Clinical Management Exam 2

9. The risk manager wants to evaluate the reasons for an increased number of falls on the rehab unit. The risk manager devises a fishbone diagram. A fishbone diagram is a useful tool to: a. identify the root causes of problems. b. list possible solutions to problems. c. help leaders select the best options. d. evaluate the outcomes of decisions made.

A A fishbone diagram, also known as a cause-and-effect diagram, is useful for determining the reasons (causes) for an effect (falls).

13. For a nurse manager in the functional nursing model, an approach that will assist in maintaining staff satisfaction in this specific model is: a. rotation of task assignments. b. frequent opportunities for in-service education. c. orientation to job responsibilities and performance expectations. d. team social events in off hours.

A 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.

22. Knowing when to have the entire team participate in the decision-making process or when to have only the team leader make the decisions depends on the situation and the desired outcomes. The autocratic process is used in which of the following situations? a. The task and the outcome are relatively simple and defined. b. It is unlikely that the group will reach a consensus. c. A decision has to be discussed thoroughly. d. A number of options need to be considered.

A An autocratic style is appropriate when rapid decision making is required and in situations where the task and the potential outcome are well-defined.

5. A staff nurse, who was fired for reporting patient abuse to the appropriate state agency, files a whistleblower lawsuit against the former employer. What reason would the court provide to uphold a valid whistleblower suit claiming retaliation by the nurse? a. Previously reported the complaint, in writing, to hospital administration. b. Threatened to give full details of the patient abuse to local media sources. c. Was discharged after three unsuccessful attempts at progressive discipline had failed. d. Had organized, before filing the complaint, a work stoppage action by fellow employees.

A An employer is unable to fire an employee who, in good faith, reports what is believed to be a violation of a law, rule, or state or federal law.

18. As a nurse manager representative on a clinical information system selection team, you would be particularly concerned if the favored system: a. involves screen displays that are best configured for nonclinical users. b. requires an upgrade to servers in the facility. c. requires staff orientation and training during implementation of the software. d. minimizes the amount of data entry necessary.

A An ideal hospital information system should include as much instrumentation as possible to minimize data entry. As a clinical end user, you would expect orientation and training on how the screen display can be configured so as to suit the purposes and preferences of users in clinical areas.

1. Planning is a process designed to achieve goals in dynamic, competitive environments. As a new manager, what is the first step you will undertake to develop a strategic plan of action for a congestive heart failure program? a. Search the environment to determine changes that may affect the organization. b. Appraise the organization's strengths and weaknesses. c. Identify the major opportunities for and threats to the organization. d. Identify and evaluate the various strategies available to the organization.

A Assessment of the external environment is the first step in the strategic planning process.

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. What factor can increase stress and escalate conflict? a. The use of avoidance b. An enhanced nursing work force c. Accepting that some conflict is normal d. Managing the effects of fatigue and error

A Avoidance as a conflict-management style prolongs conflict and tends to escalate conflict.

2. The relief charge nurse has assigned a newly licensed baccalaureate-prepared nurse to be one of the team leaders for the 3-11 shift. In making this decision, the charge nurse has overlooked this nurse's: a. clinical expertise. b. leadership ability. c. communication style. d. conflict-resolution skills.

A Because the basic education of baccalaureate-prepared RNs emphasizes critical-thinking, clinical reasoning, and leadership concepts, they are likely candidates for such roles. Benner (2001), however, identified five stages of clinical competence for nurses: novice, advanced beginner, competent, proficient, and expert. She suggests that competence is typified by a nurse who has been on the job in the same or similar situation 2 to 3 years. Nurses who are at the novice or advanced beginner stage would be less likely than their more experienced counterparts to implement any type of delivery model effectively and thus, this assignment overlooks the nurse's level of clinical expertise and leadership experience.

16. Three gravely ill patients are candidates for the only available bed in the ICU. As the supervisor, you assign the bed to the patient with the best chance of recovery. This decision reflects which of the following ethical principles? a. Beneficence b. Autonomy c. Veracity d. Nonmaleficence

A Beneficence refers to doing what's good for the patient; in this situation, doing what's good means providing care to the patient with the best likelihood of recovery.

11. A nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks toward a patient with a previous history of sexual abuse. The patient sues, claiming malpractice. What conditions do not apply in this situation and do not support malpractice? a. Injury b. Causation c. Breach of duty d. Breach of duty of care owed

A By virtue of employment, the nurse owes a duty of care to the patient; this care has been breached by a nurse, who would be expected to know that this behavior violates usual standards of care. The resultant injury, the fifth malpractice element, must be physical, not merely psychological or transient. In other words, some physical harm must be incurred by the patient before malpractice will be found against the healthcare provider, which is not evident in this situation where the action did not involve physical harm.

22. Case managed care may enhance profit in a for-profit health organization by: a. minimizing costs in high resource consumption areas. b. combining licensed and non-licensed care providers in delivering patient care. c. increasing reimbursement from third-party payers. d. reducing the amount of technology used to support clinical decision making.

A Case managed care is not revenue generating but rather revenue protecting in that better coordination of care enables efficient achievement of patient outcomes, can result in shorter length of stay, and can prevent readmission.

15. A recent nursing graduate in a busy Emergency Department triages a patient who has sustained a large, deep puncture wound in his foot while working at a construction site. He is bleeding and is in pain. The nurse enters the triage data that she has obtained from the patient into a computerized, standard emergency patient-classification system. After she enters the assessment data, she notices an alert on the computer screen that prompts her to ask the patient about the status of his tetanus immunization. What system of technology is involved in generating the alert? a. Clinical decision support b. WL technology c. Computerized provider order d. Electronic health record

A Clinical decision support (CDS) is a clinical computer system, computer application, or process that helps health professionals make clinical decisions to enhance patient care. The clinical knowledge embedded in computer applications or work processes can range from simple facts and relationships to best practices for managing patients with specific disease states, new medical knowledge from clinical research, and other types of information. TOP: AONE competency: Business SkillsCopyright © 2019, Elsevier Inc. All Rights Reserved. 4

16. Staff at Valley Hospital are concerned that recent staffing cuts will affect their ability to provide quality patient care, and they express their concerns to senior management. The CEO of Valley Hospital makes the following statement: "We need to contain costs because our funding has been decreased." 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

A Conflicts arise in four areas: goals, facts, approaches, and values. Conflicts among goals arise from competing priorities such as the provision of quality patient care and containment of costs.

6. The chief nursing officer has to write a strategic plan. The most difficult stage in the strategic planning process is: a. assessment of the external and internal environment. b. review of mission statement, goals, and objectives. c. identification of strategies. d. implementation of strategies.

A Determination of strengths, weaknesses, opportunities, and threats requires openness to what is being said and observed and is critical to setting the stage for relevant responses in the latter phases of strategic planning.

4. The clinic nurse understands that the advantages of planning include: a. assisting staff in critical thinking and improving decisions. b. orienting people to react instead of act. c. forcing managers to be cost-efficient and cost-effective. d. focusing on activities, not results.

A Effective planning means that everyone in the organization manages his own work and sees how it relates to organizational goals. Being proactive means "aggressive planning" that ensures that decisions are improved and are oriented toward organizational goals.

21. Which of the following represents an effective goal statement? a. Involve patients and families in planning health care. b. To revise clinical guidelines for incontinence care from evidence within 6 months. c. Patients and families are partners first in care planning. d. To acquire $4 million in additional funding within 12 months to support clinical education programs for dementia.

A Goal statements formalize targets for an organization. Objectives include the word to and an action word, and specify dates for attainment. Mission statements convey values and beliefs of the organization.

2. The nurse manager of a rehab unit wants to purchase a new antiembolic stocking for use with patients. To make a high-quality decision, the nurse manager would: a. involve the rehab staff in the decision. b. involve the sales representative. c. make the decision alone. d. involve administration in the decision.

A In a shared decision model, the decisions are made through an interactive, deliberate process and the staff may express and discuss options and preferences. The shared decision model has been shown to increase work performance and productivity, decrease employee turnover, and enhance employee satisfaction.

13. The maintenance department wishes to have the nursing lounge renovated, so the lounge will be more "user-friendly." The department asks the nursing staff to make a wish list of everything that they would like to see in the new lounge. This process is an example of which part of the decision-making process? a. Assessment/Data collection b. Planning c. Data interpretation d. Generating hypotheses

A In this particular model (a model similar to the nursing model), data collection is the first step toward identifying important alternatives or determining if there is a problem or problems.

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

A Intrapersonal conflict occurs within a person when confronted with the need to think or act in a way that seems at odds with that person'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.

