Essentials of Nursing Leadership & Management

A client's husband recently died. During her doctor's appointment, what would be the most appropriate statement by the nurse to the client at this time?

A) "At least your husband didn't have to suffer." B) "It's better to go quickly as your husband did." C) "Your husband's loss must be very painful for you." D) "You'll begin to feel better after you get over the shock." Answer: C

Sally has been working only 3 months after graduating from her nursing program. She confides in a friend that she wants to develop herself as a "good follower." Her friend says, "Anyone can follow—just walk behind someone and do nothing." How might Sally respond?

A) "I don't mean now, but when I become a nurse manager." B) "Effective followers need to be active participants in the workings of this unit." C) "Effective followers need to do everything the administrators want." D) "Effective followers need to always question the status quo and strive to make changes." Answer: B

While working as the charge nurse on the 7:00 p.m. to 7:00 a.m. shift, the nurse overhears the UAP speaking harshly to Mr. Hernandez, who has an expressive aphasia and a left hemiparesis from a stroke. When the UAP leaves the room, the nurse decides to speak with her. Which of the following would be the most appropriate approach?

A) "I have decided to change your assignment from Mr. Hernandez to Mrs. Hopkins." B) "I am concerned because it sounded to me as though you might be losing patience with Mr. Hernandez." C) "You need to watch your tone of voice as it sounded very harsh." D) "Perhaps you need to consider attending a training session on communication skills." Answer: B

Matthew is completing his first year of employment as an RN on a medical-surgical unit. A new graduate has just started her orientation on his unit. He found her crying in the patient lounge stating, "I can't do this. This is just not like we learned in school." What response from Matthew demonstrates his leadership skill?

A) "If you are already crying this is not the career for you." B) "I remember those feelings—come on—let's talk about it." C) "Why don't you talk to the nurse manager? Maybe she can give you a lighter load." D) "I would consider a transfer to an easier unit." Answer: B

Linda believes she should begin demonstrating leadership skills on her unit. She speaks with her nurse manager about how to do this. The nurse manager, who wants to encourage Linda's leadership development, responds by saying:

A) "Just watch me closely—it will come to you eventually." B) "Develop perseverance—just hang in there and do your work well—someone higher than I will notice you." C) "It takes a lot of energy to be a leader. You might want to sign up at the local gym." D) "Understand yourself first—what leadership skills do you want to develop?" Answer: D

Yana and Jonathan carry the gene for a rare genetic disorder that causes severe mental retardation and physiological problems incompatible with life. Yana has conceived twice, however, both children had the disorder and died within 2 months after birth. Yana has come to the fertility clinic. While her history is being taken, Yana says to the nurse, "After you harvest my eggs and fertilize them with Jonathan's sperm, throw out all the bad ones, and give me only the good ones." The best response made by the nurse is:

A) "Now, that's not very nice." B) "We never implant bad embryos; we have a reputation to keep." C) "You have to take the good with the bad." D) "Let's talk about your concerns regarding the health of these embryos." Answer: D

A new nurse manager plans to give a performance evaluation to a staff nurse who has worked on the unit for 15 years. The staff nurse has had multiple complaints regarding the delivery of client care from clients and other staff. The best statement by the nurse manager in beginning the performance appraisal would be:

A) "Tell me how you view your delivery of client care?" B) "I have reviewed your past evaluations and cannot believe that you are still here!" C) "The other day I noticed how well you taught your client about his new medications." D) "I think that the acuity on this unit is too difficult for you." Answer: A

A new graduate has been offered a nurse manager position. What is the graduate's best response?

A) "Thank you, but I'm not ready to be a manager." B) "When can I start?" C) "What is the starting salary?" D) "Tell me what the benefits of the positions are." Answer: A

A family insists that their father, Alvin Shure, 68 years old, not be told he is dying of lung cancer. While hanging his IV medication, Mr. Shure asks the nurse, "I never had a medication in a bag like that. What is it for?" The nurse knows that the medication is an antineoplastic agent. The best response by the nurse is:

A) "This is a new drug your physician ordered." B) "This medication is often used in the treatment of cancer." C) "This medication has more than one use, and I am not sure why you are receiving it." D) Request that the family tell him why he is getting the medication. Answer: B

Maggie is a new UAP. She has been working the 7:00 p.m. to 7:00 a.m. shift on a busy telemetry unit for 3 months. She is perpetually late to work. The other UAPs on the unit are complaining about the situation. Of the following responses, which demonstrates the best example of assertive communication?

A) "You are always late; what are you going to do about this situation?" B) "Being late is unacceptable; you need to change this behavior." C) "I noticed that you often arrive late; I think we need to discuss how this affects your performance." D) "Lateness creates a situation that leads to a negative day; I think it is time to work out a plan to eliminate this problem." Answer: D

Billi Jo is a new UAP. She is eager and excited about her new job in health care. She is helping the nurse move a client up in bed. The nurse observes that Billi Jo is using all her back muscles and none of her leg muscles to accomplish this task. Which response best provides constructive criticism for Billi Jo?

A) "You are not using very good body mechanics." B) "I find when I move clients, it helps to use my leg muscles more and my back muscles less." C) "I hope you are not considering a nursing career because you won't last 2 months if you move clients that way." D) "You were very helpful in moving the client up in the bed." Answer: B

Mrs. Brandon has breast cancer. She was diagnosed quite late in the illness and is terminal. She knows that she has breast cancer and has undergone a mastectomy, however, no one has told her the extent of her illness. The nurse comes in to change her dressings and hang her medication. Mrs. Brandon looks at the nurse and asks, "What is happening to me? Why won't anyone explain what is happening to me?" Her husband, Mike, and two daughters look at the nurse and shake their heads, "No." The best response by the nurse is:

A) "You seem distressed; let's talk about your concerns." B) "You know you are ill; let's talk about dying." C) "You seem concerned about your health; talk to the doctor when he comes in to see you." D) "Mike, you need to talk to your wife and tell her what is really happening." Answer: A

If more nursing unit management responsibilities were shifted to non-nursing personnel, nursing care for individual clients would be increased by approximately:

A) 15 minutes B) 30 minutes C) 45 minutes D) 60 minutes Answer: C

Which of the following clients should be assigned to the UAP?

