Leadership and Management

One of the staff nurses on your unit makes the comment, "All this time I thought Mary was black. She says she is Jamaican." The best response would be to say: a. "Who cares what she is?" b. "What did you think when you learned she was Jamaican?" c. "Why did you assume she was black?" d. "We have never had a Jamaican on this unit."

b. "What did you think when you learned she was Jamaican?" The response of the nurse manager invites cultural awareness, which involves self examination and in depth exploration of ones own biases, prejudices, and assumptions

The chief nursing officer understands that to be able to compare data across client populations and sites, it is important that nurses use: a. similar settings b. information systems c. knowledge systems d. Structured nursing languages

d. Structured nursing languages Data are standardized and use structured terminology, which enable cross site comparisons

A strategy to increase RN staff retention at Valley Hospital includes: a. Better compensation and beneftis b. clearer position descriptions c. lay offs of nursing assistants d. adequate staffing to meet acuity levels

d. adequate staffing to meet acuity levels Over the past decade, a significant amount of research has been done in the United States to evaluate links among nursing staffing, workloads, skills mix, and patient outcomes. An analysis of this research demonstrates that ensuring adequate staffing levels has been shown, among other things, to improve nurse retention and job satisfaction

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

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

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

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

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

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

In preparing a budget, the nurse manager needs to anticipate the cost of benefits (health, life insurance, pension, and retirement plans). Based on the usual cost benefits, how much should a nurse manager include for a total full time salary cost of 312,000 a. 78000-93600 b. 62400-78000 c. 46800-93600 d.31200-46800

c. 46800-93600

Sarah wonders about the direction that you have given regarding management of incontinent, confused patients. She brings you evidence that she has found regarding incontinence interventions and asks you if she and you could talk about the guidance that you have given after you have had an opportunity to read the articles she has given you. This is an example of (select all that apply): a. Assertiveness. b. Followership. c. Management. d. Insubordination.

A. Assertiveness B. Followership This is an example of followership in which a staff nurse is demonstrating assertive behavior and presenting evidence that may influence the decision making of her nurse leader and manager

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

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

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. Biomedical technology. Physiologic monitoring devices and patient surveillance systems involve biomedical technology

When assessing the appropriateness of adopting WL PDAs for a nursing unit, you need to consider the advantages, which include: a. Lower cost relative to PCs b. small display screen c. font size d. speed of operation

a. Lower cost relative to PCs PDAs offer a lower cost method of documentation and communication than PCs, as well as easy portability. Disadvantages of PDAs include small screen size, suboptimal readability, and slowness in situations when speed is most needed

A family is keeping vigil at a critically ill patient's bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with people in such situations. What role are you assuming through this action? a. Manager b. Leader c. Follower d. Laissez-faire

a. Manager As a manager, you are concerned with managing and coordinating resources to achieve outcomes in accordance with established clinical processes. Referral to a social worker alleviates demands on staff time and is consistent with hospital procedures.

To maintain patient safety, studies suggest that scheduling should avoid: a. Rotating shifts. b. Weekends. c. 8-hour shifts. d. Mandatory overtime.

a. Rotating shifts. Rotating shifts and overtime past 12 hours (mandatory or not) are being shown to increase nurse error and jeopardize patient safety

A busy neurologic ICU and step down unit most likely would use which patient classification system? a. factor evaluation b. prototype evaluation c. hybrid system d. AHRQ system

a. factor evaluation A factor evaluation system is considered more objective than a prototype evaluation system. It gives each task, thought process, and patient care activity a time or rating. Some patient types with a single healthcare focus, such as maternal deliveries or outpatient surgical patients, would be appropriately classified with a prototype system. Patients with more complex needs and a less predictable disease course, such as those with pneumonia or stroke, are more appropriately evaluated with a factor system

The nurse executive at the local hospital began working there 20 years ago and has risen to the highest designation in nursing. This career style is known as: a. linear b. spiral c. steady state d. entrepreneurial/ transient

a. linear The linear career style, as described by Friss, refers to vertical advancement in an organization and is of interest to those with a desire to gain organizational knowledge and different perspectives on nursing

A staff nurse regularly works two 12-hour shifts each week and one 8-hour shift every other week. How many FTEs is this position? a. 0.6 b. 0.7 c. 0.8 d. 1

b. 0.7 Assuming that a full time RN works 2080 hours/year (40 hours/52 weeks), the nurse works 24 hours 52 weeks + 8 hours 26weeks)/2080, which is 0.7FTE

A small rural hospital has been designated as a critical access hospital. It has 40 beds and an average occupancy of 34 beds. To prepare the staffing, the chief nursing officer computes the occupancy as being: a. 90% b. 85% c. 75% d. 60%

b. 85% A way to access a units activity level is to calculate the percentage of occupancy. Formula: daily patient census (rounded) divided by the number of beds in the unit. The occupancy level is calculated as 34/40 or 85%

As a leader on a rehab unit, you encourage all staff members to see themselves as having a role in decision making and quality care. You see your role as involving particular responsibilities in decision making but not as a hierarchal role. This view of decision making and leadership is consistent with: a. Trait theories. b. Complexity theory. c. Situated theory. d. Emotional intelligence.

b. Complexity theory. Complexity theory involves envisioning each member of the team involved in decision making, management, and leadership, with the leader not seen in a hierarchal relationship to the other team members.

Chart audits have revealed significant omissions of data that could have legal and funding guidelines. As the unit manager, you meet with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. This is an example of: a. Leadership. b. Management. c. Decision making. d. Vision.

b. Management. The process of guiding others to meet established goals, outcomes, and procedures is management. This can require collaborative decision making to determine how best to reach predetermined goals and follow established practices

Mary joins 5W nursing unit. Mary is a new graduate who is anxious to fit in. She soon learns that some of her "book learning" is being criticized by her colleagues, so she adapts her practice to what others on the unit are doing. She is demonstrating: a. Cultural awareness. b. Cultural sensitivity. c. Acculturation. d. Cultural marginality.

c. Acculturation. In accepting the practices of the dominant group on the unit, Mary is demonstrating acculturation

A business condition that may assist forecasting but add to the complexity of change is: a. consulting with professional groups about change b. researching about trends on futuristic sites c. asking patients to examine options for change d. building profit projects and sustainability into planning

c. asking patients to examine options for change Stalk and Butman suggests that asking the customer feedback on options may assist with forecasting. Adopting this strategy runs counter to current practice and would increase the complexity of healthcare planning and forecasting