15. To meet the social and human needs of a target market, it is critical to: a. assess the needs and priorities of the target market. b. revise the organization's mission statement to reflect external needs. c. assess the internal culture and needs. d. develop highly sophisticated media.

A Marketing emphasizes the identification and meeting of human and social needs, which can only be known through assessment of the needs of the consumer (as opposed to the needs of the organization).

9. Leaders in nursing must advocate for information and knowledge systems that support nursing practice. This is best accomplished by: a. participating in organizational information technology committees. b. submitting written requests for needed information systems. c. requesting budgetary funds needed for systems. d. sending staff nurses to conferences that discuss cutting-edge technologies.

A Nurse leaders and direct care nurses must be members of the selection team, participate actively, and have a voice in the selection decision. The information system must make sense to the people who use it and fit effectively with the processes for providing patient care. TOP: AONE competency: Business Skills

7. 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 specific 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.

A Nurses are the healthcare providers who spend the most time with the consumer and are in an opportune position to understand the issues, structures, and processes that affect patients. The nurse acts as the primary person to be alert to circumstances that may prevent a successful outcome for the patient and to intervene on the patient's behalf. As a nurse manager, it is important to support staff in their use of power to be in control and to make decisions at the consumer-staff level of interaction.

3. Northwestern Hospital has decided to implement peer review. As a clinical leader in the Emergency Department, you have overall responsibility for ensuring that this is in place by next month. The most important step in this process is to: a. provide an educational session for staff on peer review. b. revise the mission statement, objectives, and performance standards. c. develop objectives and performance standards with employees. d. implement objectives and performance standards.

A Once a strategic plan has been developed, the next step is open communication and execution of the specific plan, which, in this instance, is peer review.

12. In an ICU, you order new devices to measure heart rhythm and rate, respiratory rate, oxygen levels, and intracranial pressure. These devices involve: a. biomedical technology. b. telecommunications. c. retrieval of patient history information. d. Internet.

A Physiologic monitoring devices and patient surveillance systems involve biomedical technology. TOP: AONE competency: Knowledge of the Health Care Environment

19. Mr. M. complains to you that one of your staff asked him details about his sexual relationships and financial affairs. He says that these questions were probing and unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry with him and would not provide him with good care. Mr. M.'s statements reflect concern with: a. privacy. b. confidentiality. c. veracity. d. informed consent.

A Privacy protection includes protection against unwarranted intrusion into the patient's affairs.

9. A colleague asks you to give her your password access so that she can view her partner's healthcare record without using her login. This request violates the patient's right to: a. privacy. b. confidentiality. c. undue authorization of treatment. d. protection against slander.

A Privacy refers to the right to protection against unreasonable and unwarranted interference with the patient's solitude. Privacy standards limit how personal health information may be used or shared and mandate safeguards for the protection of health information. Institutions can reduce potential liability in this area by allowing access to patient data, either written or oral, only to those with a "need to know." Persons with a need to know include physicians and nurses caring for the patient, technicians, unit clerks, therapists, social service workers, and patient advocates. Others wishing to access patient data must first ask the patient for permission to review a record.

12. As a charge nurse, you counsel your RN staff member that they have has their duty of care by notifying a child's physician regarding concerns about deterioration in the child's status at 0330 hours. The physician does not come in to assess the child and does not provide additional orders. The child dies at 0630 hours. As the charge nurse, you could be held liable for what? a. Professional negligence b. Assault c. Avoidance d. Murder

A Professional negligence can be asserted when there is failure to do what a reasonable and prudent nurse would do in the same situation. In this situation, the charge nurse might have advocated further for the patient in light of the evident seriousness of the child's condition.

23. To improve outcomes on the stroke recovery unit, the unit manager leads an evidence-based practice (EBP) project. The goal of this project is to: a. enable detection of variations in clinical outcomes from well-researched standards that are supported by confirmatory evidence. b. gain quick access to literature based on studies of patients and families who have experienced stroke. c. develop a list of articles that could be accessed to address clinical issues and problems with stroke patients. d. advance the development of staff who are able to conduct independent nursing research on stroke outcomes.

A Several "intelligent" clinical information systems are in place that collect good data and then translate nursing knowledge, such as well-researched standards, into reference materials at the point-of-care. In addition, computer applications assist nurses to take action and provide patient care based on the best evidence for practice. TOP: AONE competency: Business Skills

14. In comparing team and functional models of care, a nurse manager favors the team model. In particular, she finds that the team model: a. can be effective in recognizing individual strengths and backgrounds of staff. b. promotes autonomy and independence for the RN. c. avoids conflict because of role clarity. d. is efficient in delivering care to a large group of patients, utilizing a staffing mix.

A 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.

11. 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 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.

19. 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.

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 even though nurses in advanced practice are well suited to lead teams in this model.

14. A good nursing decision maker is one who: a. uses various models to guide the process based on the circumstances of the situation. b. adopts one model and uses it to guide all decision making. c. decides not to use any models because they are all useless. d. develops a new model each time a decision has to be made.

A The decision model that a nurse uses depends on specific circumstances. Is the situation routine and predictable or complex and uncertain? Is the goal to make a decision that is "just good enough" (conservative) or one that is optimal?

8. 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

A The nurse leader should allow professionals more influence over their practice; give staff opportunities to learn new and varied skills; give recognition and reward for success and support and consolation for lack of success; and foster motivation and belief in the importance of each individual and the value of his or her contribution.

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.

A The nurse leader should follow up to determine if the conflict has been resolved because, in professional practice environments, unresolved conflict among nurses is a significant issue that results in job dissatisfaction, absenteeism, and turnover, as well as in decreased patient satisfaction and poorer quality in patient care

7. The reasons cited by nursing administrators for not planning in a systematic manner include: a. lack of understanding of the planning process. b. lack of knowledge regarding the internal and external operations of the organization. c. not enough hours in the day for both day-to-day operations and planning. d. delegation of the task to subordinates.

A The nurse manager should participate in strategic planning and quality initiatives with the governing body. Lack of knowledge is a common reason for nonparticipation in planning initiatives.

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. horizontal violence involves those with similar status but little power in the larger context. c. interprofessional collaboration reduces unresolved conflicts. d. all conflicts involve some level of disagreement.

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

17. A conflict develops between an associate nurse and a primary nurse over the assessment of a patient with pulmonary edema. Based on her assessment of the patient, the associate nurse insists that it is her role to change the care plan because she is the one who has made the assessment. As the nurse manager, you clarify that: a. it is the role of the primary nurse to make alterations based on assessment data and input. b. the associate nurse is accountable and responsible while the primary nurse is off duty and therefore is able to alter the care plan. c. neither the primary nor the associate should make changes without first consulting you as the manager. d. it really does not matter who alters the nursing care plan as it depends on situation and time to do so.

A The primary nursing model assumes that the primary nurse is accountable for patient care, even while off duty. The primary nurse is responsible for establishing the patient plan of care and therefore for altering it with the input of an associate. The associate is responsible for implementation of the established care plan when the primary nurse is off duty.

4. The nurse on the 7a-7p shift is assigning a specific component of care to an unlicensed nursing personnel (UNP) employee. The night nurse would remain: a. accountable. b. responsible. c. authoritative and liable. d. responsible and task-oriented.

A When a registered nurse delegates care to a UNP, responsibility is transferred; however, accountability for patient care is not transferred. Thus, "accountability rests within the decision to delegate while responsibility rests within the performance of the task" (Anthony and Vidal, 2010, p. 3).

2. With regard to nursing practice, nurse managers are held responsible for: (Select all that apply.) a. practicing within legal guidelines established under state law and nurse practice acts. b. ensuring that nursing staff under their supervision are currently licensed to practice. c. referring all errors in nursing judgment to state discipline boards. d. ensuring that physicians are properly licensed to provide care on patient care units.

A, B Nurses are responsible for knowing and practicing under state law and nurse practice acts. Managers are responsible for monitoring staff practice and ensuring that staff hold current, valid licensure.

1. As a nurse manager, you want to institute point-of-care devices on your unit. The rationale that you provide to support the point-of-care devices includes: (Select all that apply.) a. reduction in incidents of medication error. b. immediate documentation of care. c. comparison of patient data with previous data. d. immediate access to staffing schedules.

A, B, C Point-of-care devices that allow documentation of assessment, care, and teaching at the bedside reduce the gap in time between care and documentation, thereby reducing error, increasing accuracy, and improving communication of care. Medication devices and patient databases enable accurate clinical decision making. TOP: AONE competency: Business Skills

1. In a busy rehabilitation unit, the team manager decided that the best way to reward the staff was to give them a monetary bonus rather than time off. The staff was very concerned about the decision and went to the administration with a number of complaints. Critical thinking is a process that entails a number of steps. What steps did the manager omit? She should have: (Select all that apply.) a. identified what assumptions were underpinning the issues. b. considered why it was important to make this change or the context for the change. c. considered how this change might affect staff relationships. d. attained a majority consensus of all staff.