A) A client who has just returned from the post-anesthesia recovery room. B) A client whose call light is not working. C) A client with Alzheimer's type dementia. D) A client who is receiving heat treatment. Answer: B

Of the following clients, which one could be assigned to a UAP?

A) A client with a recent head injury B) A fresh postoperative laparoscopy client for the removal of an ovarian cyst C) A client with stable angina D) A client with a sepsis Answer: C

As a charge nurse, which of the following clients would be the most appropriate to assign to a nurse pulled to a neurological unit from a general surgical unit?

A) A client with a stable cervical fracture who is in halo traction B) A client with Guillain-Barré syndrome who is having respiratory difficulties C) A client with chronic amyotrophic lateral sclerosis D) A newly admitted client diagnosed with myasthenia gravis Answer: A

What is the goal of conflict management?

A) A conflict-free workplace B) Resolving conflicts C) Avoiding conflicts at any cost D) Problem reduction Answer: B

The RN knows that an example of a diagnostic error is:

A) A failure to act on critical lab results reported B) The failure of an IV pump to infuse at the programmed rate C) Error in administering a PO medication D) Error in calculating an IV drug dose Answer: A

A common theme in both the ANA and the ICN code is:

A) A focus on the importance of compassionate care B) Nurses making decisions for clients C) Promoting nursing practice acts D) Maintaining continuing education Answer: A

The phenomenon of change is best characterized as:

A) A natural occurrence B) Artificially imposed by administration C) A man-made occurrence D) Unpredictable and unmanageable Answer: A

The agency responsible for protecting the worksite against terrorism is:

A) ANA B) OSHA. C) CDC D) NIOSH Answer: B

For registered nurses to enhance their expertise and sense of empowerment, certain activities are necessary. Which of the following will least prepare registered nurses for enhancing their competence?

A) Actively participating in interdisciplinary team conferences B) Attending professional organization meetings C) Refraining from participating in research projects in a clinical specialty D) Returning to school to earn a higher degree in nursing Answer: C

Lorena, an RN, is flying from Los Angeles to New York. The flight attendant requests the help of a nurse or physician if one is on board. Lorena approaches the flight attendant and asks if she can assist. Lorena is protected by the Good Samaritan Act because the act states that a licensed health-care provider can:

A) Administer care any time B) Provide care that any other prudent individual with the same education would provide C) Provide the same care as a paramedic D) Provide care outside the scope of her practice as long as she knows how to perform the required procedure Answer: B

In many states there is a legal requirement to report:

A) Adverse events B) Skill-based errors C) Safety gaps D) Near misses Answer: A

Stress, according to Hans Selye, is best described in the general adaptation syndrome (GAS) and includes three stages. Which one is NOT included in the three stages?

A) Alarm B) Acceptance C) Resistance D) Exhaustion Answer: B

Servant leadership is best described as:

A) An "employees first" attitude B) Emphasis on serving the patient C) A laissiz-faire approach D) Multi-tasking as much as possible Answer: A

Mrs. Dillon, a client recovering from CHF, is being discharged this afternoon. She needs teaching reinforced. The most appropriate caregiver to complete this activity is:

A) An LPN/LVN B) A UAP C) A unit secretary D) A second-year nursing student working as a nurse tech on the unit Answer: A

The RN identifies a treatment error when:

A) An RN fails to communicate to the health-care provider a change in condition. B) An RN incorrectly administers an IV drug dose. C) A health-care provider fails to order an indicated serum lab exam. D) A nursing assistant uses an automatic sphygmomanometer that fails to deflate. Answer: B

You have just started working in a busy ER. Recently you have developed hives, nasal congestion, and conjunctivitis. You are most likely experiencing:

A) An allergic reaction to latex gloves B) A severe reaction to the ER environment C) A rhinitis reaction to the general environment D) An allergic reaction to the hospital gown Answer: A

The health-care provider orders an injection for a pediatric client. The client's legal guardian refuses to allow the nurse to administer the medication, however, the nurse proceeds to administer the injection. Legally, the nurse has committed:

A) An assault B) A battery C) An invasion of privacy D) False imprisonment Answer: B

Collective bargaining is best described as:

A) An informal problem-solving process B) A generally informal process involving all staff members C) A formal procedure governed by labor laws D) Focused on interpersonal relationships Answer: C

One way in which you can decrease the chance of a back injury to yourself is:

A) Asking for help B) Not exercising C) Refusing transfer equipment D) Missing the class on back-muscle strengthening Answer: A

An action that can lead to a malpractice suit would be:

A) Assessing a client more than once per shift. B) Listening to the physician explain the benefits and risks of a procedure as they are being explained to the client. C) Reporting that he or she has witnessed a coworker using controlled substances when working. D) Altering a client's record. Answer: D

Germaine, an RN for 6 months, has just finished orientation and is placed on the 7:00 p.m. to 7:00 a.m. shift. She is responsible for eight clients. She never leaves before 9:00 a.m. of the morning following her shift. She comes to the associate nurse manager on nights and says, "I don't think I am cut out for this. I just can't seem to get organized!" A method designed to assist Germaine organize her client care is referred to as a(n):

A) Assignment sheet B) Care plan. C) Flow sheet D) Worksheet Answer: D

Empowerment occurs more often with:

A) Authoritarian management B) Shared governance C) Laissez-faire governance D) Autocratic management Answer: B

Nancy is supervising a patient care assistant and a licensed practical nurse. When giving them assignments she states, "You two decide how you want to divide up the patients." This is an example of what type of leadership?