Which aspect of our tradition and history in nursing may impede our movements towards future oriented thinking? a. lack of confidence b. focus on the discipline of nursing c. focus on details in the everyday practice d. mistrust of trends and new evidence

c. focus on details in the everyday practice Because of our history of attention to details, we may need to challenge ourselves in developing our ability for leadership. Moving from micromanaging to focusing on setting expectations for those for whom we are accountable may feel uncomfortable. however, that movement reinforces our ability to deal with longer term issues

An important aspect of managing the costs on a unit is to plan accurately for staffing needs. Nurse managers use staffing plans to: a. assign staff on the unit on a daily basis b. ensure that days off are planned for staff c. outline the number of individuals by classification on a per shift basis d. predict the numbers and classifications of float staff needed to augment regular staff

c. outline the number of individuals by classification on a per shift basis A nurse manager needs to manage financial resources by developing staffing plans. Staffing plans plan for minimum number of professional nurses required on a unit at a given time or to the amount of minimum staffing in an extended care facility or prison, based on regulatory guidelines

A stroke unit experiences numerous changes related to implementation of new technology, a changed nursing care delivery model, and staff turnover within a period of six months. Staff members begin to show signs of reluctance to implement any more changes. This exemplifies: a. a poor relationship between leaders and staff b. lack of knowledge regarding the importance of changes c. striving to achieve stability in the midst of great disequilibrium d. the importance of chaos in promoting adherence with established practices

c. striving to achieve stability in the midst of great disequilibrium Stability and chaos are at opposite ends of a continuum. When chaos is present, change occurs but life may seem uncontrollable. Resisting further change is a move toward establishment of equilibrium

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 so as to modify practice is an example of: a. Information b. Cost effective care c. Meeting standards d. Evidence based practice

d. Evidence based practice Technology enables evidenced 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

As a nurse manager, you notice that Maria, a Hispanic nurse aide, is visibly upset. When you ask her if something is wrong, she becomes tearful and says, Why is it that John and I work together in giving patients care, he jokes about my being a little fat Mexican? The nurse managers best response is, Do you think he: a. Is sensitive to your culture b. Wants to learn more about you? c. Has been hurt and wants to hurt others? d. Is stereotyping you without thinking?

d. Is stereotyping you without thinking? Prejudices enable us to make sense of the situations in which we find ourselves, yet they also constrain understanding and limit the capacity to come to new or different ways of understanding. It is this contradiction that makes prejudice paradoxical. Prejudices enable us to predict behaviors and make sense of situations but constrain our understanding and development of new insights

Lucy, head nurse on the surgical unit, works with her staff to find ways in which they can work together with other disciplines to provide more effective care for patients on the unit. Lucy likely knows her power is: a. Limited, thereby necessitating involvement of others in implementing ideas. b. Restricted, which necessitates finding alternative means to achieve strong patient outcomes. c. Directly primarily toward those who are subordinate to her. d. Of unlimited capacity when shared with others.

d. Of unlimited capacity when shared with others. Those like Lucy, who share power, tend to be the strong collaborators and see power as an unlimited quantity when shared. Empowered nurses make professional practice possible, creating a culture that satisfies all nurses

The director of nursing has been observing staff interactions in a 20 bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader? a. The unit secretary who knows everyones business b. The chief nursing officer who is in charge and is responsible for nursing services c. The chief cardiologist who admits the largest number of patients and brings in more revenue than any other physician d. The staff nurse who persuades other staff members to practice by making evidenced based decisions

d. The staff nurse who persuades other staff members to practice by making evidenced based decisions Leaders are those who do the best job of sharing their vision of where the followers want to be and how to get there. It is the ability to inspire others to bring a vision (such as evidenced based decision making) to reality and is not necessarily tied to status or information flow

The primary reason for calculating productive hours instead of simply calculating work paid per year is that productive hours enable the manager to: a. anticipate total costs for patient care b. know how much time staff will likely be unavailable because of illness c. determine when orientation needs to occur for new staff d. determine the number of hours available for patient care

d. determine the number of hours available for patient care Total hours are critical for determining the total number of hours that need to be paid for the year. Productive hours are needed to determine what hours are actually available for patient care. The number of FTEs required is determined by dividing the total patient care hours required by the number of productive hours

Before beginning her own nursing agency, a nurse worked with other temporary nursing agencies in nine states. This career style as known as: a. linear b. spiral c. steady state d. entrepreneurial/ transient

d. entrepreneurial/ transient The entrepreneurial/transient career style, as described by Friss, is appealing to nurses who enjoy variety in experiences

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

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

A cover letter and a resume together should be no longer than _____pages. a. two b. one c. four d. three

d. three two pages is recommended for a resume and one for a cover letter

Individuals living with asthma, who also live in poverty, are much less likely to seek early care and are more likely to go to emergency rooms for assistance. This example reflects: a. Stereotyping b. Cultural diversity c. ethnocentricity d. transcultural care

d. transcultural care Transcultural care involves consideration of health beliefs and practices between genders among races, ethnic groups, and those with different socioeconomic status

As a nurse manager, you have hired two new staff members who have recently come to the United States from other countries. Which of the following strategies might indicate your efforts to assist these staff members with acculturation to your unit? a. Analyze a recent situation with them in which an order with a physician was not clarified and explore their beliefs about nurse-physician relationships b. Expect them to behave in ways that are expected of staff who have grown up and been educated in the United States. c. Stress to these new staff that your unit is a family and that staff members take pride in saying that they are from Unit 4 d. Recognize that culture develops over time and leave them alone to figure out differences between their culture and that of the unit

a. Analyze a recent situation with them in which an order with a physician was not clarified and explore their beliefs about nurse-physician relationships Acculturation refers to adapting to a particular culture. Assimilation occurs when individuals now define themselves as members of the dominant culture and is evidenced by when individuals say they are from where they live and practice. When individuals grow up within a culture and take on the characteristics of that culture, it is referred to as socialization. Assisting the staff to recognize differences in the relationships between physicians and nurses on the unit and those in their country of origin is assisting adaptation or acculturation and is promoting positive patient outcomes

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

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

In a job interview for a nursing position, Marley can be assured that which of the following will occur? a. Both eustress and distress b. only eustress c. only distress d. neither eustress or distress

a. Both eustress and distress Eustress is defined as stress that is pleasant in nature, and distress is defined as stress of an unpleasant nature. One can assume that every interview has both of these stresses