A, B, C Taking a majority consensus is not a step in the critical thinking process. Points A, B, and C are "what," "why," and "how" questions that are part of effective critical thinking processes.

1. Nurses entering the work force 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

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.

1. One of your staff nurses asks for your advice because a patient refuses to sign a consent for surgery. The patient says that he won't sign because he doesn't understand the nature of the surgery. You advise that: (Select all that apply.) a. consent must not be coerced. b. the patient has a right to choose not to consent. c. the patient must sign the consent because the doctor wants him to sign. d. witnessing a consent is related only to the voluntary nature of the signature.

A, B, D Consent must be voluntary and not coerced; the patient must understand what he is signing, must have legal capacity, and must understand the consequences of refusal. Witnessing a consent means attesting to the voluntary nature of the patient's signature.

1. An example of a nursing care activity that would not be delegated by an RN to a UNP is: (Select all that apply.) a. teaching self-catheterization to a patient with paraplegia who has limited English. b. basic care for a patient with a head injury who is rapidly deteriorating. c. one-to-one observation with a suicidal patient. d. assessment of patients being admitted through the Emergency Department. e. basic hygienic care for a patient who is post MI and stable.

A, B, D Functions such as assessment, diagnosis, planning, and evaluation cannot be delegated. In addition, stability, critical thinking, time, and safety are factors that are considered in assessing whether or not to delegate care to a UNP. Teaching self-catheterization to a patient with limited English requires critical thinking; basic care for a patient who is rapidly deteriorating exemplifies concern with stability; and assessment of patients through Emergency is related to the factor of time. An exception to safety and stability in which patients may be delegated to UNPs is when patients are placed on suicide precautions.

1. Your organization has made a decision to implement TCAB in your hospital. As a manager, what strategies would you use to implement TCAB? (Select all that apply.) a. Encourage recognition among staff of their knowledge of the patient-care environment. b. With staff, select small changes for consideration. c. Select only projects that have widespread impact. d. Secure external advisors to evaluate innovation. e. Present ideas based on best practices and ask staff for advice on implementation.

A, B, E Transforming care at the bedside (TCAB) relies on active involvement of staff in the generation of innovative ideas to improve patient care. Staff are actively engaged in selecting innovation, planning, and evaluation of the innovations. Critical to practice changes, rapid cycle change is a process that encourages testing creative change on a small scale while determining potential impact.

1. A clinic nurse developed objectives for a diabetic education program. The characteristics of well-written objectives include that they should be what? (Select all that apply.) a. Achievable b. Understandable and specific c. People-oriented d. Manager-oriented e. Means-oriented f. Measurable

A, B, F The S.M.A.R.T. acronym describes the attributes of objectives: specific, measurable, agreed-upon, reasonable (achievable), and time-bound.

1. Which of the following activities would represent a customer-friendly approach in a healthcare setting? (Select all that apply.) a. Using a local anesthetic before inserting a needle into a child's arm 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 in a laboring mother's chart d. Providing support to families when a family member is brought into trauma

A, C, D A service orientation means delivering services in a manner that is least disruptive. When possible, services should come to the patient and should be as easy, comfortable, pleasant, and effective as possible. Meeting the emotional, psychosocial, and spiritual needs of the patient is important.

4. During a fire drill, several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This autocratic decision style is most appropriate for: a. routine problems. b. crisis situations. c. managers who prefer a "telling" style. d. followers who cannot agree on a solution.

B An autocratic style is appropriate when rapid decision making is required, such as in a crisis situation.

16. Assessment of the needs of the consumer or client (in developing a strategic marketing plan) focuses on: a. present needs only. b. present and future needs. c. the development of surveys. d. secondary analysis of existing data.

B Assessment of needs takes into account needs of the consumer now and for the future, using a variety of data-gathering techniques. Future orientation aids in anticipating how marketing and programs will need to shift to meet those needs.

20. You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Determination of Evelyn's educational preparation and certification is related to the concept of: a. accountability. b. authority. c. role performance. d. assignment.

B Authority refers to the right to do and may be designated by law, educational preparation, or job description.

17. Which ethical principle is primarily involved in informed consent? a. Veracity b. Autonomy c. Beneficence d. Nonmaleficence

B Autonomy refers to the right to choose freely, which is inherent in informed consent.

4. The nurse manager must 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

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. The quality of human contacts becomes the measure by which the consumer forms perceptions and judgments about nursing and the health agency. Consumers may not be able to evaluate the quality of interventions, but they always can evaluate the quality of the relationship with the person delivering the service.

2. Two staff nurses are arguing about whose turn it is to work on the upcoming holiday. 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.

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

8. During staff-development programs, staff nurses verbalize their frustration about their workloads and having to delegate so many tasks to others. One of the main reasons that delegation has emerged as an issue is because of: a. the amount of paperwork required to complete care. b. the complexity of care required by patients. c. earlier discharge practices. d. the numbers of other disciplines present on a given unit.

B Complexity of client care, a multilevel nursing model (registered nurses, mixed with LPNs/LVNs, and UNPs), and community-based care provide many challenges in determining the care required and outcomes desired and/or mandated, and in matching needs with various abilities and authority of regulated and unregulated healthcare providers. The nurse manager should ensure that staff is clinically competent and trained in their roles in patient safety.

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. What is the appropriate approach to conflict resolution in this example? a. Collaboration b. Compromising c. Avoiding d. Withdraw

B Compromise involves negotiation or an exchange of concessions and supports a balance of power.

7. At a newly built outpatient surgical center, an integrated information system has been purchased. The chief nursing officer creates a series of staff development classes to orient the staff to this new system. One of the advantages of an integrated information system is that client-care data from all sites can be stored in and retrieved from a: a. nursing information system. b. central data repository. c. nurse expert system. d. handheld device.

B Computer information systems manage large volumes of data, examine data patterns and trends, solve problems, and answer questions. In other words, computers can help translate data into information from both within and among organizations. Data from all patient encounters with the healthcare system are stored in a central data repository, where they are accessible to authorized users. Patient information in a centralized database is organized, legible, and easily retrievable from a variety of sources and reflects a variety of data.

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.

B Conflict involves disagreement in values or beliefs within oneself or between people that causes harm or has the potential to cause harm. Conflict may result from the interaction of interdependent people who perceive incompatibility and the potential for interference.

9. 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 regarding the amount of information provided 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

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.

6. 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 monthly. 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.

B Consumers need to be treated with fairness, given explanation, and provided with information about how errors will be prevented in the future. 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.

10. An outpatient surgery manager is evaluating new infusion pumps for purchase to use in the operating room. The manager should: a. select the least expensive brand. b. use a decision-making tool to evaluate brands. c. ask the nursing staff which brand they prefer. d. select the vendor the institution usually buys from.

B Decision-making tools such as decision grids and SWOT analyses are most appropriate when information is available and options are known.

9. The day shift nurse asks an LPN/LVN to complete a task for a patient. The day shift nurse is engaging in what function? a. Delegating b. Assigning c. Sharing d. Authorizing

B Delegation refers to transfer of responsibility for work; the day shift nurse retains accountability for the outcomes of patient care therefore is using assigning of the task rather than delegation.

15. A 27-year-old woman is admitted to your ICU in a coma, following an accident. The family of the patient, who is a Native American, places a medicine pouch in the bed with the young woman. As the nurse in this situation, it is important to: a. explain to the family that the medicine pouch may contain herbs that may bother other patients. b. ask the family about the significance of the medicine pouch for them. c. remove the pouch when the family is not present. d. put the medicine pouch on the shelf beside the bed.

B Diversity encompasses more than differences in nationality or ethnicity and may include a variety of ways that patients are different from their healthcare providers. Nurses need to recognize the culture of their work setting, realizing that it may differ markedly from the culture of the consumer, and move beyond ethnocentrism to provide culturally competent care. This competence includes cultural knowledge, which involves actively learning about a community; cultural sensitivity, which entails valuing and respecting beliefs, norms, and practices of the people being served; and collaboration within a community. In this instance, it is important to understand the meaning of the pouch for the family; removal from the bed without discussion does not demonstrate respect for the values and beliefs of this family.

11. With delegation, responsibility and accountability remain with the: a. physician. b. professional who delegates. c. individual who receives the delegation. d. individual who previously performed the task.