A) Autocratic B) Laissez-faire C) Democratic D) Situational Answer: B

Sally meets with all the staff to get input on the governance of the unit. Her management style is most likely:

A) Autocratic B) Participative C) Directive D) Permissive Answer: B

A mental way to reduce stress is to:

A) Avoid humor B) Ignore social support systems C) Continue the same thought patterns D) Develop realistic expectations Answer: D

Burnout differs from reality shock in that:

A) Burnout occurs early in the nursing profession. B) Reality shock occurs late in the nursing profession. C) Professional frustration is the cause of burnout. D) Low expectations of the job cause reality shock. Answer: C

Wilhelmina, an RN for over 6 years, had her license suspended because an audit of her continuing education credits showed that she had not met the mandatory course requirements. The Board of Nursing has the ability to do this based on:

A) Case law B) Administrative law C) Civil law D) Statutory law Answer: B

A problem-solving process used in the nurse-client relationship is known as:

A) Case management B) Nursing process C) Evaluation techniques D) Remediation theory Answer: B

One way to lower the resistance to change would include:

A) Centralization of information B) Confirmation of currently held beliefs C) Provision of psychological safety D) Ensuring the involvement of few people to reduce confusion Answer: C

The stages of change described by Lewin include:

A) Change, change, and more change B) Change and refreezing C) Comfort, discomfort, and recomforting D) Unfreezing, change, and refreezing Answer: D

In dealing with conflict, it is important to approach it in a(n):

A) Competitive manner B) Destructive manner C) Cooperative manner D) Ambivalent manner Answer: C

Problem resolution, as opposed to negotiation, is appropriate in which of the following situations?

A) Complex, widespread disagreement B) Highly charged situation C) Political issue D) Interpersonal misunderstanding Answer: D

Physiological changes that can be associated with stress include:

A) Constricted pupils B) Decreased blood sugar C) Tachycardia D) Bradypnea Answer: C

Empowerment is psychological and includes a feeling of:

A) Control B) Loss C) Effectiveness D) Quantity Answer: C

Larry was brought to the hospital by two police officers. He was combative and verbally abusive. After waiting for over an hour, Larry tells the nurse he is leaving. The nurse removes Larry's clothes from the room, leaving him only in his underwear. The nurse may be charged with:

A) Cruel and unusual punishment B) Slander and libel C) False imprisonment D) Assault and battery Answer: C

Conflict can occur when there is:

A) Decreased workloads B) Acceptance of cultural differences C) A secure work environment D) Tension between groups Answer: D

One of the simplest ways to reduce stress is:

A) Deep breathing B) Inadequate rest C) Poor nutrition D) Daily exercise Answer: A

Behaviors of an effective leader include:

A) Denying the exchange of information B) Inability to communicate effectively C) Giving only negative feedback D) Developing oneself and others Answer: D

Providing psychological safety is accomplished by:

A) Designing the change to be technically of high quality B) Allowing time for learning a new procedure C) Delaying change implementation as long as possible D) Putting the changes into effect as fast as possible Answer: B

What is the least effective way for a new graduate to manage pressures from the first position?

A) Develop more effective communication skills. B) Set new professional goals. C) Do not focus on self in order to have more time to work. D) Work with a mentor Answer: C

In order to manage time effectively it is important to:

A) Do the tasks that take the least amount of time first B) Do the tasks that take the most amount of time first C) Prioritize tasks according to importance D) Alternate shorter tasks with longer tasks Answer: C

Juliana, an RN, is caring for Mary Lewis, 80 years old. Ms. Lewis falls and injures herself. Which of the following actions should Juliana take to decrease her liability?

A) Document the incident carefully on an incident report form. B) Chart the facts surrounding the client's fall, condition, and follow-up care. C) Do not document anything about the fall. D) Just tell the on-coming nurse that Mary fell. Answer: D

Mr. Phillipe has suffered a stroke. His daughter brings DNR and power of attorney documents to the hospital. The purpose of the DNR is to:

A) Document the terminal nature of the client's condition B) Allow an alternative to the universal standing order to provide cardiopulmonary resuscitation to all clients C) Provide an opportunity for the client, family, and caregivers to discuss the nature of the client's condition and the best possible course of action if the client has a cardiac arrest D) Provide legal protection for nurses who believe a client should not be resuscitated Answer: B

The RN knows that adherence to standards of care and hospital policies and procedures, as well as exercising care that a reasonable nurse would demonstrate in similar circumstances, will limit risk for common areas of risk in all of the following EXCEPT:

A) Documentation errors B) Attendance errors C) Medication errors D) Patient falls Answer: B

The employer is responsible for providing a safe working environment by:

A) Driving all employees to work B) Following the OSHA guidelines C) Teaching employees to use their back muscles for lifting clients D) Allowing the recapping of contaminated needles Answer: B

Which of the following would not be considered one of the elements for a negligence claim?

A) Duty B) Breach of duty C) Spontaneous duty D) Harm Answer: C

Ways to manage burnout include:

A) Eating constantly B) Drinking daily C) Keeping to oneself D) Exercising routinely Answer: D

Crossing the Quality Chasm identified six aims of health care. Health care should be safe, effective, timely,:

A) Efficient, cost effective, and government-managed B) Equitable, free, and decisive C) Accessible, efficient, and equitable D) Patient-centered, efficient, and equitable Answer: D

The American Nurses Association recommends that questionable practices in the workplace be reported. These may NOT include:

A) Endangering a client's health B) Abusing authority C) Violation of rules or standards of practice D) Being short-tempered with others Answer: D

Of the following qualities, which would least likely be attributed to an effective nursing leader?

A) Energy and integrity B) Pessimism and stress C) Courage and initiative D) Optimism and perseverance Answer: B

The best indication that a conflict is resolved is when:

A) Everyone falls silent. B) The group that was correct is the winner. C) Issues remain a concern. D) Everyone is satisfied with the solution. Answer: D

In Continuous Quality Improvement (CQI), data collection is:

A) Everyone's responsibility B) The means to lay blame to those who commit errors at the bedside. C) Limited to data available from a patient chart D) Limited by the CQI software limitations Answer: A

Communication has the best chance of being interpreted accurately when:

A) Face-to-face communication is used B) The message is repeated by the sender C) Sent electronically D) More than one mode is used Answer: D

A positive aspect of hierarchy is:

A) Few policies or practices B) Consistent operation C) Flexibility D) Promotion of creativity Answer: B

Ways to deal with reality shock include all of the following EXCEPT:

A) Finding a mentor B) Leaving the profession C) Exhausting yourself D) Communicating effectively Answer: C

Which of the following would be considered an extrinsic value?