Which of the following will require greater attention in the future? a. Chronic disorders b. obstetrical outcomes c. prevention of hospital based errors d. team conflict resolution strategies

a. Chronic disorders Lifestyle choices, obesity, and an aging population will lead to an increased emphasis on prevention, personal accountability, and innovations such as robotics in the management of chronic illnesses

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 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

A unit manager watches a new RN graduate interacting with a patient. When the RN comes out of the room, the unit manager says, "I don't know what they taught you in your nursing program, but if I see you do that again, I will write you up." This example demonstrates: a. Coercive use of power. b. Appropriate application of control. c. Use of informatory power. d. Use of power to provide coaching.

a. Coercive use of power. Influence is the process of using power. Influence can involve the punitive power of coercion, as is used in this example

The nurse manager for a units culturally diverse staff creates a staff development program so the professional nursing staff members can enhance their understanding of cultures on the basis of published literature. The literature reveals that the following characteristic is inherent in a culture. It: a. Develops over time b. Maintains a strong work ethic c. Changes easily d. Develops quickly

a. Develops over time Culture is a patterned behavioral response that evolves slowly as times change. The culture may or may not maintain a strong work ethic

In designing programs through your institution to address the needs of Hispanics in your community, you most likely would develop programs related to: a. Diabetes b. Cardiovascular disease c. Cancer d. Asthma

a. Diabetes Hispanics with diabetes are twice as likely to die from diabetes as non-Hispanics

A nurse manager must implement a 2% budget cut on the nursing unit. Which approach should the manager use to most effectively empower the staff of the unit? a. Discuss the guidelines for the budget cuts with the staff, making the decisions with those who participate b.Inform the staff of the budget cuts in a series of small group meetings and accept their ideas in writing only c. Provide the staff with handouts about the budget cuts and let them make recommendations in writing d. Hold a series of mandatory meetings on the budget cuts, asking staff for ideas on the cuts

a. Discuss the guidelines for the budget cuts with the staff, making the decisions with those who participate Empowerment is the process of exercising ones own power to facilitate the participate=ion of others in decision making and taking action so they are free to exercise power. It means releasing authority and enabling others to have accountability, for participation and decisions

A dispute arises between an RN staff member and an LPN over a patient issue. The tension between the two begins to affect other staff members, who are drawn into the conflict; eventually, the team becomes polarized toward either the RN or the LPN. This situation might have been prevented through: a. Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves. b. Asking other staff members what the real issues were in the dispute between the RN and the LPN. c. Reassigning one of the parties to another unit when it became apparent that the two individuals could not resolve the dispute themselves. d. Calling a staff meeting at the onset of the dispute to allow the team and the RN and LPN to discuss the initial dispute.

a. Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves The initial step in conflict resolution should have been involved an expedient response to the issues and putting a focus on the issues involved in the dispute between the LPN and RN through negotiation involving the two parties, before the dispute involved others

the manager of a surgical area has a vision for the future that requires the addition of RN assistants or unlicensed persons to feed, bathe, and walk patients. The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea. the best initial strategy in this situation would include: a. Exploring the values and feelings of the RN group in relationship to this change b. Leaving the RNs alone for a time so they can think about the change before it is implemented c. Dropping the idea and trying for the change in a year or so when some of the present RNs have retired. d. Hiring the assistants and allowing the RNs to see what good additions they are

a. Exploring the values and feelings of the RN group in relationship to this change Influencing others requires emotional intelligence in domains such as empathy, handling relationships, deepening self-awareness in self and others, motivating others, and managing emotions. Motivating others recognizes that values are powerful forces that influence acceptance of change. Leaving the RNs alone for a period of time before implementation does not provide opportunity to explore different perspectives and values. Avoiding discussion until the team changes may not promote adoption of the change until there is opportunity to explore perspectives and values related to the change. Hiring of the assistants demonstrates lack of empathy for the perspectives of the RN staff

During orientation of new nurse managers, the chief nursing officer stresses strategies that help nurse managers to achieve a powerful image. Which groups of behaviors best contribute to a powerful image for the nurse manager? a. Greeting patients, families, and colleagues with a handshake and a smile; listening carefully when problems arise b. For men, no facial hair, always wearing a suit and tie; for women, always wearing a suit and high-heeled shoes c. Maintaining a soft voice during times of conflict; making unbroken eye contact during interactions d. Smiling all the time; always wearing a suit and carrying a briefcase; women should wear no jewelry

a. Greeting patients, families, and colleagues with a handshake and a smile; listening carefully when problems arise A powerful and positive approach is communicated through confident behaviors such as greeting others, smiling, and showing respect for the opinions of others through listening. Grooming and dress need to be clean, neat, and appropriate to the situation. Speech needs to be firm and confident

A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the nurse manager about seeing his acupuncture doctor for treatment of his migraine headache. The best response to this patient would be: a. How long have you been using acupuncture treatment? b. Do you think acupuncture relieves your pain satisfactorily? c. What have you told your heart specialist about your migraines and treatment? d. Have you tried nonprescription pain medication or been given a prescription drug for your headaches?

a. How long have you been using acupuncture treatment? Acknowledging the patients use of acupuncture demonstrates cultural sensitivity through acknowledgement of treatments that would be consistent with the patients cultural interpretation of illness and responses to it. The other responses indicate lack of cultural sensitivity as well as cultural imposition, in that the nurse diverts the line of inquiry toward interventions that would be common to the nurses experience of health care in Western cultures

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 non clinical 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. Involves screen displays that are best configured for non clinical users 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 the suit the purposes and preferences of users in clinical areas

High levels of work-related stress affect all but which of the following? (Select all that apply.) a. Job satisfaction b. Absenteeism and turnover c. Nurses' health d. Client welfare

a. Job satisfaction b. Absenteeism and turnover c. Nurses' health d. Client welfare Many writers and researchers have found that these work related areas are adversely affected by stress.