B Even though the delegatee (the one who receives the delegation) receives direction from the professional who delegates a task and must have the authority to complete it, the delegator retains accountability for the overall outcome and completion of the activity. The delegatee has responsibility (obligation to engage in the task) and authority for the task.

A nurse manager was orienting new staff members to computerized charting. To understand computerized charting, staff members must understand informatics. The three core concepts in informatics are: a. hardware, software, and printers. b. data, information, and knowledge. c. decision making, data gathering, and reporting. d. wireless technology, voice recognition, and handheld devices.

B 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. TOP: AONE competency: Business Skills

22. A member of a patient's family calls the nurse manager of the palliative care unit to express concern that a member of the family, who died on the weekend, had requested analgesics from the RNs on duty. An RN came with the analgesic nearly 45 minutes later, just after the patient had died. The manager is aware that the unit was especially busy that weekend because many patients were seriously ill, staff had called in ill, and the staffing manager was unable to completely replace staff who were absent. The manager is deeply troubled that the family member had to die in pain because it violates what she knows should have been done. This manager is experiencing: a. compromised agency. b. moral distress. c. moral sensitivity. d. moral dilemma.

B Moral distress is experienced when nurses cannot provide what they perceive to be best for a given patient. Examples of moral distress include constraints caused by financial pressures, limited patient care resources, disagreements among family members regarding patient interventions, and/or limitations imposed by primary healthcare providers.

8. One means of ensuring that the nurses floated to other patient care areas in healthcare organizations are qualified to work in the areas they are floated is: a. employing additional staff to assist with orientation processes. b. cross-educating staff members to other areas of the institution. c. transferring patients to units where the staffing pattern is optimal. d. orienting staff members to all patient care areas as part of their general orientation to the institution.

B Nurses should be floated to units as similar as possible to their own to decrease the potential for liability. Negotiating cross-training, a proactive approach to temporary staffing problems, reduces the potential for liability.

23. In hiring nurses during the transition from team nursing to a primary nursing model, Benner's work would suggest that you give priority to nurses who are at least at which level of competency? a. Advanced beginner b. Competent c. Proficient d. Novice

B Nurses who have less than 2 or 3 years' experience in primary nursing and/or less than 2 or 3 years of nursing experience will likely require more assistance than other nurses, which will put a greater demand on the unit during a time of transition.

20. A nurse manager is excited by the possible use of speech recognition (SR) systems for documentation of patient care, especially during crisis situations when staff members need to focus on performing rapid assessments and implementation of procedures. She learns, however, that SR systems would be impractical at this point. What would lead to this conclusion? a. SR systems are not available outside pilot projects. b. The type of speech required for voice recognition is unlikely to occur in a pressured situation. c. The hands-free function has not been perfected in SR technology. d. Wireless communications are prone to unreliability in transmission.

B Speech recognition systems rely on staccato-like speech, pauses between words, and programming for each user, any and all of which would be unlikely in a pressured crisis situation. SR is being used primarily for therapeutic purposes and in situations where data entry is stable.

23. While walking past a patient's room, you overhear one of the RN staff telling a patient that the patient has no right to refuse chemotherapy treatment because the family and the doctor think the treatment is the best option for the patient. This patient is 40 years of age and alert. When you meet later to discuss what you heard with the RN, it is important to: a. discuss how statute law enforces the right of the doctor, but not of families, to ensure that patients comply with recommended treatment plans. b. discuss that statute law provides for patient autonomy and refusal of treatment. c. remind the nurse to provide clearer explanations to aid in the patient's comprehension of the treatment and compliance. d. acknowledge the nurse's role in ensuring that she does not fail in her duty of care for the patient.

B Statute law states that the patient must be given sufficient information, in terms he or she can reasonably be expected to comprehend, to make an informed choice. Inherent in the doctrine of informed consent is the right of the patient to informed refusal. Patients must clearly understand the possible consequences of their refusal.

6. The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model. Which of the following methods would be the most cost-effective? a. Functional method b. Case management method c. Primary care method d. Team method

B Team nursing, functional nursing, and case management are all considered efficient, cost-effective methods of care delivery because they enable utilization of various types of healthcare providers (rather than baccalaureate nurses in direct care, which is the primary nursing method). Case management is considered particularly cost-effective in patient care settings because it maintains quality care while streamlining costs for high-risk, high-volume, high-cost patient populations and seeks the active involvement of the patient, the family, and diverse healthcare professionals.

18. As a head nurse, you are concerned about the service orientation on your unit. 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.

B The National Database of Nursing Quality Indicators (NDNQI®) is a national repository for unit-based quality data that can be used by organizations to benchmark the outcomes of care against those of other institutions (ANA, n.d.). Unit-based quality indicators, including satisfaction with nursing care, are a key feature of the NDNQI®. In addition to hospitals being provided with their own and comparison data, researchers are able to access de-identified data in order to answer important questions about nursing care quality. Pain management, the discharge process, and post-discharge patient callbacks are specific areas where nurses can make significant improvement in patient satisfaction. Because patients and nurses may differ in what they see as factors that produce satisfaction, total reliance on nursing perceptions of patient satisfaction may not provide a complete picture.

3. When interviewing an applicant for an RN position, the nurse manager describes the unit's care delivery system as one in which the nursing assistants are cross-trained to perform specific tasks and the RNs complete all treatment, medication administration, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be: a. the case method. b. functional nursing. c. primary nursing. d. nurse case management.

B 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.

16. Decision making is described by the nursing educator as the process one uses to: a. solve a problem. b. choose between alternatives. c. reflect on a certain situation. d. generate ideas.

B The hallmark of decision making is choosing among options. Generating options is one phase of decision making, and solving a problem refers to problem solving, which is problem centered. Decision making does not always begin with problems, but rather is defined as a purposeful, goal-directed effort that uses a systematic process to choose among options.

19. In transitioning to a primary nursing model, it is important for a nurse manager who enjoys a high level of control over patient care to understand that his or her decision making at the patient care level: a. is increased. b. is decreased. c. is relinquished. d. remains the same.

B The nurse manager who is considering movement to primary nursing needs to consider how the role of the manager changes, as well as the roles of the staff. The role of decision making at the patient care level is relinquished to the primary nurse, and the role of manager becomes that of facilitator, coach, mentor, role model, and clinical resource.

18. You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. This incident is an example of: a. incompetence of the UNP. b. failure to follow-through. c. skills but no motivation. d. lack of accountability.

B The nurse should maintain open lines of communication and seek information, and the UNP should know how, when, and what to report. Communication of delegation of tasks includes specific information about what is being delegated, expected outcomes, and deviations (which includes what immediate action needs to be taken). This 2-way communication and follow-through allows patient care to be altered, if necessary, in a timely manner.

20. 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.

B The provision of humanistic care within a high-tech environment is characteristic of high tech-high-touch approaches and reflects the idea that the more that high-tech is used, the more patients also desire high-touch.

20. You are considering putting forward a proposal to move the model of care from team nursing to a primary nursing hybrid: patient-focused care model. In considering this proposal, you recognize that significant costs specific to operationalizing this model are related to: a. implementation of an all-RN staff complement. b. significant changes in the physical structure of units. c. orientation of staff to new roles and responsibilities. d. testing and piloting technology at the bedside.

B This particular model includes a focus on patient care that includes multidisciplinary teams and assistants at the bedside. Services, including laboratories and pharmacies, are decentralized to bring them closer to where care is delivered.

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

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

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

20. John Smith, one of three managers at BSG Labs, drafted a policy that would allow his department to do more testing in his lab. This policy included the times for regular collection as well as a new process for emergency laboratory testing. The policy and procedures were never followed. The reason was that: a. the policy was too lengthy and inundated readers with too much detail. b. the policy made decisions for other departments in the company. c. the staff did not believe that the new policy would be effective. d. testing should not be done in the lab.

B Two primary criteria make for effective decisions. First, the decision must be of a high quality; that is, it achieves the predefined goals, objectives, and outcomes. Second, those who are responsible for its implementation must accept the decision. Higher quality decisions are more likely to result if groups are involved in the decision-making and problem-solving process. Taking ownership of the process and outcome provides a smoother transition in changes.

21. In a telehealth organization, a nurse who is licensed in New York and Pennsylvania provides teaching to a patient who resides in Pennsylvania. The patient charges that the teaching failed to provide significant information about a potential side effect, which led to delay in seeking treatment and untoward harm. Under which state nurse practice act and standards would this situation be considered? a. New York b. Pennsylvania c. Neither New York nor Pennsylvania d. Both New York and Pennsylvania

B Under the law, the state in which the patient resides and not the state where the nurse holds his or her license determines the state nurse practice act that is considered.

