the nurse decides what information and how much information is needed, and how it is to be delivered.

7. The nurse manager analyzes the data from the patient satisfaction surveys. What can a nurse manager do to strengthen service recovery and improve consumer relationships? a. Post comparisons of patient satisfaction scores with those of other units on a monthly basis. b. Involve the staff in resolving consumer issues quickly and effectively. c. Ensure that staff members apologize to patients when they complain about services. d. Ask that patients with complaints about services place them in a written format

ANS: B Consumers are more concerned with fairness and are more concerned with explanation than with apology. Staff can be assisted to respond to patient concerns through scripting, support, and an atmosphere that places an emphasis on learning and solutions rather than on blaming.

16. A patient who has a history of involvement with drugs and weapons comes up to you in the hallway and asks you a question regarding directions in treatment. When you respond, he moves closer in to you and puts both hands up on either side of your neck. No one else is in the hallway. Your best response at this point is to: a. Yell at him to stop. b. Calmly ask the patient to remove his hands. c. Hit the patient in the mid section. d. Use pepper spray.

ANS: B In a potentially violent situation, it is important to look and behave in a calm and confident manner, even if you do not feel calm or confident. The person that you are de-escalating will notice and take his cues from you

19. As a head nurse, you are concerned about whether your unit is managing pain well and study the results of a recent patient satisfaction survey very closely. Which of the following findings and approaches might provide useful information for you? a. Patients find nurses friendly and accessible; data are aggregated for the institution as a whole. b. Data indicate that nurses are responsive to requests for assistance; data are available for the unit and the institution. c. Specific questions related to management of comfort are included for the institution as a whole. d. The survey asks for a range of responses for the unit and the organization, with a focus on facilities, such as cleanliness and responsiveness of administrative services.

ANS: B Information related to the institution as a whole may not provide a useful benchmark for your unit in particular. The most useful information consists of data related to your unit, and although the questions might not reflect the quality of pain control achieved, questions related to responsiveness to need provide an indication of how well patients perceive needs, including perhaps those for pain control, being met.

18. John is a circulating nurse in the operating room. He is usually assigned to general surgery, but on this day he is assigned to the orthopedic room. He is unfamiliar with the routines and studies the doctor's preference cards before each patient. The fourth patient comes into the room and John prepares a site for a biopsy using a Betadine solution. The surgeon prefers another solution. He notices what John has done and immediately corrects him by rudely insulting John. Which of the following is the most appropriate approach to conflict resolution in this example? a. Collaboration b. Compromising c. Avoiding d. Withdraw

ANS: B Negotiation must occur for the situation to be rectified. John must apologize for his error, and so must the surgeon for his inappropriate response. Resolution must be accomplished while understanding that time is of importance. This strategy results in each side being appeased to some degree.

1. Your healthcare organization places a high value on workplace safety and integrates this into all aspects of administrative and patient care processes. As a unit manager, you thoroughly endorse this direction, and during the selection and hiring of new staff, you consistently: a. Refuse to hire applicants who are pushy during interviews. b. Thoroughly follow up with all references before offering a position. c. Ask applicants during the interview if drug or alcohol abuse is a problem. d. Refuse to interview applicants with sporadic work histories.

ANS: B Sporadic work histories and a "pushy" attitude may or may not be associated with aggression and violence. Checking references thoroughly helps to effectively check out impressions gained during the interview and may yield useful information about issues related to violence and aggression in previous employment.

1. A group of staff nurses is dissatisfied with the new ideas presented by the newly hired nurse manager. The staff wants to keep their old procedures, and they resist the changes. Conflict arises from: a. Group decision-making options. b. Perceptions of incompatibility. c. Increases in group cohesiveness. d. Debates, negotiations, and compromises.

ANS: B The nurse manager should serve as a change agent, assisting others in understanding the importance, necessity, impact, and process of change.

21. Technology is integral to a cardiac ICU. Sue, the nurse manager, implements a patient-centered approach that focuses on the meaning of the experience for the patient and family, primary nursing, and a health literacy approach. Sue is: a. Using high-tech-low-touch approaches. b. Using high-tech-high-touch approaches. c. Providing products. d. Providing tangible products of satisfaction.