You pull staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions. Staff members are becoming distanced from the family. After inviting the concerns of staff, you explain that the organization values patient-centered care and suggest that evidence supports that acting as an advocate and a listener is helpful to families. You ask the staff for ideas as to strategies that are effectively patient-centered in these situations. In this situation, you are taking on which role? a. Leadership b. Management c. Follower d. Visionary

a. Leadership As a leader, you provide and communicate vision and direction based on evidence and experience, and you engage others in decision making that moves them toward the vision with a reasonable level of risk taking

During a discussion of concern about approaches used with aggressive patients in the Emergency Department, several staff members express concern for their safety. As a leader, the nurse manager should: a. Look directly at speakers and acknowledge their concerns b. Promise to implement each suggestion that is made c. Implement the idea that receives the most discussion d. Listen but implement the plan that she had in mind before the discussion began

a. Look directly at speakers and acknowledge their concerns One of the five rules for leaders is to listen to the constituents in this instance, the staff members who have safety concerns. Active listening in the United States means establishing direct eye contact and asking probing questions. Listening does not obligate the leader to any one course of action. Action will be based on what is best for the group

The workgroup on NU23 is marked by apathy toward the wards patients, high absenteeism, open conflict among team members, and high turnover of personnel, including managers. The underlying behavior in this situation may be characterized as: a. Powerlessness b. Anger c. Apathy d. Oppression

a. Powerlessness Emotions such as anger and apathy result from a workplace in which powerlessness is exhibited

A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who begins to complain loudly about the quality of care his mother is receiving. His behavior is so disruptive that it is overheard by staff, physicians, and other visitors. The family member rejects any attempt to intervene therapeutically to resolve the issue. He leaves the unit abruptly, and the nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner? a. Reflect to gain insight into how the situation could be handled differently in the future. b. Try to catch up with the angry family member to resolve the concern. c. Discuss the concern with the patient after the family member has left. d. Notify nursing administration of the situation.

a. Reflect to gain insight into how the situation could be handled differently in the future. Goleman suggests that emotional intelligence involves insight and being able to step outside of the situation to envision the context of what is happening as well as being able to manage emotions such as frustration effectively

Becky graduated five years ago and is keenly interested in pursuing leadership opportunities. She has been active in learning about leadership through workshops and Internet research and recently began a graduate degree program with a focus on nursing administration. She has excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and sometimes aggressive behavior tends to alienate other staff members on the unit. In coaching Becky, you: a. Suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation. b. Suggest that she not consider leadership roles because her interaction skills are more suited to roles in which she has limited opportunities to work with others. c. Ask staff members on the unit with whom she works to provide her feedback about ways in which her behavior irritates or turns them away. d. Encourage her to continue her graduate courses, as information about strategies and technical aspects of the role will compensate for negative interactions.

a. Suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation. Leadership involves radiating positive energy and the ability to inspire and motivate others. Management can be taught through formal instruction, but leadership is attained through reflection on rich personal experience

A nurse executive is hired to restore a unit's productivity, which has decreased as the result of low staff morale. The nurse executive utilizes which of the following leadership principles? a. The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment b. If the staff members increase productivity, then they are given opportunity to engage in learning events such as workshops and conferences. If the staff members are not satisfied, they will insist on a different leader, who will get them what they want. c. Leaders at the national level who are seeking relief for nurses in the workplace are seen as the solution to the nursing shortage. d. Workplace satisfaction depends on staffing ratios, adequate pay, and tuition reimbursement, and these are things the leader can control.

a. The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment Stephen M.R. Covey suggests that Smart Trust is a method for restoring trust in organizations. Smart Trust actions include declaration of the leaders intent and assumption by the leader that others also have positive intentions. Building trust involves signaling goals and intended actions in advance. Actions such as promising external rewards such as additional learning opportunities, workload relief, and compensation are consistent with transactional leadership, which leads to low to stable commitment with limited satisfaction

A staff nurse asks the nurse manager for a few days off for personal reasons. The nurse manager turns in the request to the human resources office with a note indicating that the staff nurse has demonstrated excellent working skills and is a valued employee. The nurse manager has used the influence of her position to help this staff member. Influence is the process of: a. Using power. b. Empowering others. c. Understanding power. d. Moving past apathy.

a. Using power. Influence involves the use of power to effect certain outcomes. In this situation, to arrange days off for a valued employee

Literature on oppression in nursing has: a. Verified the presence of behaviors associated with oppression within nursing. b. Suggested that nurses are oppressed because of the actions of other groups. c. Failed to establish that oppression is present in nursing groups. d. Indicated that nurses use oppression negatively.

a. Verified the presence of behaviors associated with oppression within nursing. Oppressed group behavior is apparent when a population is dominated by another group and begins to take on the characteristics of the dominant group, often bullying and abusing their peers. In the twenty first century, bullying and incivility have become epidemic in both nursing education and clinical settings

After being interviewed for the unit manager position, the staff nurse reflects on the interview process. The staff nurse is aware that leadership begins: a. Within. b. Through a relationship with a mentor. c. With the job description. d. With the chief nursing officer of the organization.

a. Within. People notice differences in workplaces and tend to choose those that evidence a high degree of trust between leaders and followers. Stephen M.R. Covey suggests that trust begins with self and that leaders must focus first on developing character and confidence, which is their credibility. Credibility enables leaders to trust themselves and gives others someone or something that they can trust

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

a. assess the perceptions of the nursing staff regarding the particular service problem 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 patients 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

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

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

As a team, you and the staff have determined that there is a need to reduce medication errors on your unit. Together, you developed thee questions that you would like addressed and searched the literature for relevant research studies. Based on the evidence, you suggested a change to your practices and now are involved in implementation of these changes. Today, there was a major study released that would significantly change what you have decided to do. What are you and your staff experiencing? a. compression complexity b. distress c. information lag d. technology advancement

a. compression complexity This situation exemplifies complexity compression, a term that means many changes are happening almost simultaneously and before one practice can be firmly implanted in our minds, we are already addressing some other new change. This compression can be distracting of useful

After a major flu vaccination campaign, an agency bills a private insurance company for allowable costs for administration of each vaccination according to the schedule established by the insurance company for reimbursement. This is an example of which major payment method? a. cost based reimbursement b. charges c. contractual allowance d. prospective reimbursment

a. cost based reimbursement Because the agency is submitting costs after the campaign is completed and in accordance with an established schedule of allowable costs, a retrospective, cost based reimbursement payment method is being utilized. If a desire for profit was indicated, then the answer would be charges

A new graduate is seeking a new position in nursing and wants to sell herself effectively. The best strategy is to: a. create a resume b. practice interviewing c. call the personnel office d. create a curriculum vitae

a. create a resume A resume provides a customized overview of your professional background that relates specifically to a position for which you are applying. Resumes advertise your skills to a prospective employer

As a nurse manager, you see and 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 direct care and procedures d. cannot encompass nurses within this framework

a. currently does not include nurses in its vision of multifaceted primary care 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