6. During a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on: a. supportive behavior by the leader and immature followers. b. the development level of the followers and the behavior based on the situation. c. well-developed followers combined with a strong leader who acts quickly. d. the leader's ability to evaluate personnel and communicate that evaluation.

B When abilities, relationships, and/or time is limited (as in a crisis situation), the leader assumes a bigger role in guiding and in making decisions, or "telling" behavior. Leaders need to behavior differently and use different leadership styles in different situations.

12. 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 a different provider. 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.

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.

19. You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Before assigning Evelyn to Mrs. N.'s care, the most appropriate action of the care coordinator would have been to: a. determine Evelyn's educational background and preparation for this role. b. ask Evelyn if she has worked with inhalers before and to describe what she knows about them. c. advise that if Evelyn has any questions about what to do with the inhaler, she should come to the coordinator. d. advise Evelyn that working the inhaler is not really complicated and that she should ask the patient how to check medication levels in the inhaler.

B When delegating tasks, in addition to specifying the task to be completed, outcomes, priorities, time lines, deviations, report time frames, monitoring, and resources, asking the delegatee to give examples of each is helpful in ensuring that communication is clear and has been understood. Preparation of UNPs lacks consistency; therefore, the safest practice is to determine the knowledge and skill level of the UNP in relation to the skill and the patient before delegating.

13. Which of the following indicates safe delegation? a. The nurse supervisor for a large urban acute care department asks the unit manager to accept two new acutely ill patients, which the manager does. The unit is short two staff, and the replacement is inexperienced. b. A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit manager's unit is fully staffed and patients are stable. c. The nurse supervisor asks the head nurse for Unit A to make do without a replacement for an ill staff member because Unit A was originally overstaffed anyway. Patient acuity levels are very high on Unit A and two staff are orientating. d. The nurse supervisor asks the charge nurse on Unit B to cover Unit F, which is two floors up, because the charge nurse for Unit F is ill. The charge nurse for Unit B is an experienced manager but has no experience with the nursing care required on Unit F.

B When span of control (number of individuals for whom a manager is responsible) is compromised by geographic factors such as lack of proximity, instability in patients' conditions, or lack of experience, the span of control that is being delegated may lead to unsafe care.

4. You are the nurse manager of a nursing service organization that provides around-the-clock care to clients in their homes. To achieve maximum reimbursement for a client who is recovering from a hip replacement, the nursing staff most likely will follow the nursing care guidelines presented in the: a. nursing care plan. b. physician's orders. c. critical pathway. d. clinical practice guidelines.

C A critical pathway outlines outcomes, clinical standards, and interventions for a patient in each phase of treatment. The goal of critical pathways is effective coordination of care across various staff and levels of care.

11. You document your patient's vital signs into a bedside documentation device and are able to compare your patient's vital signs with patients who have similar diagnoses and similar medications, and who are of a similar age. You are accessing: a. e-mail. b. telecommunications. c. a database. d. technology.

C A database is a collection of data elements stored and organized together for the purposes of interpreting information such as vital signs.

15. 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 A particular challenge in team nursing is that staff mixes and staff may change daily because of individual schedules and shortages.

22. 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.

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.

21. 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

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 occurring.

15. You volunteer at a free community clinic. A 13-year-old girl presents with chlamydia. The team leader at the clinic advises that: a. the state-defined age of legal consent is 18; therefore, no treatment can be delivered. b. the teen is underage and should be referred to the family general practitioner. c. care can be provided as long as consent is voluntary and information about treatment and options is provided. d. treatment is provided as long as telephone consent is obtained from a parent or legal guardian.

C All states have a legal age for consent; generally, this age is 18. However, emancipated minors, minors seeking treatment for substance abuse, and minors seeking treatment for communicable diseases can provide their own consent.

18. Nurses are valuable partners in marketing strategies because they: a. are more likely than other members of the organization to use marketing tools. b. have a strong background in using evidence to support decisions. c. have close involvement with patients, who are the target group for marketing. d. constitute the largest staff group in most healthcare organizations.

C As nurses are directly involved with patients who use services and who are the target group for marketing efforts, nurses have excellent insights into patient needs.

10. To conduct assessment of the internal environment, the strategic planning team for Pacific Hospital: a. invites community members and staff of the hospital to an evening focus group session. b. discusses what it sees as the primary threats and opportunities in demographic shifts affecting the hospital. c. invites all levels of staff to focus groups on the effectiveness of the hospital environment, including information systems and staffing. d. asks the board to provide a summary of major opportunities for the future.

C Assessment of the internal environment should include all levels of staff and facilitates feedback on effectiveness of strengths and weaknesses of systems and processes within the institution.

3. A patient refuses a simple procedure that you believe is in the patient's best interest. What two ethical principles are in conflict in this situation? a. Fidelity and justice b. Veracity and fidelity c. Autonomy and beneficence d. Paternalism and respect for others

C Autonomy refers to the freedom to make a choice (e.g., refuse a procedure), and beneficence to doing good (performing a procedure that will benefit the patient).

3. Several nurses on an adolescent psychiatric unit complain that the teens are becoming unmanageable on the 0700-1900 shift. To resolve this problem, the nurse manager decides that the staff should have a brainstorming session. The goal of brainstorming is to: a. evaluate problem solutions. b. critique the ideas of others. c. generate as many solutions as possible. d. identify only practical and realistic ideas.

C Brainstorming encourages creativity when one is beginning to problem-solve and avoids premature shutting down of ideas through early evaluation. The goal is to generate ideas, no matter how seemingly unrealistic or absurd.

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

C By walking away, the nurse is engaged in an action or a behavioral response, which is the action stage of conflict that is outlined in the four stages of conflict (Thomas, 1992). In this stage, the nurse might have used more effective strategies, such as clarifying Mr. Hill's views on feeding his wife and engaging in dialogue with Mr. Hill to clarify his concerns and attempt to reach a common goal.

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 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

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.

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

C Facilitating greater control over practices implies trust and acknowledges expertise and performance.

18. The principle that requires nurses to uphold a professional code of ethics, to practice within the code of ethics, and to remain competent is which of the following? a. Veracity b. Autonomy c. Fidelity d. Honesty

C Fidelity refers to promise keeping or upholding one's promise to practice as a reasonable and prudent nurse would do and in an ethically competent manner.

12. 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 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.

16. An RN colleague, who is a long-standing and collaborative member of your team, is performing a complex dressing with new orders written for the first time for the assigned patient. Which of the following would be the most appropriate communication with her? a. "How do you usually do this kind of dressing?" b. "The dressing needs to be done today and tomorrow with the supplies on this cart." c. "Here is what you need for the dressing, and I will show you what needs to be done." d. "I know you know what you are doing. Let me know if you have any problems."

C If a situation involves a new task and the relationship is ongoing (two individuals who will usually continue to work together), the delegator explains what to do and how to do it. Hersey described the leader's behavior as explaining or persuading, which, is characterized as "selling." The RN who is assigned to the patient is an experienced nurse and team member, but is new to this specific situation. In situations where the nurse is experienced but the task is new, explain (and demonstrate) what needs to be done.

7. The unit manager is working in a large metropolitan facility and is told that two UNPs are to be assigned to work with her. Delegation begins with: a. acknowledging the arrival of the second UNP on the unit. b. providing clear directions to both UNPs. c. matching tasks with qualified persons. d. receiving reports from the prior shift.

C In delegating to the UNPs, the nurse must consider what cannot be delegated, as well as the factors of safety, time, critical thinking, and stability of patients.

9. Jane has transferred from the ICU to the 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 which type of conflict? a. Organizational b. Intrapersonal c. Interpersonal d. Disruptive

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

15. From the information supplied in this chapter, which statement best defines critical thinking? Critical thinking is a: a. high-level cognitive process. b. process that helps to develop reflective criticism for the purpose of reaching a conclusion. c. high-level cognitive process that includes creativity, problem solving, and decision making. d. discussion that guides the nursing process.

C It is generally accepted by many authors and researchers that this statement best defines critical thinking.

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.

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.

24. In considering whether or not to accept a job offer as a nurse manager at a Magnet® hospital, you look at an environment that you might encounter as a head nurse at the hospital. You determine that you could expect to: a. find it difficult to recruit new staff. b. see rapid turnover of staff on your unit. c. find nurses who exemplify interest in quality care. d. find limited interest in excellence in the nursing environment.

C Magnet® hospitals exemplify hospitals whose focus processes attract and retain nurses who value and promote quality care and excellence in nursing environments.

16. 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 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. TOP: AONE competency: Business Skills

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 task force 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

C Negotiation involves an exchange of concessions (membership on a committee in return for attendance at a workshop) or trading. This strategy supports a balance of power.

17. Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high turnover rate among rehab-assistants because of the heavy work assignments. Despite his need for staff, Justin decides to review each application thoroughly and interview candidates carefully because he recognizes that it is important to hire staff who can best provide high-quality care and who will fit well with the team. Which of the following decision-making models did Justin use in making his decision? a. Subjective model b. Objective model c. Optimizing model d. Satisficing model

C Optimizing is a decision style in which the decision maker selects the option that is best, based on an analysis of the pros and cons associated with each option. A better decision is more likely when using this approach, although it takes longer to arrive at a decision.

11. Select the statement that best defines the difference between problem solving and decision making: a. decision-making skills require critical thinking; problem-solving skills do not. b. problem-solving skills require critical thinking; decision-making skills do not. c. decision making is a goal-directed effort; problem solving is focused on solving an immediate problem. d. problem solving is a goal-directed effort; decision making is focused on solving an immediate problem.

C Problem solving is focused on solving immediate problems, whereas decision making is a goal-directed process that is aimed at selecting appropriate actions from among options. Not all decisions begin with a problem.

12. Which of the following exemplifies accountability? Karen, the nurse manager on 5E: a. consistently submits her budgets on time. b. gets along well with her staff and with other managers. c. outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury. d. actively solicits ideas regarding scheduling from her staff.

C Reliability, dependability, and obligation to fulfill the roles and responsibilities of the nurse manager are consistent with responsibility. Accountability refers to being answerable for actions and results.

21. High-quality decisions are most likely to be made in nursing situations when: a. team leaders make the crucial decisions. b. individuals are advised of the problems. c. group size is neither too small nor too large. d. members are passively involved.

C Research has shown that group size is important. Too small a group means a limited number of options generated. Too large a group can mean lack of structure or lack of meaningful discussion.

16. 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 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.

6. 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 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.

8. 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. JCAHO standards. b. information systems. c. informatics competencies. d. requirements for nursing licensure.

C 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. TOP: AONE competency: Business Skills

13. 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.

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.

5. 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

C The definition of health literacy used by the federal government is "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (U.S. Department of Health and Human Services, 2010).

13. At the beginning of the strategic planning processes, Pacific Hospital learns that nursing staff members are uncomfortable with utilizing evidence-based practice, and that staff perceives that only limited resources are available to support translation of evidence into their usual practice. Because this issue has been identified, the management team determines that a plan of action is required to address the issue. Who should be involved at this point? a. Nursing unit managers b. Staff nurses c. All staff d. Administration

C The first phase in planning is conducting an assessment of the external and internal environments. Assessment of the internal environment should include all levels of staff and facilitates feedback on effectiveness of strengths and weaknesses of systems and processes within the institution.

8. From your observation of planning activities in the organization, you have noticed that planning and decision making occur at various levels of the organization. The nurse manager has overall responsibility for which of the following? a. Sending out postcards b. Organizing a telephone follow-up c. Monitoring ongoing activities and projects d. Listing the patient population

C The nurse manager should articulate organizational decision making for the criteria model adopted by the organization and monitor ongoing implementation of the plan.

9. In a small rural nursing home, a director of nursing decides, because of a shortage of nurses, to implement a partnership model to help with basic tasks that comply with state rules regarding delegation. What type of design constitutes a partnership care delivery model? a. RN and LPN/LVN b. RN and RN c. RN and medication assistants d. RN and certified nurses' aides

C The partnership care delivery model is a variation of primary nursing in which an RN works with a consistent assistant, who performs basic nursing functions consistent with state delegation rules.

10. The case method of care delivery could be best justified in which of the following scenarios? a. Stable patient population with long-term care and family needs b. Acute care surgical unit with predictable postsurgical outcomes and many technical procedures c. Pediatric intensive care unit that heavily involves families as well as patients d. Home healthcare environment with patients at varying levels of acuity

C 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.

2. The charge nurse is making patient assignments for the next shift on the unit. There is one critical patient on the unit, who is going to require more care than the other patients. Before delegating this patient in an assignment, what is the appropriate action by the charge nurse? a. Delegate the admission assessment to the LPN. b. Review the employee's performance assessment for the most recent period. c. Assess the amount of guidance and support needed for the nursing care of the patient. d. Create a task analysis of critical behaviors for the individual.

C To delegate effectively, the charge nurse must assess the abilities required in the situation and the abilities that staff have to anticipate the amount of direction, monitoring, explanation, and independence that can be assumed.

6. To solve a problem, the nurse manager understands that the most important problem-solving step is: a. the implementation phase. b. identification of numerous solutions. c. accurate identification of the problem. d. evaluation of the effectiveness of problem resolution.

C To proceed effectively, it is important to determine if a problem exists and to accurately identify a problem. Failure to resolve problems is most often linked to improper identification of the problem.

11. A nurse is admitted to a psychiatric unit. The staff expresses frustration with her because they have explained her medication regimen several times, and yet, when she leaves the unit with a pass, 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.

C 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. Using a Health Literate Care Model involves weaving health literacy strategies into care by assuming that patients do not understand their health conditions or what to do about them, and then, subsequently assessing patients' understanding. For example, a nurse who is an expert clinician in a specialty practice area, when diagnosed with a serious chronic illness, may not have the appropriate background to make informed healthcare decisions.

23. County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah provides Colleen, her RN colleague with details regarding the patients to whom Colleen has been assigned on the day shift. This is an example of: a. accountability. b. responsibility. c. assignment. d. delegation.

C When an RN assigns care to another RN, it is termed an assignment and not delegation, because both accountability and responsibility are transferred.

14. A 39-year-old patient awaits a kidney transplant. Because he must immediately arrange to get to the hospital when a donor kidney is available, it is important that he can be reached anywhere and at any time. To ensure that he receives the message, what type of technology is most effective? a. Internet b. Telecommunications c. WL pager d. CDS

C Wireless (WL) communication is an extension of an existing wired network environment and uses radio-based systems to transmit data signals through the air without any physical connections. Patients awaiting organ transplants are provided with WL pagers so that they can be notified if a donor is found. TOP: AONE competency: Business Skills

17. Which of the following exemplifies a service orientation for a facility? 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 the importance of palliative care. d. A children's preoperative holding area is implemented in response to requests from families and staff nurses for development of an area.

D A service orientation needs to translate caring into appropriate, timely action that meets the needs of patients. Activities such as documentation of details or promotion of services may remain at the technical or conceptual level without a commitment to caring interactions. The institution of a holding area where families can be with children represents a caring action that arises out of interactions and knowledge of patient needs and thus, is service oriented.

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.

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

18. The nurse manager is comparing functional nursing and primary nursing for potential adoption. The nurse manager determines that patient and nurse satisfaction in primary nursing are: a. similar to those in functional nursing. b. not of significance in either model. c. low by comparison with functional nursing. d. high when compared with functional nursing.

D Although some studies suggest there is little difference between functional nursing and primary nursing, primary nursing tends to be more satisfying for RNs, who enjoy a high level of accountability and autonomy in decision making. Patient satisfaction is also high, as patients form close therapeutic relationships with the nurse because of the continuity of the relationship. Functional nursing is criticized for low patient satisfaction and potential staff dissatisfaction related to boredom and an autocratic approach to management.

22. A necessary, basic condition for successful integration of clinical information systems is: a. software. b. standard medical nomenclature. c. confirmatory evidence from nursing-led studies. d. strong interdisciplinary cultures.

D An integrated clinical information system draws on specific knowledge from many involved disciplines that interface at the patient. Successful integration of clinical information systems requires that the various disciplines work together collaboratively to transform the data into meaningful knowledge. TOP: AONE competency: Communication and Relationship-Building

14. During a staff shortage, you hire an RN from a temporary agency. The RN administers a wrong IV medication that results in cardiac arrest and a difficult recovery for the patient. Liability in this situation: a. is limited to the temporary agency. b. is restricted to the RN. c. could include the RN, the agency, and your institution. d. may depend on the patient's belief regarding the employment relationship.

D Apparent agency may apply here because your liability and that of your institution could be established if it can be shown that the patient believes that the RN was an employee of yours and of your institution.

14. 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.

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.

23. What exemplifies the predominant style of conflict management for staff nurses? a. Sarah and Jonas, two RNs, disagree about 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 2 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.

D Avoidance and accommodation are the predominant conflict management styles of nurses. Accommodating involves neglecting one's own needs while trying to satisfy the needs of another.

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 area. 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.

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 incivility or intimidation.

21. When hiring a case manager for a rehabilitation setting, you would most likely consider a: a. registered nurse with a master's degree. b. physiotherapist with a background in stroke rehabilitation. c. social worker with a background in counseling. d. health professional with advanced background who is client and outcome focused.