ANS: B The provision of humanistic care within a high-tech environment is characteristic of high tech-high touch

6. The chief nursing officer plans a series of staff development workshops for the nurse managers to help them deal with conflicts. The first workshop introduces the four stages of conflict, which are: a. Frustration, competition, negotiation, and action. b. Frustration, conceptualization, action, and outcomes. c. Frustration, cooperation, collaboration, and action outcomes. d. Frustration, conceptualization, negotiation, and action outcomes.

ANS: B Thomas (1992) determined that conflict proceeds through these four stages in this particular order.

10. Two nurses on a psychiatric unit come from different backgrounds and have graduated from different universities. They are given a set of new orders from the unit manager. Each nurse displays different emotions in response to the orders. Nurse A indicates that the new orders include too many changes; Nurse B disagrees and verbally indicates why. This step in the process is which of the following in Thomas' Stages of Conflict? a. Frustration b. Conceptualization c. Action d. Outcomes

ANS: B Thomas' Stages of Conflict include conceptualization, which involves different ideas and emphasis on what is important or not or about what should occur

13. John is an older adult patient who comes regularly to the multigroup practice in which you are a nurse practitioner. He says that he doesn't understand what he is supposed to be doing about his medications, because every time he comes to the clinic, he sees someone else who has different ideas. John's experience represents what aspect of the current consumer experience? a. Nurses are well-trusted members of the healthcare team. b. Fragmentation of care results in lack of respect and trust. c. Care providers often have conflicting ideas about care. d. The public does not trust care providers other than nurses.

ANS: B When consumers visit a multigroup practice, they do not have the option of selecting a specific healthcare provider, and thus, there is less opportunity to build a trusting relationship with a provider.

22. Sarah is involved in intervening when a patient attempts to harm herself on the unit. During the interaction, the patient slaps Sarah across the face. As a head nurse, it is important that you: a. Offer Sarah immediate education and training in self-defense. b. Assist with follow-up documentation and offer access to counseling. c. Provide access to a lawyer. d. Encourage Sarah to see the incident as a normal part of care.

ANS: B When violence occurs, it is important to foster an environment that offers open communication, support, assistance with documentation, and psychological and other supported therapies.

4. Delaney, one of your staff nurses, confides that Marjorie, another nurse, has been actively telling others that you are incompetent and do not know what you are doing in relation to patient care, and that you lie to the staff about attempts to get more staffing. Through telephone calls and conversations during breaks, she is recruiting other staff to her position. Delaney confides that most of the staff find you fair, honest, and knowledgeable. Marjorie's behavior can best be characterized as: a. Political action. b. Bullying. c. Building alliances. d. Disgruntlement.

ANS: B Workplace bullying involves aggressive and destructive behaviors such as running a smear campaign and failing to support another nurse.

15. In addressing the staff turnover rate in Question 13, you are: a. Confirming the high correlation between managerial incompetence and violence. b. Demonstrating awareness that workplace violence, if present, has significant costs. c. Aware that staff and manager experiences contribute to high turnover. d. Aware that violence is a rare but present factor in the workplace.

ANS: B Workplace violence and aggression contribute to staff turnover and toxic work environments. Loss of the organizational investment required to train new staff and departure of experienced staff can increase operating costs and reduce the quality of care.

21. A safety and security plan is important to a healthcare organization because it: a. Lays out preventive measures in relation to violence. b. Provides direction as to changes in facilities that protect staff. c. Establishes expectations in relation to behavior and tolerance of violence. d. Establishes policies and practices that guide prevention of violence and expectations in the workplace.

ANS: D A safety plan provides overall direction in relation to what is expected, how violence is prevented, and what will occur when violence happens.