To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages. To maximize patient safety and reduce costs, the healthcare organization: a. develops a centralized pool of float nurses b. assigns nurses from less busy units to ones with increased acuity levels c. floats nurses only between units on which the nurses have been cross trained d. assigns float nurses to basic care only

a. develops a centralized pool of float nurses a centralized pool usually includes experienced nurses who maintain a broad range of competencies. Other approaches are less satisfying for nurses, are less efficient, and may be less safe

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

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

In reviewing the job description of a nurse manager, the staff becomes aware that a nurse manager's role is complex. Which of the following duties are required of a nurse manager (select all that apply)? a. ensure unit productivity reports b. develop policy and legislation to protect nurses well being c. plan staffing of UNPs only d. Prepare a unit budget that reflects unit staffing needs e. monitor nurse sensitive indicators such as falls and incidence of infections

a. ensure unit productivity reports d. Prepare a unit budget that reflects unit staffing needs e. monitor nurse sensitive indicators such as falls and incidence of infections A nurse manager manages financial resources by developing business and staffing plans

A functional resume focuses on: a. experience and skills gained in positions b. positions held and specific roles in positions c. academic qualifications and achievements d. relating skills and experience to qualifications in a specific position

a. experience and skills gained in positions Functional resumes highlight skills and experience gained rather than details of specific positions. As with resumes in general, skills and experiences are customized to create an image of an individual in a particular position

Knowing your professional strengths is important to: a. finding your fit in positions and a career path b. maintain a professional status c. act in a manner that is legal and ethical d. understand the role expectations of a position

a. finding your fit in positions and a career path Being aware of your strengths is critical in determining what you will bring to a position and can be used to find your fit and possible career path. Knowledge and experience are important in maintaining the privilege of belonging to a profession and of behaving ethically and legally

A necessary leadership strength for nurses of the future is: a. inspiring others to work their best to create the future b. understanding the nuances of fundraising to make up funding shortfall c. guarding the tendency of other professions to encroach on nursing roles d. adapting work life to an aging nursing workforce

a. inspiring others to work their best to create the future Senge said that all leadership is really about is people working at their best to create the future. Predictions of the future highlight the importance of interprofessional teams and of a shift towards understanding the importance of health care

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

a. investing time and energy in teaching clients A philosophy that patient education is an investment with a significant positive return is one of the three Ps of a successful consumer education focus. Money invested in teaching is money well spent

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

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

A nurse manager must also consider a number of internal variables that will affect staffing patterns. An internal variable to be considered is: a. organizational staffing policies b. state licensing standards c. american nurses association d. consumer expectations

a. organizational staffing policies State licensing standards outline what a nurse can do. Internal policies determine what a nurse may do in a particular setting as well as the amount of flexibility that is allowed to manage times of high and low volumes, as well as changes in acuity. Organizational policies can put the nurse manager in a situation where patient safety cannot be maintained or financial obligations met

The nurse manager of a unit has lost many staff members, and the unit is now staffed with a large number of agency and traveling nurses. She knows that the agency and traveling nurses are all contracted to stay on the unit for the next 3 months. One way to improve morale and decrease stress in the unit would be to: a. plan a social event and include the agency and traveling nurse staff members b. plan unit based social events for your remaining permanent staff members c. request hospital based floating nurses to substitute for the temporary staff d. implement team nursing

a. plan a social event and include the agency and traveling nurse staff members Social support, in the form of positive work relationships, can be an important way to buffer the effects of a stressful work environment. Including all staff in the social event enables those who are not normally part of the team to experience this support and provides an opportunity for the staff as a whole to develop supportive relationships

In developing curricula that will address needs based on forecasts for the future, nursing educators need to contemplate a. prevention strategies b. leadership skills and knowledge c. violence de-escalation strategies d. strategies for job security

a. prevention strategies b. leadership skills and knowledge c. violence de-escalation strategies Future forecasts suggest health factors such as obesity that are implicated in the development of chronic disorders will increase, as will chronic disease. Leadership skills have been identified as a key competence for nurses of tomorrow, and competence with technology will be needed as technology continues to revolutionize health care. Rather than emphasizing job security, nurses will need to be prepared to be in a new environment with many options and episodic

The difference between staffing and scheduling is that staffing: a. puts the right person in the right position b. puts the right person in the right place and time c. refers to the number of nursing hours per patient per day d. looks after interpretation of benefits and compensation

a. puts the right person in the right position Nursing staffing involves planning for hiring and deploying qualified human resources to meet the needs of a group of patients. Scheduling, on the other hand, is a function of implementing the staffing plan by assigning unit personnel to work specific hours and days of the week

The chief nursing officer is pleased with the nurse managers 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 in 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. recognition of the nursing staff for excellence in promoting consumer relationships 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

Which of the following actions is most representative of how health care of the future might be delivered? As a nurse leader, you: a. refer families who require immediate help to a local food bank. You also work with local agencies and families to establish a mothers collective in which mothers learn about nutrition and prepare low cost, nutritious meals that are shared with the mothers in the collective b. work together with a local agency to set up a free clinic in which addicts and the homeless can receive free health. care and prescriptions for immediate needs c. ensure that individuals who are admitted to your unit are asked about their smoking history and that preoperative and postoperative planning takes into account how smoking will affect status during and after surgery d. address the health of those who are overweight and obese on your unit by ensuring that hospital meals offer nutritious, healthy food choices that are satisfying

a. refer families who require immediate help to a local food bank. You also work with local agencies and families to establish a mothers collective in which mothers learn about nutrition and prepare low cost, nutritious meals that are shared with the mothers in the collective Referral to a food bank addresses the needs of a specific population, while exemplifying an important leadership strength: thinking long term, acting short term. The project that involves mothers will teach mothers about nutrition and engage them in preparation of low cost, healthy meals while promoting longer term changes in healthy eating

A hospice nurse has been feeling very stressed at work because of both the physical strain and the emotional drain of working with clients with AIDS. She tries to walk 1-2 miles three times a week and to talk regularly with her husband about her work related feelings. One reasonable stress management strategy would be to: a. start taking yoga lessons b. make an appointment to meet with a psychiatrist c. start jogging 5-6 miles every day d. plan to go for a drink with fellow nurses after work every day

a. start taking yoga lessons Stress relief techniques include 30 minutes of exercise 5 times a week, as well as techniques such as yoga that relieve mental stress

In designing a program for young adults, regarding safe sexual practices, which of the following might reach the greatest number in your target group? a. web based applications b. print based media such as newspapers c. television advertisements d. brochures in kiosks in mall

a. web based applications Mobile technology is changing the digital divide, with young adults, minorities, those with no college experience, and those with lower household incomes being more likely to indicate that phones are their main source of internet access