D Case managers can come from a variety of disciplines but should have advanced preparation with the particular at-risk population being served, be comfortable in an advocate role, and be outcome and patient focused.

24. As part of an information technology implementation team, you are implementing a clinical decision support system. Particular considerations for successful implementation of this project include: a. ensuring that the system is reliable. b. ensuring that patient information is reliable. c. developing unique identifiers for individuals. d. developing rules that support inferences.

D Clinical decision support systems provide support for novice nurses, in particular, as they enable entry of real-time data from patient situations and inferences that apply the logic that expert nurses would use. These inferences require rules to be developed for the system.

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 creative conflict resolution? a. Avoiding b. Competing c. Compromising d. Collaborating

D Collaboration, although time consuming, is the most creative stance. The collaboration technique involves both sides in the conflict working together to develop an optimal outcome. This results in a win-win solution.

21. Which of the following exemplifies the predominant 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.

D Compromise involves trading and negotiation and is the predominant conflict management style of managers.

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. Interprofessional collaboration c. Expression of one's own needs and ideas d. Avoidance of the issue or concern

D Conflict involves a level of interdependence and is a condition for conflict but not necessarily for continuance of the conflict. Expression of one's ideas and concerns is considered assertive and effective in resolving conflict if the concerns and needs of the other are also considered. Interprofessional collaboration has been shown to be effective in resolving conflict. Avoidance tends to prolong and sometimes escalate conflict.

13. As the head nurse involved in leading determination of which patient surveillance systems to acquire for your unit, one of your aims is to avoid adverse events through the implementation of appropriate technology. This particular aim recognizes that: a. human error is significant in contributing to adverse events. b. documentation of patient data is often illegible and therefore, misinterpreted. c. data systems provide backup documentation with adverse events that staff cannot provide. d. physiologic monitoring systems enable detection of early changes before an adverse event occurs.

D Data about adverse events suggests that a majority of physiologic abnormalities are not detected early enough and may be present hours before the event actually occurs. Physiologic monitoring aids in early detection of changes.

18. Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high turnover rate among rehab-assistants because of the heavy work assignments. Despite his need for staff, Justin decides to review each application thoroughly and interview candidates carefully because he recognizes that it is important to hire staff who can best provide high-quality care and who will fit well with the team. Which of the following decision-making solutions should Justin consider to have a more efficient department? a. Replace staff only with qualified applicants. b. Determine what the problem or problems are before hiring new staff. c. Consult with the human resources department and develop a plan for hiring new staff. d. All listed are appropriate to consider.

D Decision making involves a goal-oriented consideration of many options that are objectively weighed according to their possible risks, consequences, and positive outcomes. The options should be ranked in the order in which they are likely to result in the desired goals or objectives. The solution selected should be the one that is most feasible and satisfactory and has the fewest undesirable consequences. In this instance, all of the options listed might be considered and weighed.

15. In delegating to a UNP in a home health setting, which of the following represents the most appropriate delegation communication? a. "You will be taking care of Mrs. S., who needs assistance with her bath." b. "You will need to help Mrs. S. get into and out of her shower. Ensure that you check the condition of her feet, and let me know if you have any concerns when you check in." c. "I am not sure that you know how to do this, but I am giving you Mrs. S. She is quite obese and needs skin care." d. "Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness."

D Delegation communication includes what is being delegated (and what is not), outcomes, specific deadlines (if applicable), specific reporting guidelines (what, when), and who may be consulted. Communication also includes conveying recognition of the authority to do what is expected.

17. After an extensive campaign to ensure that the community surrounding Pacific Hospital has been exposed to the emphasis of excellence in clinical care that occurs through the use of evidence, the marketing team finds that the public perception has changed little. This determination is made possible through: a. marketing surveys. b. focus groups. c. informal feedback. d. comparison of data against benchmarks.

D Developing benchmark data at the beginning of a project enables comparison of later data against the benchmark to determine if a marketing plan has met its objectives.

1. Complex care of acutely ill patients is required on a surgical unit, which utilizes differentiated nursing practice as its model of care delivery. On what is the concept of differentiated nursing practice is based? a. Licensure status b. Experience in the agency c. Leadership capabilities d. Education and expertise

D Differentiated nursing practice models are models of clinical nursing practice that are defined or differentiated by level of education, expected clinical skills or competencies, job descriptions, pay scales, and participation in decision making.

12. Sue, a nurse manager, has a staff nurse that has been absent a great deal for the past 3 months. A whistleblower gives some information to Sue indicating that the staff nurse will be resigning and returning to school. Because of this, Sue decides to do which of the following? a. Immediately fire the staff nurse. b. Speak to the whistleblower and elicit more information. c. Speak to the staff nurse and ask her to resign. d. Do nothing.

D Doing nothing is often warranted because of lack of energy, time, or resources to solve the real problem adequately, and because the benefits are not seen as sufficiently compelling to commit to an action. Do nothing may also be utilized when the individual is not able to do anything for the particular situation or issue.

23. Benchmarks in the strategic marketing planning process are useful in: a. establishing programs. b. setting targets. c. rewarding employees. d. measuring progress.

D Establishing benchmarks enables measurement of the interim and final achievements of programs.

5. After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of unmanageable teenage patients. To maximize group effectiveness in decision making and problem solving, the nurse manager has: a. prevented conflict. b. formed highly cohesive groups. c. used majority rule to arrive at decisions. d. encouraged equal participation among members.

D Groups are more likely to be effective if members are involved, the group is cohesive, communication is encouraged, and members demonstrate some understanding of the group process. The nurse leader or manager should provide a nonthreatening and positive environment in which group members are encouraged to participate actively.

The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports related to patients falling during the 11-7 shift. The nurse manager knows that the best way to resolve the problem is to: a. use creativity. b. obtain support from the 7-3 shift. c. use institutional research. d. identify the problem.

D Identification of a problem is the first step in problem solving and occurs before any other step. The most common cause for failure to resolve problems is the improper identification of the problem/issue; therefore, problem recognition and identification are considered the most vital steps.

7. A clinic nurse has observed another nurse deviating from agency policy in performing wound care. The best approach for the clinic nurse to take is to: a. stay out of it. b. inform the nursing supervisor. c. fill out a notification form (incident report). d. assess the risk to the client and the agency before proceeding.

D If the situation is subjective, nonroutine, and unstructured or if outcomes are unknown or unpredictable, the nurse leader and manager may need to take a descriptive or behavioral approach. More information (such as degree of risk to the client and to the agency) needs to be gathered to address this situation effectively.

7. 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 In a functional nursing model, where other team members are focused on performing specific tasks, the nurse manager assumes primary responsibility for patient outcomes.

16. You are involved in designing a clinic for women in an inner-city neighborhood. A goal of this clinic might be: a. development of services that are identified in various studies as important for this target group. b. partnership with area city councilors and health professionals to provide services that are consistent with their vision and funding sources. c. provision of immunization and addictions services and health screening services for women in the area. d. development of services that have been identified by the women and neighborhood advocates as necessary for their health care.

D Involvement of persons in their own health care is a cornerstone of healthcare reform and is important for improving health outcomes and patient experiences. While studies and partnership with key informants are important sources of information in the design of services, engagement of the women through their neighborhood advocates may increase activation and resulting behavior. Patient activation refers to patients' willingness and ability to take independent actions to manage their health and care.

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.

D It is important for each person in the conflict to clarify the conflict as "I see it" and how "it makes me respond" before all the persons involved in the conflict can define the conflict, develop a shared conceptualization, and resolve their differences.

21. As a nurse manager, one challenge is to orient new staff to your agency's policies and procedures, as well as to provide training across various shifts. A cost-effective and effective learning strategy would be: a. development of new learning modules and software to support document retrieval. b. e-mail distribution to staff home e-mail addresses regarding important policies. c. preparation of DVDs that can be viewed on computers at the nursing station during "down times." d. linking policies and procedures to the network for access when required at the point-of-care.

D Knowledge technology consists of systems that generate or process knowledge and provide clinical decision support (CDS). The clinical knowledge embedded in computer applications can range from simple facts and relationships to best practices for managing patients with specific disease states, new medical knowledge from clinical research, and other types of information. The most accessible and cost-effective approach would be utilization of what is already available in the work environment, such as the systems that provide CDS. TOP: AONE competency: Business Skills

1. The manager in the coronary care unit believes an important ethical consideration in performance evaluations is to include the employee's good qualities and give positive direction for professional growth. What ethical principle does this represent? a. Justice b. Fidelity c. Beneficence d. Nonmaleficence

D Nonmaleficence refers to "doing no harm." For a nurse manager following this principle, performance evaluation should emphasize an employee's good qualities and give positive direction for growth. Destroying the employee's self-esteem and self-worth would be considered doing harm under this principle.