1. Which of the following activities would represent a customer-friendly approach in a healthcare setting? (Select all that apply.) a. Sending a patient with a migraine headache to wait in the emergency room sitting area so that a patient with chest pain can be seen b. Repeating patient history information to the admitting clerk, the admitting nurse, and the ultrasound technician c. Ensuring that birthing preferences are on file and available when a laboring mother comes in d. Providing support to families when a family member is brought into trauma

ANS: B, C, D Service is a measure of what matters to the patient; quality is a measure of how well a standard is met. Although the patient with chest pain is seen first, and this decision would be consistent with usual practices associated with triaging, customer-friendly approaches would lead to approaches that enable handling of patients with urgent rather than emergency health concerns.

12. A nurse is admitted to a psychiatric unit. The staff expresses frustration with her because they have explained several times her medication regimen, and yet, when she goes on passes, she fails to follow it. The staff believe that, as a nurse, she should be able to understand what is expected. The nurse's failure to follow the regimen indicates: a. Early cognitive impairment. b. Lack of motivation. c. Lack of health literacy. d. Worsening health state.

ANS: C A number of factors may be involved in the nurse's lack of adherence to her regimen and failure to follow through on teaching. What is evident from the response is that she lacks health literacy or the capacity to obtain, process, and understand basic health information and services.

23. During review of a patient's progress, the healthcare team determines that a patient requires treatment that is generally accepted at that time in the usual illness trajectory of a patient. The patient is unable to pay. As the head nurse, you persist in ensuring that this patient receives the treatment. You are: a. Empowering the patient. b. Avoiding litigation. c. Advocating for the patient. d. Supporting the clinical pathway.

ANS: C Advocacy means defending the rights and interests of others and, in this situation, the right of a patient to receive care, as determined by standards utilized in a critical pathway.

22. Which of the following actions best exemplifies advocacy? a. Developing a list of agencies that will provide free services for the homeless b. Working in a needle exchange program for individuals in an inner-city environment c. Acting on behalf of a patient to promote end-of-life wishes to an ethics committee d. Working in a free clinic for immigrant workers

ANS: C Advocacy means making known and defending and protecting the rights and interests of others, as well as ensuring the dignity and respect due to others. Simply being employed in an environment where this might be a focus of practice does not necessarily ensure that advocacy is actually occurring.

2. As part of performance appraisal, the nurse manager designs strategies to acknowledge staff members. What practices by the nurse manager best acknowledge staff accountability and contribution? a. Providing new and varied learning experiences for staff members b. Fostering group cohesiveness through standardization of unit activities c. Allowing professionals greater influence over their practices d. Giving recognition for success and support for failure to staff members

ANS: C Allowing greater control over practices implies trust and acknowledges expertise and performance.

14. In selecting the appropriate action in Question 13, it is important that: a. All documentation is reviewed. b. Usual processes for discipline are followed. c. Confidentiality is assured. d. An incident report is filed.

ANS: C Confidentiality is important if an employee fears intimidation or retribution from a manager.

8. A nursing instructor is teaching a class on conflict and conflict resolution. She relates to the class that conflict in an organization is important, and that an optimal level of conflict will do the following: Generate: a. Creativity, a problem-solving atmosphere, a weak team spirit, and motivation of its workers. b. Creativity, a staid atmosphere, a weak team spirit, and motivation of its workers. c. Creativity, a problem-solving atmosphere, a strong team spirit, and motivation for its workers. d. A bureaucratic atmosphere, a strong team spirit, and motivation for its workers.

ANS: C Differences in ideas, perceptions, and approaches, when managed well, can lead to creative solutions and deepened human relationships. Work on conflict suggests that complete resolution of conflict is counterproductive to the achievement of organizational goals, organizational change, and cohesiveness of employees

13. You note that Unit 64 has had a high turnover rate of staff during the past year. In investigating this situation, an important source of data might include: a. Employee evaluations. b. Level of experience of staff. c. Exit interviews with staff. d. Selection processes and decisions.

ANS: C Exit interviews may assist in identifying issues such as workplace violence, bullying, and intimidation by managers.