A) Food B) Water C) Money D) Shelter Answer: C

Nonmaleficence means:

A) Freedom to make decisions for oneself B) Doing no harm, either deliberately or unintentionally C) Doing good for the benefit of others D) Treating everyone equally, regardless of gender, race, religion, or disease Answer: B

Beneficence means:

A) Freedom to make decisions for oneself B) Doing no harm, either deliberately or unintentionally C) Doing good for the benefit of others D) Treating everyone equally, regardless of gender, race, religion, or disease Answer: C

A method for working smarter and not harder would be:

A) Gathering all the equipment needed to help a physician perform a procedure in advance of the physician coming to the unit B) Trying to perform a task you are unsure about prior to asking for assistance or instructions C) Ignoring client statements such as, "I don't feel right," as assessing these issues at the time interrupt your routine D) Obtaining all your vital signs first thing in the morning so that you do not have to repeat them prior to giving medications Answer: A

The essence of leadership is the leader's ability to:

A) Get people to work together B) Influence other people C) Help others meet their personal goals D) Influence the group to follow the leader's way of thinking Answer: A

The existing health-care delivery system is influenced by trends and issues beyond the health-care system, including:

A) Globalization, standard precautions, and technology B) Societal demographics, economics, and legislation C) Core measures, diversity, and regulation D) Evidence-based practice, system errors, and environment Answer: B

Marie, an RN, accompanies the surgeon to Ms. Allen, a diabetic with gangrene of the lower left extremity. The surgeon explains to Ms. Allen that he will perform a below-the-knee amputation that will remove the infection. He will give her some antibiotics, and she will probably go home in a few days. After the surgeon leaves, Marie brings in the consent forms and asks Ms. Allen to tell her what the surgeon said. Ms. Allen states, "Oh, he is going to remove the infection and give me antibiotics and then I can go home. I feel so much better now because my other doctor told me they were going to cut off my leg!" Based on this information, Marie's next step should be to:

A) Have Ms. Allen sign the consent form B) Draw a picture of a below-the-knee amputation for Ms. Allen C) Tell Ms. Allen that she did not hear what her doctor told her D) Call the surgeon and explain the situation to him Answer: D

Historical, social, political, and economic trends and issues:

A) Have contributed to the complexity of today's health-care system B) Have had a limited impact on today's health-care delivery system C) Can be positively correlated with outcomes of care at the bedside D) Have been mitigated by the strong influence of professional organizations like the ANA and the AMA Answer: A

Glenn is an RN on a busy medical-surgical unit. He comes to work today for his usual shift after working a double shift yesterday. At the end of this day, two RNs call in, and the nurse manager tells Glenn he needs to stay and cover the next shift. Glenn may refuse to accept an assignment if:

A) He is being asked to care for too many difficult clients B) He believes his assignment is unsafe C) He is being asked to work overtime D) He believes there are not enough nurses to work with him Answer: C

Nancy has been working as an RN in long-term care for 4 months. She has been offered the evening supervisor position at a local nursing home. The salary is attractive. What should be her main consideration prior to accepting this position?

A) Her clinical expertise, business sense, and leadership skills. B) Staffing ratios and number of RNs on the evening shift. C) Vacation, sick time, and tuition reimbursement. D) Mission and philosophy of the facility. Answer: A

There are four stages of burnout syndrome according to the text. Which of the following is NOT one of these stages?

A) High expectations and idealism B) Optimism and early job satisfaction C) Withdrawal and isolation D) Irreversible detachment and loss of interest Answer: B

A sentinel event occurs at a hospital. Which of the following is NOT an end result of the Continuous Quality Improvement Process?

A) Identification of the factors contributing to the event. B) Improving the system to prevent future sentinel events. C) Termination of all health-care professionals involved. D) Reporting to Risk Management the potential for similar events. Answer: C

Creativity is especially important in which phase of problem-solving?

A) Identifying the issue B) Generating possible solutions C) Evaluating the solutions D) Implementing the solution Answer: B

Which of the following would not be acceptable behavior in the on-line communication environment?

A) If you were face-to-face, would you say this? B) Follow the same rules of behavior on-line that you follow when dealing with individuals in person C) Sending copies of information only to individuals with a need to know. D) Using a communication language style that will cause a reaction on the part of the receiver. Answer: D

Once resistance to change is recognized, it must be:

A) Ignored B) Pacified C) Addressed D) Justified Answer: C

Which of the following is least effective when giving evaluation feedback? When it is given:

A) Immediately B) Frequently C) Privately D) Negatively Answer: D

The IOM identified five Core Competencies for health professionals. As the RN you identify and plan to develop all of the following identified competencies EXCEPT:

A) Implement quality and safety initiatives B) Employ evidence-based practice C) Work in interdisciplinary teams D) Utilize informatics Answer: A

Negative feedback should be given:

A) In the nursing station B) During report C) With a yearly evaluation D) Privately Answer: D

Individual staff members are likely to respond to change:

A) In ways that can be predicted consistently B) Consistently negatively C) In ways affected by personality and life experience D) Consistently positively Answer: C

A single-payer or National Health Coverage aims to

A) Increase the financial burden of health care on employers B) Increase the financial burden of health care on consumers C) Decrease the cost of care by eliminating third-party insurers D) Decrease the cost of care by decreasing quality and safety of care Answer: C

The nurse manager is examining factors contributing to the nursing shortage affecting her unit. Her unit is most likely feeling the effects of the nursing shortage for all of the following reasons EXCEPT:

A) Increased age of the RN workforce B) Increased demand for RNs from competing employers C) Decreased hiring of foreign nurses D) Decreased job satisfactions of the RN workforce Answer: C

The term "shared governance" describes:

A) Informal ways in which access to opportunity is made available to staff B) Staff nurses' inclusion in decision-making through representation in governing practice and management issues C) Nurses' involvement in decision-making at the administrative level D) A shared staffing on various levels to serve the needs of the institution Answer: B

According to "trait theories," the most common traits of a good leader are:

A) Information giving and decision-making B) Public speaking and nonrisk behaviors C) Intelligence and initiative D) Verbal and written communication skills Answer: C

The role of the manager includes:

A) Interpersonal, informational, and decisional actions B) Extroverted personality, hidden agenda, and personal gain C) Introversion, asking questions, and inability to take action D) Extreme prejudice, being unknowledgeable, and being uncaring Answer: A

You have used the S-BAR method of communication and your patient needs immediate attention and has not received it. Your best response would be to:

A) Keep calling the same practitioner until you get results B) Hope the practitioner will act soon C) Go up the chain of command D) Ask the next shift to follow-up Answer: C

When making assignments, two legal responsibilities the RN must take into consideration are:

A) Knowing the job requirements and evaluating the outcomes. B) Assessing how much supervisory time is necessary and assessing the competence of each staff member C) Writing job descriptions and communicating them to all staff members D) Making sure the supervisor's and the employee's strengths are matched and giving adequate supervision Answer: B

Which of the following qualities would be detrimental to effective nursing management?

A) Leadership B) Clinical expertise C) Business sense D) Minimum communication Answer: D

Lorena has worked in Labor and Delivery for 15 years with a total RN staff. She is now the associate nurse manager of a busy postpartum unit and has RNs and UAPs. She realizes that she needs to make assignments to members of the health-care team based on each individual's:

A) Length of service B) Scope of practice C) Ability to perform the task D) Job title Answer: C

Effective methods for the RN to influence the health-care system include all of the following methods EXCEPT:

A) Letter-writing regarding important topics to legislators and ANA leadership B) Verbalizing concerns to peers during a unit staff meeting C) Voting for candidates who support your views and those of your profession D) Volunteering on unit or hospital-based quality or safety initiative Answer: B

Eddie, an RN, is charge nurse and is setting up the day's assignments. Lindsey, a newly licensed RN, has been floated to the unit. When making an assignment for Lindsey, Eddie must consider:

A) Lindsey's age B) Lindsey's knowledge of the institution's standards of practice C) Lindsey's nursing degree D) Lindsey's knowledge base and level of skill Answer: D

Liu Chen, an RN, is taking a client history. She is entering the information into her handheld as the client speaks to her and asks questions clearly and concisely. However, Liu asks questions regarding information the client has already given. The client says to Liu, "Are you listening to me?" Of the following, which best indicates Liu is listening to the client?

A) Maintaining appropriate eye contact. B) Glancing around the room and writing a note. C) Asking another question immediately after receiving an answer to the first question. D) Typing notes on the computerized record while the client is speaking. Answer: A

State and federal governments have attempted to restrain the cost of health care through all of the following EXCEPT:

A) Mandated nurse staffing ratios B) Regulation and competition C) Employer incentives D) Bedside nursing responsibilities Answer: D

To promote safe, quality health care, the American Nurses Association (ANA):

A) Mandates safe RN staffing levels to health-care agencies B) Regulates RN competency to practice at the bedside C) Maintains oversight of the National Database of Nursing Quality Indicators D) Funds research promoting consumer protection from RN mistakes and errors Answer: C

Workplace issues currently under discussion by the American Nurses Association do NOT include:

A) Mandatory overtime B) Rotating shifts C) Staff development opportunities D) Staffing ratios Answer: C

The order of the basic listening sequence is:

A) Message, encoder, feedback, decoder, method of sending B) Encoder, message, method of sending, decoder, feedback C) Decoder, message, encoder, method of sending, feedback D) Feedback, decoder, message, method of sending, encoder Answer: B

Jeremy graduated from an associate degree nursing program 2 years ago. He is brought before the State Board of Nursing for offering to give physicals for summer camp for $25. Because Jeremy has violated the Nurse Practice Act in his state, he is charged with committing a:

A) Misdemeanor B) Felony C) Civil law D) Common law Answer B

An example of a human relations-oriented manager is one who:

A) Motivates employees to work to their highest potential B) Uses control rather than guidance C) Assumes close supervision over staff development D) Implements punishment rather than rewards potential Answer: A

David, the nurse manager, asks to see Allison, a new RN, for a few minutes after lunch. When Allison mentions this to her colleagues at lunch, they fill her with dread about the purpose of the meeting. Allison reluctantly stops by David's office. He asks Allison to sit down and says, "I thought you should know that I heard you explaining the procedure for a cardiac catheterization today to Mrs. Young. You did a great job, and I also wanted to let you know that the unit has literature that you can give the clients regarding many of the procedures they may undergo while here." Allison leaves the office feeling very good about herself. David provided Allison with:

A) Negative feedback B) Constructive criticism C) Destructive criticism D) Positive feedback Answer: D

When issues and problems arise that cannot be resolved through discussion, the next step might be:

A) Negotiation B) Discussion C) Problem-solving D) Arguments Answer: A

Madeline is working in the pediatric oncology unit as a pediatric client care technician and enjoys playing with the children. Every time the nurse needs her for something, Madeline can be found in the play area or in a child's room. The nurse believes if Madeline would do her tasks, then she would be able to deliver better nursing care. The nurse is finally exasperated with Madeline after finding her in the playroom one more time. The nurse says, "You are lazy and never get anything of importance done for this unit!" The nurse has just provided Madeline with:

A) Neutral criticism B) Positive feedback C) Negative feedback D) Constructive criticism Answer: C

The RN has delegated the care of a fresh postoperative client to the LPN on the team. The LPN notifies the RN that the client's vital signs are elevated and that the client is complaining of pain and dyspnea. Which of the following is the most appropriate action to be taken by the RN?