Recruiting among the emerging workforce (18- to 35-year-olds) is a challenge for healthcare agencies. Marketing brochures should address the leadership and vision of the healthcare agency. Which of the following workplace environments will attract applicants in the emerging workforce? a. A highly professional environment b. A nurturing and receptive environment c. An environment highlighted by lots of meetings, so staff members can have lots of input d. A totally online environment, so staff members will not have to interface with uncaring colleagues

b. A nurturing and receptive environment A study of the student nurses who represent this age group indicates that they want a leader who is receptive, approachable, a team player, and motivating

As the RN charge nurse on the night shift in a small long-term care facility, you've found that there is little turnover among your LPN and nursing assistant (NA) staff members, but they are not very motivated to go beyond their job descriptions in their work. Which of the following strategies might motivate the staff and lead to greater job satisfaction? a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night LPNs and NAs. b. Allow the LPNs and NAs greater decision-making power within the scope of their positions in the institution. c. Help the LPNs and NAs with their work, whenever possible. d. Ask the director of nursing to increase job security for night staff by having them sign contracts that guarantee work.

b. Allow the LPNs and NAs greater decision-making power within the scope of their positions in the institution. Hygiene factors such as salary, working conditions, and security are consistent with Herzbergs two factor theory of motivation; meeting these needs avoids job dissatisfaction. Motivator factors such as recognition and satisfaction with work promote a satisfying and enriched work environment. Transformational leaders use motivator factors liberally to inspire work performance and increase job satisfaction

The new head nurse on G Unit has been the subject of a great deal of discussion and complaining during breaks. She is a competent nurse of tremendous integrity with approximately 30 years' experience. Her predominant method of problem solving and communication is through meetings, which can go over the allotted time. The staff may: a. Be represented by a high number of Baby Boomers. b. Be presenting different generational values and attitudes than the head nurse. c. Be unresponsive to her transactional leadership style. d. Want a leader rather than a manager.

b. Be presenting different generational values and attitudes than the head nurse. Leaders who come out of the Baby Boomer generation may be more comfortable with collective action than followers who come out of the Emerging Workforce generation, who are more comfortable with interactions if they are seen as having value for them and with activities if they are seen as having benefit. A group that is highly weighted toward the Emerging Workforce generation may find the approach of a leader who is part of the Baby Boomer generation frustrating and may not understand the meaning of value of the meetings

When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidates lack of eye contact reflects the candidates cultural sensitivity. You are exhibiting: a. Acculturation b. Cultural Sensitivity c. Ethnocentrism d. Transculturalism

b. Cultural Sensitivity Cultural sensitivity refers to the affective capacity to feel, convey, or react to ideas, habits, customs, or traditions unique to a group of people. In this situation, acknowledgement of the candidates background in relation to eye contact demonstrates cultural sensitivity

During performance appraisal, you praise Xia for her attention and care to nursing details. You suggest that her care would be further enhanced by greater acknowledgement of patients feelings. Xia bursts into tears and leaves the office. Later, you learn that criticism is perceived as akin to failure in Xia's culture. You reflect on how you could modify your approach in the future to acknowledge different cultural interpretations of feedback. Your response is indicative of: a. Bias b. Cultural awareness c. cultural diversity d. ethnocentricity

b. Cultural awareness Cultural awareness involves self examination and in depth exploration of ones own cultural and professional background, including biases, prejudices, and assumptions, including assumptions about thinking modes and decision making

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. Data indicate that nurses are responsive to requests for assistance; data are available for the unit and the institution. 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. 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

Joan, the nursing unit manager, finds it difficult to work with Thomas, a new graduate. Thomas has many ideas, and his manner of presenting them irks Joan. After reflection and discussion with others, Joan recognizes that she also feels threatened by his behavior. She comes to understand that Thomas is trying to establish his own role on the unit, is not trying to challenge her, and needs guidance, coaching, and affirmation. Joan is demonstrating: a. A positive self-concept. b. Deepening self-awareness c. Leadership. d. Acquiescence.

b. Deepening self-awareness According to Goleman, stepping outside oneself to envision the situation while assuming ownership is a component of emotional intelligence

As a senior executive, you are keen to develop your hospital as a learning organization. Part of your purpose in translating this vision into practice is to (select all that apply): a. Retain funding from third-party payers. b. Develop leaders. c. Maintain and/or improve quality of care. d. Stay abreast of new knowledge and evidence.

b. Develop leaders. c. Maintain and/or improve quality of care. d. Stay abreast of new knowledge and evidence. Learning organizations are concerned with providing opportunities and incentives for individuals and groups to engage in lifelong learning, in recognition of the positive impact that learning has on patient outcomes and staying abreast of new knowledge. Lifelong learning and reflection are also characteristics of leaders

Nurses who engage in in-fighting, seek physician support against nursing colleagues, and avoid membership in nursing organizations: a. Refuse to believe that they are acting like members of groups that suffer socioeconomic oppression. b. Do not understand how their failure to exercise power can limit the power of the whole profession. c. Purposefully choose to exercise their power in the workplace through indirect means. d. Suffer from learned helplessness as a result of abuse by powerful nurse executives.

b. Do not understand how their failure to exercise power can limit the power of the whole profession. Becoming an active, productive, collegial member of groups and teams within the workplace and in professional associations and community groups ensures that the nursing voice is heard on healthcare issues and problems and is an appropriate exercise of power

A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of the older adult patient. Using complexity principles, what would be the best approach to take in making this change? a. Leverage the hierarchical management position to get unit staff involved in assessment and planning. b. Engage involved staff at all levels in the decision-making process. c. Focus the assessment on the unit, and omit the hospital and community environment. d. Hire a geriatric specialist to oversee and control the project.

b. Engage involved staff at all levels in the decision-making process. Complexity theory suggests that systems interact and adapt and that decision making occurs throughout the systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts, and therefore, all levels of staff would be involved in decision making

Amy has worked in the dialysis unit on staff for about 12 years. She is frequently consulted by other nursing staff regarding protocols and policies on the unit. What type of power is Amy using? a. Position power b. Expert power c. Personal power d. Competency power

b. Expert power According to the types of power outlined in the text, Amy is most likely evidencing expert power in that she is being consulted regarding areas of knowledge and competency on the unit and is at the same level, potentially, in the hierarchy as her colleagues