5. During coffee and other breaks, Rosalie, the new RN, is shut out of conversations with the other staff. When she approaches other staff on the unit to ask questions, they turn and walk off in the other direction. The behavior of the staff is characteristic of: a. Dislike. b. Lack of trust in Rosalie's abilities. c. Horizontal violence. d. Cultural incompetence.

ANS: C Horizontal or lateral violence and bullying are terms used to describe destructive behaviors towards co-workers, such as the "silent treatment" and shutting others out of socializing.

6. While working with an aggressive patient, it is important for the nurse to: a. Speak firmly. b. Call the individual by name. c. Place herself between the patient and the door. d. Ignore threats against her.

ANS: C In situations where a patient may become aggressive, it is important to ensure that you are not trapped in the room.

17. Kala, a unit manager, in discussing a role the CEO would like her to perform, makes the following statement, "I will sit on the hospital taskforce on improving morale if you send me to the hospital's leadership training classes next week, so I can further develop my skills and thus be more effective." Which of the following conflict management styles is Kala using? a. Collaborating b. Avoiding c. Negotiating d. Accommodating

ANS: C In this particular situation, an exchange of concessions (membership on a committee in return for attendance at a workshop) or trading occurs. This strategy supports a balance of power.

9. Jane has transferred from ICU to CCU. She is very set in the way she makes assignments and encourages her new peers to adopt this method without sharing the rationale for why it is better. This is a good example of a process and procedure that creates ________ conflict. a. Organizational b. Intrapersonal c. Interpersonal d. Disruptive

ANS: C Interpersonal conflict transpires between and among nurses, physicians, members of other departments, and patients.

3. In which of the following situations would you, as the head nurse, be concerned about potential safety issues? a. Jordan comes to your office to complain about inadequate staffing on the unit. He says that he is concerned because he attributes a recent incident to the staffing levels. b. Henry, a long-standing RN on the unit, has begun to miss work regularly. He calls in but is vague about his reasons for the absences. c. Carla, RN, has just ended a relationship with Jake, RN, and he will not leave her alone. You are meeting with Jake today because colleagues on nights have reported that Jake seems to have been intoxicated last night and the previous night. d. Sarah is very quiet and says almost nothing in team meetings. Lately, she has been much more animated since becoming friendly with a couple of other RNs on the unit.

ANS: C Jake seems at most risk for violence because of his alcohol use and the end of what may be an obsessive relationship with Carla. In the other situations, Jordan is expressing a legitimate concern and is behaving assertively; Henry may have health concerns or other issues that are private and interfering with his work life; and Sarah's change in behavior is likely related to a higher level of comfort with work and colleagues.

22. Lee, the head nurse in ER, has attempted to meet Jillian, one of her staff RNs, for several days to discuss concerns about Jillian's relationships with her team members. Lee hopes to offer Jillian coaching so that Jillian's relationships can be more satisfying for Jillian and her team members. Each time Lee and Jillian set a time to meet, Jillian phones in sick. In this situation, Lee and Jillian are demonstrating: a. Similar conflict management strategies. b. Escalation of conflict. c. Avoidance and compromise strategies. d. Competing and compromise strategies.

ANS: C Jillian is demonstrating avoidance by staying away from meetings to discuss her team relationships, and Lee is demonstrating compromise by offering coaching in return for Jillian's being able to engage in more satisfying relationships.

17. Jenny tells you that she is always able to tell when others are about to become violent because they yell. Your response to Jenny is based on your understanding that: a. Her perception is accurate. b. Yelling is more likely associated with aggression. c. Violence is signaled by a variety of behaviors. d. She is mostly accurate in her thinking.

ANS: C The STAMP Assessment Components and Cues outline a wide variety of verbal and nonverbal cues that might signal the potential for violence.

14. The complexity of the healthcare environment for consumers is increased by: a. Falling levels of education among the public. b. Increased levels of poverty. c. Complex compensatory systems and a variety of delivery systems. d. Increased numbers of uninsured or underinsured.

ANS: C The complexity of options in health care and the processes and policies involved in funding health services for patients, as well as fragmented relationships with a growing variety of healthcare providers, contribute to the complexity of the system for patients, especially for those who might need it most, such as the poor, uninsured or underinsured, and homeless.