A) No further action is necessary as the LPN is experienced. B) Request that the LPN offer the client a narcotic analgesic that had been ordered for the postoperative period. C) Place a call to the attending surgeon and report that the client is having pain. D) Assess the client and analyze the preoperative and perioperative data before calling the surgeon. Answer: D

Staff members at the bottom of the organizational hierarchy have:

A) No power B) No power and no authority C) High authority and high power D) Little authority, but some power Answer: A

Louis, an RN, is caring for Emil Jones, a 58-year-old newly diagnosed diabetic. Louis needs to instruct Emil regarding his insulin pump. While performing client teaching, which of the following barriers to communication can Louis eliminate? A) Noise from the television

A) Noise from the television B) Language differences C) Educational level D) Mr. Jones' lack of attentiveness Answer: A

During a code Sue begins giving order to the staff. Her management style at this time is:

A) Nondirective B) Permissive C) Controlling D) Participative Answer: C

Ways to reduce risk of infection to yourself and others include:

A) Not going into the client's room B) Wearing gloves whenever you go into a client's room C) Placing all clients in isolation rooms D) Good hand-washing practices Answer: D

After administering an incorrect dosage of a medication the nurse realizes that too little medication was given to the client. The nurse then administers a second dose in order to give the correct dosage. Legally, the nurse must:

A) Not tell anyone about the error B) Document that the correct medication was administered C) Document the error in the nursing notes D) Both A and B Answer: C

Narcotics have been missing from the narcotic count every other weekend and on Fridays. Several of the same employees work those shifts, and Sue Ellen is often late and has been very "touchy" lately. You have tried to talk with her, but she is not willing to talk with you. Your first step should be to:

A) Notify the State Board of Nursing. B) Discuss the situation at a staff meeting. C) Bring your observations to your nurse manager. D) Confront Sue Ellen while she is drawing up medications. Answer: C

A nursing student is preparing for the NCLEX. Which of the following activities would be most appropriate 2 days before the student is to take the examination?

A) Pack a bag of items that may be needed during the test. B) Map out the route to the exam site. C) Eat a diet high in fats and carbohydrates. D) Both A and B Answer: D

Personal change is best described as:

A) Part of one's development as a leader B) An entirely different phenomenon from technical change C) Much more difficult to put into practice D) Something that happens within a person's comfort zone Answer: A

New nursing graduates may assist in implementing change by:

A) Participating in staff meetings B) Maintaining current status of client data C) Using procedures suggested by the hospital D) Ignoring quality improvement issues Answer: A

The skills lacked by most new nurses are in the area of:

A) Personal management skills B) Time management skills C) Documentation D) Nursing task skills Answer: B

The most important factor related to stress is:

A) Physiological stress impacts all other stressors. B) How we interpret stress determines our body's response to it. C) We have little or no control over environmental stressors. D) Cumulative effects of minor everyday hassles are more stressful than a major life event. Answer: B

Threats to the employee do NOT include:

A) Potentially lethal chemicals B) Exposure to infectious materials C) Recapping safety devices in each room D) Radioactive materials in open containers Answer: C

Ground rules are set during a negotiation in order to:

A) Prevent escalation of the conflict B) Restrict freedom of discussion C) Clarify the source of the conflict D) Reduce formality Answer: A

The Rhythm Model uses the anachronism PQRST. The letters stand for:

A) Prioritize, Question, Re-check, Self-reliance, Treat B) Plan, Quantify, Re-evaluate, Self-assurance, Treat C) Prioritize, Quantify, Re-check, Self assurance, Treat D) Plan, Question, Re-evaluate, Self-reliance, Treat Answer: A

The health-care institution where Cori is a nurse manager has moved to e-mail as a method of communication. When using this communication method, it is important to remember that:

A) Professional e-mail must use formal headings. B) Professional e-mail may remain informal. C) E-mail does not require the same level of courtesy as a formally written communication. D) Professional e-mail should be written in all capital letters. Answer: B

OSHA requires employers to protect employees by:

A) Providing annual training B) Giving free hepatitis B vaccines C) Maintaining universal precautions D) Maintaining staffing ratios Answer: D

What is the "essence" of management?

A) Providing close supervision B) Getting work done through others C) Constant monitoring of unit expenses D) Staff development Answer: B

Which of the following is an example of the decisional activities of a manager?

A) Providing leadership B) Encouraging continuing education C) Coaching employees D) Completing staff evaluations Answer: D

A new graduate is considering working at a health-care institution that focuses on core values. It is important for the new graduate to:

A) Read the organization's mission and philosophy B) Develop a new set of values that blend with the organization C) Speak with other nurses who work in the institution D) Both A and C Answer: D

Which of the following actions would be typical for a manager who adheres to the scientific management approach?

A) Reads research studies on management B) Stays in touch with his or her feelings C) Carefully works out the time each nursing task should take D) Allows staff to develop and enforce their own holiday schedule Answer: C

Delegation is defined as:

A) Reassigning the responsibility of performing a job from one person to another B) Explaining how you want a job done C) Telling other people what to do D) Developing ways to classify people into job categories to learn what they are capable of doing Answer: A

Which of the following basic elements is NOT included in Lewin's Model of Change?

A) Refreezing B) Unfreezing C) Unchanging D) Change Answer: C

Luci, an RN, arrives at work. The nurse manager tells her that the ICU needs more help and as Luci is the most experienced RN on this unit, she is being reassigned to work in the ICU for the day. Luci tells the nurse manager that although she is the most experienced, she has never worked in the ICU. She shares her concerns with the nurse manager regarding the lack of familiarity with the technical equipment and protocols of the ICU. The nurse manager states that she understands Luci's concern and reluctance, however, Luci is to go to the ICU. The most appropriate action Luci should take is to:

A) Refuse to go to the ICU. B) Go to the ICU and tell the charge nurse that she is ill and needs to go home. C) Go to the ICU and inform the charge nurse of the tasks she is able to perform and those tasks with which she feels she needs assistance. D) Call the nurse manager's supervisor and report her for unsafe delegation. Answer: C

The American Nurses Association (ANA) recommends four tactics to fight sexual harassment. The one that is NOT considered an ANA recommendation is:

A) Reporting the incident to your supervisor B) Ignoring the situation and hoping it goes away C) Documenting the incident to keep the facts fresh in your mind D) Seeking support from your friends, relatives, and state associations Answer: B

Jim has demonstrated strong leadership skills during his first year as an RN. He observes that one of his coworkers appears very anxious when dealing with demanding families. Jim displays emotional intelligence when he:

A) Reports to the nurse manager that his friend is very anxious when dealing with demanding families. B) Says to his friend, "Dealing with these demanding families can be very anxiety-producing." C) Says to his friend, "You seem very anxious when dealing with these families; maybe you should seek counseling help." D) Ignores the behavior because everyone takes a different time to adjust to the role of an RN. Answer: B

The role of ethics committees is to:

A) Resolve ethical dilemmas B) Prevent the physician from getting the institution into legal confrontations C) Establish guidelines to eliminate ethical dilemmas D) Provide appropriate guidance for the health-care team, family members, and the client Answer: D

Sources of coercive power come from which of the following?