Which of the following nurses is most likely to inspire others to do their best? a. Nancy, RN, is an individual who enjoys detail and organization. She regularly leaves notes for the next shift about what has been done incorrectly or omitted b. Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious c. Clara has been the head nurse on Unit 3Y for years. She is quiet but enjoys patients and their families. She has not been to a conference in years because her unit is her entire life d. Karen is a team leader. She is extraordinarily vigilant about ensuring that everyone is treated fairly in assignments. She is also very conscientious about care and regularly checks up on what everyone is doing to ensure that it is done correctly

b. Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious To be inspired, people must have a positive leader who radiates energy, a zest for learning, and an interest in the common good, and is engaged in self renewal. This leader is hopeful and optimistic. Leaders, not managers, inspire others to work to their highest level

Two nurses approach their manager about a conflict regarding the next month's schedule. The nurses are talking loudly and at the same time. The manager most effectively uses communication skills to resolve the conflict by: a. Taking both nurses aside, separately and then together, and charging them with resolving the problem without her direct intervention. b. Listening to each nurse speak to the other without interruption and asking clarifying questions to help them resolve the issue themselves. c. Separating the nurses, instructing each to decide how the problem can be resolved, and meeting with them the next day. d. Calling an emergency scheduling committee meeting and asking volunteers to resolve the conflict between the two nurses.

b. Listening to each nurse speak to the other without interruption and asking clarifying questions to help them resolve the issue themselves Negotiation involves the presentation of an opening position with each party, then moving on until the achieve a mutually agreeable result or until one or both move away from a failed negotiation. Negotiation occurs when one party has something that the other party values.

Your colleague Mary, a recent graduate, announces one day that she intends to leave nursing in 3 to 4 months to pursue a position in marketing. While at your agency, she plans to give patients excellent care and to learn as much as she can, because Who knows? Nursing is a great job with a great pay and I may return someday. Mary's statements most accurately exemplify which orientation to the concept of nursing. Nursing as a(n): a. Profession b. Occupation c. Flexible discipline d. Career with off an on ramps

b. Occupation Concern with nursing as potentially one in a series of possibly well paid jobs reflects a view of nursing as an occupation

The Sunny Long Term Care facility has experienced numerous difficulties with staff relationships, despite its success in maintaining financial viability and judicious use of resources. Staff members complain that the primary concern of the facility include applying policy, saving money, and ensuring that lawsuits are avoided. There is little trust in, and involvement of staff members. This facility may be: a. Well managed and well led b. Overly managed and not well led c. Poorly managed and well led d. Overly led and overly managed

b. Overly managed and not well led This organization is concerned primarily with coordination of resources, application of current policy, and economic issues connected to the present. These behaviors are consistent with the management role. There is little evidence that the organization displays leadership, which involves trust, belief, hope, and vision

A nurse staffing plan takes into account: a. Specific nurse-to-patient ratios per shift. b. Participation of nurses in projecting staffing needs. c. Compensation and benefits for each level of staff. d. The occupancy load of a unit.

b. Participation of nurses in projecting staffing needs. Nurse staffing plans employ nursing judgement and flexibility that is based on acuity, nurse experience, and unit configuration rather than set nurse to patient ratios. The American nurses association has opted to support the nurse staffing committee as the approach to ensure safe staffing. In 2013, national legislation was introduced that requires all acute care hospitals to establish a committee made up of 55% direct care RNs

Sarah, RN, complains to you that a male nurse from a different culture sits very close during charting and leans toward her when speaking. In responding to Sarah, you consider that differences across cultures that are relevant to this situation include: a. Eye contact. b. Personal space. c. Harassment. d. Expressions of feeling.

b. Personal space. Body movements, eye contact, gestures, verbal tone, and physical closeness when communicating are all part of a persons culture. For the nurse manager, understanding these cultural behaviors is critical in accomplishing effective communication within the diverse workforce population

The nurse manager in the Emergency Department needs to implement new staffing patterns. As a transformational leader, the nurse manager should: a. Explain in detail how well the new idea will work. b. Reinforce how this change will respond to the ideas and solutions generated by staff members. c. Reason with staff members that the new idea will save money and allow more free time. d. Imply that raises will be smaller than anticipated if the new idea is not accepted.

b. Reinforce how this change will respond to the ideas and solutions generated by staff members. Transformational leadership inspires and motivates others through influence and persuasion rather than through rewards and punishment. This type of leader listens to the views of others, empowers others to lead, finds ways to remove barriers, and serves as an advocate for those who care for patients

As a new manager in the ED, you meet with each of the staff to ask about their priorities and what they think is going well in the department or what is of concern to them. Almost all of the staff express frustration and distress at being treated rudely or disrespectfully by patients, staff from other departments, and physicians and complain that they feel that nurses in the ED are not valued. With the staff, you brainstorm to raise the profile of nurses. Which of the following strategies would be most effective? (Select all that apply.) a. Requesting increased compensation b. Speaking positively about ones work c. Dressing and grooming in a clean and neat manner d. Using titles (Mr., Mrs., Ms.) and last names e. Submitting a written complaint to senior administration regarding rude behaviors f. Developing a code of conduct for the ED staff

b. Speaking positively about ones work c. Dressing and grooming in a clean and neat manner d. Using titles (Mr., Mrs., Ms.) and last names f. Developing a code of conduct for the ED staff Demonstrating a positive and professional attitude about being a nurse to nursing colleagues, patients and their families, other colleagues in the workplace, and the public facilitates the exercise of power among colleagues while educating others about nurses and nursing. A powerful image is an important aspect of demonstrating this positive professional attitude and includes how we identify ourselves, how we dress, whether we are punctual for commitments, and whether we speak positively about our work. Bullying and incivility are negative expressions of power that can affect patient outcomes. The Joint Commission standard demands that leaders ensure that a code of conduct is implemented to ensure patient safety and a culture of quality

The style of leadership that Kari is exhibiting is likely to: a. Ensure that the organization is financially stable b. Stifle innovative thinking about ways to move out of financial jeopardy c. Lead to apathy and disinterest in the organizational goals d. Lead to decreased attrition of staff on her unit

b. Stifle innovative thinking about ways to move out of financial jeopardy Whether or not the organization achieves financial stability is a function of financial envisioning and planning, but the style of leadership (transactional) that Kari is demonstrating is likely maintaining the status quo within the organization, without generating creative and innovative ideas to address the financial issues. Staff commitment is low to stable, and conformity to organizational goals is motivated by external rewards