11. Mrs. Hill, aged 68, was hospitalized after a stroke. The speech therapist recommended that oral feeding be stopped because of her dysplasia. During visiting hours, Mr. Hill fed his wife some noodles. The nurse noticed this and stopped Mr. Hill from feeding his wife, telling him it was the doctor's decision. An hour later, the nurse returned and found Mr. Hill feeding his wife again. The nurse tried to stop him again. Mr. Hill refused and claimed that the clinical staff was trying to starve his wife; he also threatened to get violent with the nurse. The nurse decided to walk away and documented the event in Mrs. Hill's chart. According to Thomas' Four Stages of Conflict, in which stage could the nurse have been more effective? a. Frustration b. Conceptualizing c. Action d. Outcomes

ANS: C The nurse's actions did not include actions such as clarifying Mr. Hill's views on feeding his wife or on what is necessary to achieve good care for his wife and did not engage in dialogue with Mr. Hill, thus preventing identification of a common goal. The action stage involves a behavioral response such as clarification or dialogue.

18. Which of the following exemplifies a service orientation? a. Staff members on the unit are encouraged to chart details about family support networks. b. Chart audit reveals that details related to assessment of family history are missing. c. The palliative care unit organizes a tree of light fundraiser each year to highlight services provided through palliative care. d. A children's preoperative holding area promotes family interactions for those undergoing surgery.

ANS: D A service orientation involves concern for the quality of the nurse-patient relationship and fostering a therapeutic relationship that meets patient needs. A service orientation needs to translate caring into appropriate, timely action. Activities such as documentation of details may remain at the technical level without a commitment to caring interactions.

23. Which of the following best exemplifies a preferred style of conflict management for staff nurses? a. Sarah and Jonas, two RNs, disagree with the best approach to assisting a family that has complex needs. They decide that they will consult with family and together will decide what is best. b. Jennifer needs to switch a shift to attend a family function. She arranges to trade with Nancy, who wants a day off next to a 3-day break. c. Lindsay asks Melody to stay late for the third day in a row. Melody refuses, stating that she has already helped out for two days by staying late for Lindsay. d. Lara asks Stacey to switch shifts with her because Lara wants to attend a concert. Stacey would prefer not to but does to enable Lara, who is new in town, to be with her friends.

ANS: D Accommodating involves neglecting one's own needs while trying to satisfy the needs of another.

1. The chief nursing officer decides to establish a client advocacy position in an oncology unit. Advocacy is best represented by: a. Establishing private and professional networking systems. b. Asking social services to handle clients' concerns. c. Identifying community support groups. d. Empowering others by promoting self-determination.

ANS: D Advocacy involves empowering and promoting self-determination in others.

15. Corrine, a student nurse, often hears that nurses are gatekeepers and wonders what that term means. As a nurse leader, you explain that this is a reference to the: a. Assessment and admission of patients into care. b. Orientation of patients to services once they are admitted. c. Function of controlling which patients see the physician and which do not. d. Coordination of care, services, advocacy, and access for patients within the healthcare system.

ANS: D As gatekeepers to the system, nurses advocate for and coordinate care, services, and access for patients across all providers, settings, and levels of care.

20. The head nurse and a staff nurse are having a conflict over how to use and apply a new procedure for dressings in the medical/surgical unit. The staff nurse wishes to use the new procedure based on newly released nursing research. The head nurse wishes to use a protocol that has been used in the department for a number of years. The head nurse later makes comments to other staff on her unit about the credibility of the staff nurse. This behavior is associated with: a. Lateral violence. b. Horizontal violence. c. Confrontation. d. Bullying.

ANS: D Bullying involves aggressive or destructive behavior or psychological harassment of a recipient who is in a position of power differential with the perpetrator (the head nurse). Bullying is closely related to lateral or horizontal violence and involves such behaviors as withholding information, undermining activities, sabotage, and backstabbing.