A) Responsibility B) Recognition C) Expertise D) Punishment Answer; D

Mrs. Chou has been suffering from senile dementia Alzheimer's type for over 5 years. Her family has kept her at home, and each member has participated in her care. The community health nurse has been supporting the family in this effort. Recently, Mrs. Chou has stopped interacting with the family, refuses to eat, and sleeps a great deal. The family is conflicted over how to care for their dying mother. The nurse understands that her role in this conflict is to:

A) Say nothing; this is a family issue. B) Speak with the members individually and persuade them to do "what is best for their mother." C) Discuss the conflicting opinions with the physician. D) Persuade the family members to meet together to express their feelings to one another. Answer: D

Which of the following methods uses technology to decrease the time spent on paperwork?

A) Scanning in nurses' notes B) Using multidisciplinary charting sheets C) Bar-coding certain types of client data D) Keeping charts at the beside Answer: C

Jose and his girlfriend are driving on the highway and witness a motor vehicle accident. He calls 911 and pulls over to the side of the road. He immediately begins to assess the victim to determine what he can do until the paramedics arrive. His girlfriend says, "This guy can't give you permission to help him; maybe you should just leave him alone." Jose explains that he has implied consent. Implied consent is assumed when a client:

A) Sees a physician or nurse by appointment in the office or clinic setting B) Arrives in the operating suite C) Is admitted to the hospital D) Is treated at the scene of an accident Answer: D

Michelle believes that her employees operate from the Theory Y philosophy. Based on this, how would she assist them in developing a scheduling plan for the unit?

A) Send a completed schedule for 2 months out over e-mail. B) Ask for a committee of volunteers to develop the schedule. C) Meet with each employee to get his or her input about the best scheduling plan. D) Delegate scheduling to her assistant nurse manager. Answer: C

Three nursing students are in the elevator and overhear Evan, one of the staff nurses, discussing his neighbor who was hospitalized last night for liver failure. Evan told his colleague that a mutual friend told him that the neighbor was "known for liking his brandy." A family member was in the elevator and also overheard the conversation. Evan may be charged with:

A) Slander B) Libel C) Fraud D) Breach of confidentiality Answer: A

Mr. Jeremy received the wrong dose of a narcotic, and the error was caught during the shift's narcotic count. The nurse performing the count was not the nurse who signed out the medication. The nurse's next action should be to:

A) Speak about the error with the nurse who gave the medication. B) Report the medication error without first consulting the nurse who signed out the medication. C) Call the nurse manager and ask her to handle the situation. D) Write out an incident report. Answer; A

Which statement is least likely to be related to stress?

A) Stress can be cumulative. B) The impact of stress is the same no matter how you respond to it. C) Perceptions of stress vary with individuals. D) Stress is always self-limiting. Answer: B

Which of the following is FALSE regarding the three aspects of health-care evaluation?

A) Structural factors guarantee quality health care. B) Processes include evaluation of the care that nurses and respiratory therapists provide. C) Outcome measures evaluate the effectiveness of care provided by nursing and other health-care team members D) A comprehensive evaluation of health care includes structure, process, and outcomes. Answer: A

When giving feedback it is important to include:

A) Suggestions for change B) Only negative feedback C) Positive feedback followed by negative feedback D) A general opening statement comparing this person with others Answer: A

Which skills will not be useful in becoming a better follower?

A) Supporting the ideas of your colleagues B) Becoming an effective listener C) Demonstrating energy and enthusiasm in the workplace D) Contradicting others if their ideas are not useful to the team Answer: D

Which of the following is a common goal for a health-care organization?

A) Survival B) Limited existence C) Cooperation with the competition D) Downsizing Answer: A

Mr. Reynolds is admitted through the emergency department after being involved in a motor vehicle accident. His airbag failed to deploy, and he was hit in the abdomen with the steering wheel. He has an IV of 0.9% NS @ 100 mL/hr, BP 92/58, and complains of weakness, fatigue, and abdominal pain. On assessment, the nurse discovers that Mr. Reynolds is nauseated and just vomited 560 mL. The nurse is quite busy and decides to delegate client care activities to the nursing assistant. Of the following activities, which should the nurse keep?

A) Taking and recording vital signs every 15 minutes B) Recording accurate intake and output C) Obtaining a baseline weight to guide therapy D) Increasing the IV rate to 250 mL/hr if the blood pressure drops to 85/50 Answer: D

An example that may be a cause of reality shock is:

A) Taking care of six clients during your first day on the floor B) Getting to lunch every day C) Having the nurse technician do all of the a.m. care D) Charting after finishing each assessment Answer: A

A nurse is caring for a client who has dementia and urinary incontinence. Which nursing action could be appropriately delegated to a UAP?