24. An example of a factor that would impede a patient's learning is: a. poverty. b. limited health insurance. c. being an older adult. d. heavy sedation.

D Nurses need to be sensitive to the teaching needs of those at risk for disparities in health care: persons of a different race or ethnic group, women, children, older adults, rural residents, and those with limited or no health insurance, low health literacy, and/or low socioeconomic status. It is important that lower expectations for persons who are disadvantaged, have a low literacy level, or have limited English proficiency are not unintentionally communicated.

22. After a year, the staff at Pacific Hospital is frustrated, and implementation of evidence-based practice has gone poorly. In responding to this situation, the strategic planning team at Pacific Hospital: a. recommends that the mission, objectives, and goals of the hospital be reassessed. b. revises the goal statements in the strategic plan. c. consults an external team on preparation of materials on evidence-based practice. d. holds focus groups with staff to determine what kinds of issues, challenges, and obstacles have occurred in implementation.

D On a consistent basis, the strategic plan is reviewed at all levels to determine whether the execution of goals, objectives, and activities is on target. As stated, a sense of flexibility regarding the objectives is important to consider, and objectives may change as a result of legislation, budget changes, and change in structure or other environmental factors. Involving staff enables development of creative methods to ensure that necessary changes occur.

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 and begin to criticize and make rude comments about managers who embrace this model, as well as colleagues who support it. The comments are largely ignored because those who are making them are well established nurses who are often vocal about their displeasure with the organization. Organizational conflict is arising from which of the following? a. Staffing practices b. Increased participation in decision making c. Allocation of resources d. Tolerance of incivility

D Organizational conflict arises from discord related to policies and procedures (such as staffing policies and practices and allocation of resources), personnel codes or conduct or accepted norms of behavior (such as incivility), and patterns of communication. A major source conflict in organizations stems from strategies that promote more participation and autonomy of staff nurses.

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. Sarah explains to Lucy 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.

D Productivity decreases with destructive conflict, whereas constructive conflict strengthens relationships.

12. 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. The outcome as depicted by Thomas' conflict stages can be considered to be: a. compromising. b. confronting. c. constructive. d. destructive.

D Resolution was absent because the nurse did not have time to effectively deal with the issues in the conflict. This can lead to negativity, increased frustration, and further distancing between individuals or groups, including between patients and nurses.

23. A nurse makes a medication error that is not serious and does not cause harm to the patient. As the charge 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.

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.

2. The nursing manager of a surgical unit has been asked by administration to evaluate client outcomes post cardiac catheterization. Using data about client outcomes post cardiac catheterization for the past 6 months in order to modify practice is an example of: a. information. b. cost-effective care. c. meeting standards. d. evidence-based practice.

D Technology enables evidence-based practice by collecting good clinical knowledge, translating nursing knowledge into reference materials that can be accessed at the point-of-care, and, potentially, assisting nurses to take action based on best evidence for practice. TOP: AONE competency: Knowledge of the Health Care Environment

17. Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She is assigned David, a patient who has been admitted with a severe head injury. In communicating with Sally, what does is an appropriate action by the charge nurse? a. Provide a detailed explanation of what she needs to do with ICP monitoring. b. Tell her when she needs to provide an update about David's status. c. Ask her to tell you what she knows about ICP monitoring and share expectations about reporting. d. Advise her that you are available if she needs you.

D The charge nurse and Sally have a well-established relationship and Sally has the expertise to work effectively with David; therefore, the charge nurse would need to provide little guidance but would need to communicate that they are available if needed. Hersey refers to this leader behavior as "delegating."

2. A community-based pain management program is being planned for your region. As a coordinator of a home care agency, you have been requested to develop a conceptual framework, mission statement, philosophy, and objectives for the program. In what order will you pursue this endeavor? a. Objectives, philosophy, and mission statement b. Philosophy, objectives, and mission statement c. Philosophy, mission statement, and objectives d. Mission statement, philosophy, and objectives

D The development of the mission statement is the first step in defining the purpose and direction of the organization after an assessment has been completed.

5. The nurse case manager is working with a client admitted for end-stage renal disease. The case manager's major goal during this hospitalization for this patient is to: a. implement the care pathway on admission. b. provide direct nursing care throughout the hospitalization. c. supervise the nursing staff members who implement the care map. d. prevent additional hospitalizations resulting from complications of the client's disease.

D The goals and outcomes established in a critical pathway are designed to support the aims of case management, which are shortened hospital stays and prevention of hospital readmissions.

24. The agency in which you are a nursing leader makes a decision to reduce the number of RN positions in favor of PN positions because agency data suggest that the clients in the agency can receive appropriate care from PN staff. Furthermore, the agency is facing a decline in funding and without restructuring, some clients might not receive services at all. You provide this information on this decision to the staff and ask them to advise you if they have any feedback, concerns, or alternative solutions. This decision-making style is known as: a. paternalistic. b. shared. c. reasoned d. informative.

D The informative model offers the staff the ability to make a decision after the information has been shared and without the active involvement of the manager.

14. In implementing the strategic plan for effective utilization of evidence to guide nursing practice at Pacific Hospital, the nursing unit managers take the next step, which is the implementation. Implementation most likely would involve: a. revisiting the mission statement and objectives. b. reevaluating external and internal factors affecting evidence-based practice. c. preparing a budget to support implementation. d. developing unit-based objectives related to the plan.

D The previous planning (assessment of internal and external environments, development of a mission and plan, and allocation of resources) has already been completed. The next step involves adapting the strategic plan to the nursing units.

3. A key advantage that a charge nurse has in terms of delegating is that: a. clients receive less attention because too many staff make it difficult to coordinate care. b. nurses report less pressure to perform necessary tasks themselves. c. administration can predict overtime more accurately. d. team skills can be used more effectively.

D The use of multilevel healthcare providers enables healthcare organizations and nursing to provide patient-centered care, with a focus on abilities and skills that can be employed to perform "what is needed now." As tasks become more complicated, delegating skills to others enables the nurse to effectively deliver a complex level of care.

23. Jane, an experienced head nurse, is given the task of completing the summer vacation schedule for the pediatric unit. She is fully aware of the hospital's restrictions on time off and the number of staff on vacation at any given time, as well as its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative? a. Ask for requests for vacation time in advance, and post the times. b. Post the completed vacation schedule. c. Post a tentative schedule, and request feedback. d. Post a blank schedule, and ask staff members to fill in their times by a given date.

D This is based on a decision-making model that allows experience and knowledge to predict whether a decision will or will not work. The experience of the head nurse suggests that it is important to involve staff in decisions that affect them the most.

10. You are working in a home health service and have three unlicensed nursing personnel (UNPs) assigned to your team. You have worked with two of them for 2 years; the third is new. The two experienced UNPs have patients with complex illnesses for whom they provide basic care. The third member of the team has been assigned to patients with less complex illnesses. Your best approach to supervising their care is to: a. remain in the office and ask each UNP to check in with you upon arrival at their first patient care site. b. ask another RN to supervise the two experienced assistants so you can be with the new person full time. c. meet the new staff member at the first patient care site and ask the others to call if anything is unusual. d. meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual.

D When ability and willingness are strong, the involvement of the delegator is needed less.

24. Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and as a result, a suit is launched in which both Sarah (the delegator) and Leslie (the delegatee) are named. Sarah is named in the suit because she: a. retains accountability for the care of the patient. b. worked the same shift as Leslie. c. has passive accountability for delegation. d. retains accountability for the outcomes of care for the patient.

D Whenever care is provided by someone other than a registered nurse, accountability for care remains with the manager/delegator even though others provide aspects of care.

8. In a rural hospital, the unit for which you are charge nurse has a particularly busy morning. A 52-year-old patient is complaining of left-sided chest pain and a multiparous patient is about to deliver. A child with asthma is experiencing early signs of an attack. The other RN on the unit is a recent graduate who has not yet been orientated to the labor room and has limited cardiac nursing experience. An unlicensed assistant is available to assist. You must decide which patient situation you will take and where the new graduate RN's skills can best be used. Given the limitations in skills and experience, number of staff available, and time constraints, you must make a decision that involves: a. a higher order thinking process. b. selecting the best option for reaching a predefined goal. c. optimizing. d. satisficing.

D With this approach, the decision maker selects an acceptable solution, one that may minimally meet the objective or standard for a decision. This approach allows for quick decisions and may be the most appropriate when lack of time is an issue.