21. Which of the following exemplifies the preferred conflict management style of nurse managers? a. Elizabeth, the head nurse on neurology, finds that Tom, the RN nurse on nights, is irritable in relation to any suggestions or new ideas, and so she comes in to work after Tom leaves the unit. b. The technology committee has recommended a clinical system for implementation on the nursing unit. Staff is anxious about the change. Tim, the head nurse, asks staff for ideas on how to meet the technology goals and to meet staff needs. c. During management meetings, George, the head nurse on nephrology, dominates meetings and decisions. Lee, the head nurse on the cardiac step-down unit, begins to miss the management meetings. d. Ann, RN, asks her head nurse if she can go on the permanent evening shift. The head nurse, Rajib, agrees, as long as Ann agrees to be involved in assisting to mentor evening staff in the use of the new clinical information system.

ANS: D Compromise involves trading and negotiation and is the preferred conflict management style of managers.

11. Linda, a staff nurse on nights, yells at Ali, another RN, and tells Ali that she is stupid and can't get anything right. In responding to this situation as head nurse, it is critical that you: a. Require that Linda attend anger management classes. b. Investigate to see if Ali did anything to aggravate Linda. c. Call both immediately into the office in the morning to discuss the situation. d. Respond to Linda in a way that is consistent with organizational processes and with similar situations.

ANS: D Erratic or arbitrary discipline, favoritism, or behavior that undermines the dignity of either individual undermines efforts at curbing workplace violence. Disciplinary actions must be proportionate, consistent, reasonable, and fair.

19. Factors that influence the ease with which conflict is resolved include all except which of the following? a. Level of interdependence of the parties b. Importance of the outcome c. Perceived fairness of the process of resolution d. Experience and education level of those in conflict

ANS: D Experience and education do not necessarily contribute to successful conflict resolution. The other factors have been identified in studies as important in resolving conflict.

4. The nurse manager on a pediatric intensive care unit wants to evaluate patient satisfaction. The nurse manager understands that ultimately, positive relationships with consumers of care are evaluated by the: a. Cultural sensitivity of staff. b. Cost-effectiveness of care delivery. c. Economic value of service. d. Outcomes for clients and their perceptions of care.

ANS: D Health literacy involves merging preferences and needs with the capacity to understand and process basic health information and obtain services.

25. An example of a factor that would impede a patient's learning would include: a. Poverty. b. Recent diagnosis of chronicity. c. Being an older adult. d. Heavy sedation.

ANS: D Lower expectations for learning cannot always accompany teaching for those who are economically disadvantaged or those who have been recently diagnosed; this needs to be assessed. Age may be a factor in structuring a learning experience. Heavy sedation will affect focus and retention.

15. Sarah is a nurse manager in a surgical unit. She is concerned about a conflict between Lucy, a staff nurse, and one of the maintenance personnel. She explains to Jill that unsatisfactory resolution of the conflict is typically destructive and will result in: a. Decreased frustration between the maintenance worker and her. b. A good relationship with the maintenance department. c. Eventual resolution of the problem without further intervention. d. Decreased productivity on her part.

ANS: D Research by Saltman et al. (2006) determined that productivity decreases with destructive conflict, whereas constructive conflict strengthens relationships.

12. In Question 11, the outcome as depicted by Thomas' conflict stages can be considered to be: a. Compromising. b. Confronting. c. Constructive. d. Destructive.

ANS: D Resolution was absent because the nurse did not have time to effectively deal with the issues in the conflict, leading to escalation of the conflict.

24. A nurse makes a medication error that is not serious and does not cause harm to the patient. As the head nurse, your best action would be to: a. Call attention to it by posting the critical incidents report at the nursing station. b. Include the mistake on the nurse's performance appraisal. c. Apologize to the patient for the error, and indicate that discipline has occurred. d. Educate the nurse on how to provide an apology to the patient.

ANS: D Service recovery ensures responsiveness to the patient, and as part of service recovery, it is important to address an error in the most productive way, which also includes the nurse who made the error offering an apology to the patient.