A) Teaching the client to use the call bell when needing the bed pan. B) Offering the bed pan to the client every 2 hours. C) Obtaining a sterile urine sample for culture and sensitivity. D) Assessing the client for skin breakdown. Answer: B

Resistance to change has three major sources:

A) Technical concerns, psychosocial needs, threats to a person's position B) Staffing concerns, physical needs, threats to hierarchy needs C) Prior concerns, social needs, threats to self-actualization D) Technology concerns, personal needs, threats to hospitalized clients Answer: A

State and federal agencies oversee legislation, licensure, and reporting programs as well as administer quality and safety initiatives such as:

A) The Hospital Quality Initiative B) The National Database of Nursing Quality Indicators (NDNQI) C) The Health Effectiveness Data Information Set (HEDIS) D) The Magnet Recognition Program Answer: A

Which of the following non-profit agency or organization completed the report that now serves as the foundation and strategy for health system reform?

A) The Joint Commission B) The U.S. Senate C) The American Medical Association D) The Institute of Medicine Answer: D

Which of the following is NOT accurate regarding the organization and agency efforts to support quality and safety in the health-care system?

A) The U.S. Department of Health and Human Services is the primary agency responsible for protecting health in America. B) The American Nurses Association manages a database of unit-specific nurse-sensitive data known as NDNQI. C) Nonprofit organizations such as the Robert Wood Johnson Foundation and Leapfrog Group all have the singular focus to improve health-care outcomes for the underserved. D) The purpose of the Joint Commission is to provide voluntary accreditation of hospitals and health-care organizations. Answer: C

To control costs and decrease the money lost from uncharged supplies, the hospital has decided to move to a controlled distribution system for supplies. This requires the nurses to attend several in-service sessions to learn how to work with the new system. The nurses are complaining that they do not have time to "learn another thing!" For change to be successful, it must be accepted by:

A) The administration B) The persons who will be involved C) The persons who designed the change D) The managers Answer: B

The staff is discussing the confusion they have over some directions regarding a JCAHO project given by Linda, the associate nurse manager. Each staff member has a specific assignment, however, some of the tasks seem to be duplicated. Based on the five elements of communication, who is responsible for the clarity of messages?

A) The decoder B) The transcriber C) The encoder D) The receiver Answer: C

Which of the following is usually not part of a job evaluation?

A) The job description B) Being compared with others C) The results of the employee's efforts D) What the evaluator has seen Answer: B

The RN who is the team leader gives assignments to all the team members. The decision is based on:

A) The number of staff willing to work B) The age and desires of the team members C) The RN needing to take orders and write client outcomes D) The condition and needs of each client Answer: D

Kimberly has been a nurse for 10 years, and she is precepting Loren, a new RN. Loren is having difficulty prioritizing client care. Kimberly explains to her that prioritizing client care is based on:

A) The nursing process B) Virchow's triad C) Client requests D) Maslow's hierarchy Answer: D

Change is best implemented when:

A) The reason for the change is least understood. B) Individuals participate in the change. C) Management insists on the change. D) The change causes stress. Answer: B

The most obvious aspect of organizational culture is/are:

A) The unwritten rules B) The employee handbook C) The care environment D) The organizational climate Answer: B

Sharing decision-making responsibilities may be difficult for some managers for which of the following reasons?

A) They believe that empowered staff members have higher levels of job-related tension. B) There is inadequate staffing on the unit. C) There is a lack of time and situational support. D) They may be reluctant to give up their control. Answer: D

Which of the following guidelines is not appropriate when giving negative feedback?

A) Think before you speak B) Allow personal feelings to guide your response C) Focus on behavior, not the personality D) Uncover hidden feelings Answer: B

Anne wanted to simplify the current method of ordering missing medications. She devised what she thought was an excellent idea and presented her plan to the nurse manager on the unit. Her idea was rejected. What step in the process of change did Anne forget to follow?

A) Threatening others B) Provoking resistance C) Unfreezing D) Refreezing Answer: C

The structure of many organizations is the:

A) Traditional approach B) Organic structure C) Decentralized approach D) Network structure Answer: A

According to OSHA, employers must provide all of the following EXCEPT:

A) Tuberculosis testing and hepatitis B vaccine B) Client rooms that are painted with pleasant colors C) Protective equipment, such as gloves, gowns, and masks D) Immediate treatment after exposure to bloodborne pathogens Answer: B

Emotional intelligence is also an important part of leadership. Which of these qualities is not part of emotional intelligence?

A) Understanding self B) Listening skills C) Acknowledging others D) Responding quickly to a crisis Answer: D

The major hallmark of situational leadership is:

A) Understanding the readiness of the follower B) Major focus on interpersonal relationships C) Effective listening skills D) Motivating others Answer: A

A healthy work environment includes an atmosphere of work excitement. Which factor will NOT contribute to a healthy work environment?

A) Variable work schedules B) Growth opportunities C) Depersonalization D) A variety of work experiences Answer: C

The two basic channels of communication are:

A) Verbal and interpretive B) Nonverbal and interpretive C) Nonverbal and verbal D) Verbal and written Answer: C

A nurse working in the critical care unit is described as being an excellent friend and critical thinker. This would be considered an example of:

A) Virtue ethics B) Moral ethics C) Nursing ethics D) Power ethics Answer: A

A clinic run by volunteer doctors and nurses belongs in which of the following categories?

A) Voluntary for profit B) Publicly supported C) Not for profit D) Governmental agency Answer: C

Jose has switched to the night shift from the evening shift so that he has more time to spend with his family. However, he is finding it difficult to sleep during the day. His wife asks him to do numerous tasks around the house while he is at home. The lack of sleep is beginning to affect his job performance, and he has made several medication errors over the past month. His evaluation is a month away. The best approach for the nurse manager to take in this situation would be to:

A) Wait until his evaluation in a month B) Ask the night supervisor to speak with him C) Schedule a meeting with Jose for the next morning D) Ignore the situation because the manager knows Jose will improve Answer: C

The Institute of Medicine (IOM):

A) Was unable to quantify the prevalence or significance of health-care quality issues B) Was organized after efforts of the AMA failed to improve health-care system quality C) Was given authority to legislate health-care system quality and safety deficits D) Authored a series of reports that provided the foundation for health-care system reform Answer: D

Circumstances surrounding health-care work that contribute to workers' susceptibility to homicide and assault include:

A) Working in low-crime areas B) Having good hospital security C) Experienced staff to deal with problems D) Working in large groups Answer: C