13. Jill is the head nurse on a unit in a large hospital. Two of the staff nurses are constantly arguing and blaming each other, and a resolution has not occurred in months. To solve the existing conflict, which is the most desirable conflict resolution? a. Avoiding b. Competing c. Compromising d. Collaborating

ANS: D The collaboration technique has both sides in the conflict working together to develop an optimal outcome. This results in a win-win solution.

4. The nurse manager decides to use a mediator to help resolve the staff's conflict. A basic strategy for truly addressing this conflict is to: a. Identify the conflicting facts. b. Be determined to resolve the conflict. c. Schedule a meeting time for resolution. d. Have a clear understanding of the differences between the parties in conflict.

ANS: D The manager must determine if a conflict is constructive or destructive. In this situation, the manager has determined that the conflict is destructive and does not want the conflict to escalate, so has engaged a mediator.

24. In trying to achieve Magnet™ status, the chief nursing officer establishes a shared governance model to help nurses experience job satisfaction. However, some nurses who have enjoyed working with less autonomy resist this change, thus creating organizational conflict. Organizational conflict arises from which of the following? (Select all that apply.) a. Flat organizational structure b. Clarity in role responsibilities c. Increased autonomy through self-governance d. Less participation in decision making

ANS: D The nurse leader utilizes change theory and leadership theory to plan for the implementation of organizational changes. Knowledge of these theories suggests conflict resolution, and management is more effective in a flattened organizational structure where there is openness, shared decision making, and adaptability in roles.

12. Residents in a new long-term care facility attend a large dining hall for meals. In reviewing reports of aggression and violence, you note that behaviors such as hitting, or attempting, to hit staff are increasing. Further investigation suggests that this behavior occurs most often at mealtimes. A possible intervention would be to: a. Seat residents with the highest potential for violence next to those with the lowest potential for aggression. b. Feed residents earlier in the day. c. Restrain residents who are violent or aggressive during meal times. d. Establish a smaller dining area that is away from the main area that is for residents who have potential for aggression/violence.

ANS: D Violence and aggression are more likely during times of increased activity, such as mealtimes. Reducing activity levels through interventions such as a separate dining area may reduce incidents of violence and aggression.

A review of systems (ROS) is based on information obtained from the client during the interview. This information is an example of ______________ data.

Subjective

"Which of the following is subjective information to be entered in the client's medical record? A) Skin warm and dry. B) Pain intensity 8 out of 10. C) Breath sounds clear to auscultation. D) Amber urine in sufficient quantities."

B - Pain is purely a subjective phenomenon. Although the pain intensity rating is an objective number, it depends on the client's report. The other options are objective data.

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:

Balance value-added services against costs and revenues

"What type of interview technique is the nurse using when the nurse asks the question, ""Do you have pain or cramping?"" A) Active listening B) Open-ended questioning C) Closed-ended questioning D) Problem-oriented questioning"

C - The example is a closed-ended question which the client can answer with a one-word reply. Open-ended questions allow the client to answer with more information. The other options are not correct.

"Which of the following is an open-ended question the nurse might use when interviewing a client? A) ""Do you have any concerns right now?"" B) ""Is your family worried about your being in the hospital?"" C) ""What do you mean when you say, 'I don't feel quite right'?"" D) ""How many times do you get up to go to the bathroom at night?"""

C - The way the nurse asks question 3 allows the client to respond completely and with more than a one-word answer. The other options allow the client to respond with one word and make it unlikely that the client will give additional information.

"During data clustering, a nurse: A) Provides documentation of nursing care B) Reviews data with other health care providers C) Makes inferences about patterns of information D) Organizes cues into patterns that lead to identification of nursing diagnoses"

D - During data clustering, the nurse organizes cues into patterns that indicate individualized nursing diagnoses and identify collaborative problems. The other options are incorrect.

"Which of the following is objective information to be recorded in the client's medical record? A) Anxious over upcoming test. B) Increasing stress over past 2 months. C) Performs breast self-examination monthly. D) Expelled 1 tablespoon of yellow sputum."

D - Objective data are measurable data. Options 1, 2, and 3 describe data that cannot be measured by the nurse but depend on the client's reports; thus they are subjective data.

"A client who is alert and awake is being transferred to another hospital with a copy of his medical records. Before the transfer the nurse must: A) Ask the hospital lawyer if this requires approval from the risk management department. B) Discuss the need to copy the medical records with the client's family. C) Be certain that the physician writes an order for the record to be copied. D) Obtain written permission to copy the medical records for the receiving hospital."

D - Obtaining permission to copy the records demonstrates the nurse's understanding of the provisions of the Health Insurance Portability and Accountability Act (HIPAA). Discussing medical records with the client's family is inappropriate because the client's family does not make the decision for a client who is capable of making his own decision. Policies and procedures would already be in place for the nurse with regard to copying medication records. It is not necessary to call the hospital lawyer. Copying a client's medical record does not require a physician's order.

"A nurse assessing a client who comes to the pulmonary clinic asks, ""Tell me what medications you are taking for your breathing problem. I see from your last visit that Dr. Russell recommended routine exercise. Can you also tell me how successful you have been in following his plan?"" The nurse's assessment covers which of Gordon's functional health patterns? A) Value-belief pattern B) Cognitive-perceptual pattern C) Coping/stress tolerance pattern D) Health perception/health management pattern"

D - The health perception?health management pattern involves the client's self-report of health and well-being, how the client manages his or her health, and knowledge of preventative health practices. The cognitive-perceptual pattern involves sensory-perceptual patterns, language adequacy, memory, and decision-making abilities. The coping?stress tolerance pattern involves the client's ability to manage stress, sources of support, and the effectiveness of the patterns in terms of stress tolerance. The value-belief pattern involves the values, beliefs, and goals that guide the client's choices or decisions.

"Assessment data must be descriptive, concise, and complete. In performing an assessment the nurse should not: A) Include subjective data from the client. B) Perform a thorough physical examination. C) Use interpersonal and cognitive skills. D) Include inferences or interpretative statements not supported with data."

D - The nurse should not generalize or form judgments not supported by the collected data. Inferences and interpretive statements must be supported by data. Assessments do include conducting a thorough physical examination, using interpersonal and cognitive skills, and obtaining subjective data from the client.

"The purpose of assessment is to: A) Make a diagnostic conclusion. B) Delegate nursing responsibility. C) Teach the client about his or her health. D) Establish a database concerning the client."

D - The purpose of assessment is to establish a database about the client's perceived needs, health problems, and responses to these problems. The data also reveal related experiences, health practices, goals, values, and expectations. The other options are not purposes of assessment.

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:

Financial plan

After reviewing her monthly budget report, the nurse manager sees that she has a negative variance, which prompts her to change the staffing schedule. A negative or unfavorable variance in a monthly expense report may result from:

Higher than expected client acuity

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:

Minimize costs.

An example of an initiative that may reduce total healthcare costs would be

Offering nurse practitioner-led clinics that educate parents about nonpharmacologic strategies for managing ear infections

A nurse manager approves two staff nurses to attend a national conference. When reviewing the budget, the nurse manager looks at which line item?

Operating Budget

Which of the following factors is not implicated in rising healthcare costs?

Rising Medicare costs

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:

Staffing

Physicians in a small urban hospital are reluctant to discharge older adult patients because many of the patients lack private insurance and the resources to travel distances for follow-up care. The hospital administration pressures the physicians to discharge patients sooner and to be more consistent with the number of hospitalization days specified within the DRGs. Which of the following would most likely prompt the action of administrators?

The hospital is incurring a deficit related to a gap between the PPS and the DRGs and costs of care

The chief nursing office continues to seek ways to improve healthcare services to clients and to save the hospital money. However, with the federal guidelines of paying agencies based on capitation, the chief nursing office faces a challenge. Capitation provides incentives for healthcare providers to control costs by:

Using fewer services per client

The nurse asks the client's spouse, "Mrs. Smith, your husband told me that for the past week he has not been eating the meals you prepare. Do you agree?" This is an example of __________________ of assessment data.

Validation