Within the deaf culture, there is considerable disagreement about the use of SEE (Signed Exact English) and ASL (American Sign Language). This is indicative of: a. Dominant versus nondominant behaviors. b. The need to recognize diversity within groups. c. The impact of cross-culturalism. d. How language separates subgroups.

b. The need to recognize diversity within groups. When working with various cultural groups and diversity, it is important to recognize that diversity also exists within groups. Cultural differences among groups should not be taken in the context that all members of a certain group or subgroup are indistinguishable

A nurse manager is excited about 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 been not perfected in SR technology d. Wireless communications are prone to unreliability in transmission

b. The type of speech required for voice recognition is unlikely to occur in a pressured situation 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

A nurse executive who considers herself a Baby Boomer will have the challenge of convincing the emerging workforce of the necessity of committee meetings. One of the primary reasons that the Baby Boom generation appears to have so many meetings in the work environment is that: a. They feel more comfortable in a group. b. They find that the journey to the solution is as important as the solution itself. c. They were deprived of collective action opportunities in the past and now feel that solutions are better when many people have input. d. Baby Boomers are aging and need the respite from work that meetings offer, so they can recuperate from the physical demands of the work environment.

b. They find that the journey to the solution is as important as the solution itself. Baby Boomers mistrust authority and trust in collective action, based on successes with social movements in their formative years

Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style? a. Transformational b. Transactional c. Trusting d. Truthful

b. Transactional Transactional leaders tend to rely on position and power, and they tend to reward and punish according to performance and conformity with expectations

At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. It would now be best to: a. Arrange another meeting in a weeks time so as to allow a cooling off period b. Turn the dispute over to the director of nursing c. Insist that the participants continue to talk until a resolution has been reached d. Back the unit managers actions and end the dispute

b. Turn the dispute over to the director of nursing According to the principles outlined by Ury, Brett, and Goldberg, a cooling off period is recommended if resolution fails

A nurse manager is experiencing poor staff morale on her unit. While participating in a baccalaureate course, the nurse manager had learned that one of the reasons nurses lack power today is probably because of the past. In the early decades of the profession, nurses lacked power because: a. Nurses freely chose to defer to physicians and administrators with more education b. Women lacked legal, social, and political power because of legal and cultural barriers c. The first nursing licensure laws prohibited nurses from making most decisions d. Nurses astutely recognized the risks of grabbing too much power too soon

b. Women lacked legal, social, and political power because of legal and cultural barriers Nursing mirrored the lack of legal, social, and political power that was prevalent in the early decades of the profession

You overhear a newly graduated RN telling one of your colleagues that leadership and management belong to the unit manager and not to her. As a nursing colleague, your response demonstrates understanding that the perception of the new graduate: a. Is correct. Leadership is not the role of the staff nurse. b. Would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals. c. Has been influenced by nurse leaders and managers who leave for other positions. d. Is related to the general perception that nurse leaders and managers are not satisfied in their jobs.

b. Would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals. Care coordination that involves the intersection of individual, family, and community based needs requires that nurses have self confidence, knowledge of organizations and health systems, and an inner desire to lead and manage. There is often a view that leadership is isolated to those holding managerial positions and that a direct care nurse is subject to following by adhering to the direction of others. Such views fail to acknowledge that to be a nurse requires each licensed individual to lead, manage, and follow when practicing at the point of care and beyond

According to Leininger, "cultural imposition" is a major concern in nursing because nurses have a tendency to impose their values, beliefs, and practices on patients of other cultures. The discussion topic most likely to be without cultural imposition would be: a. Abortion. b. Wound management. c. Blood transfusion. d. Advance directives.

b. Wound management. Abortion, blood transfusion, and advance directives are heavily imbued with values, beliefs, and practices that may be different between patients and nurses

During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is: a. empowering b. a leadership tag c. a symbol d. a management task

b. a leadership tag According to the complexity theory, leadership tags, which are similar to values, reflect the patient centered philosophies and values driven characteristics that define an organization and give it personality

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. ask the family about the significance of the medicine pouch for them 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

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

b. assessing parents preferences for the amount of information desired 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

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

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

A particular classification system assigns revenue according to the functional capacity of patients and the progression of patients during their stay in rehabilitation units. More independent patient activities, such as prompted voiding, require higher staff utilization than dependent activities but do not result in increased staff resources. This is an example of: a. Bureaucracy b. concern related to the validity of classification systems c. inadequate reliability of classification systems d. inappropriate subjectivity in making judgements about staffing

b. concern related to the validity of classification systems Validity of categories and implications for staffing levels are in question in this situation because staffing levels are not reflective of the levels of activity required for patient care

To enhance team leadership skills for your team leaders, you arrange opportunities for: a. certification b. continuing education c. graduate courses d. volunteerism

b. continuing education Continuing education provides systematic learning opportunities that augment existing skills and knowledge for delivery of quality care and advancement of career goals. Graduate and certification courses provide advanced knowledge and skills

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

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

The chief nursing officer understands that a nurse manager can exhibit stress that is related to trying to keep up with the number of electronic messages that arrive, as well as trying to remain accessible to staff. What is a strategy that would assist the manager to manage the information overload effectively? a. ignore messages unless they are labeled as important b. determine who is most likely to send useful or important information or requests c. check email messages once a day d. encourage face to face meetings rather than email

b. determine who is most likely to send useful or important information or requests Reduction of stress related to information overload requires the development of information receiving and information sending skills. Information sending skills include determining most common sources of useful data, labeling files, and folders to which email messages can be directed, deletion of emails, and focusing on the most important pieces. Information sending skills include keeping email messages short (and calling if the message needs to be a long one) and considering the most appropriate medium for messages (telephone, fax, face to face)

During the budgeting process, nurse managers are typically responsible for which of the following? (Select all that apply.) a. determining the inflationary rates for the upcoming year b. developing unit operation objectives c. justifying capital equipment requests d. predicting cash flow e. negotiating budget with other managers and administration

b. developing unit operation objectives c. justifying capital equipment requests e. negotiating budget with other managers and administration Although involvement in budget processes will vary from institution to institution, these are typical responsibilities for nurse managers during the budget process

Your organization is in the middle of redesigning patient care units, with decisions based on best practices and various other sources of evidence. In the middle of the transition, there is a temporary halt called to the transition because of a redesign of the health care system and greater emphasis on primary care. What would be a healthy response to this situation? a. salvage as much of the original planning as possible so as to reduce expenditures b. engage in consultation to create innovative solutions that bridge the existing plans and the new directions c. abandon the current planning in favor of addressing the new trends d. continue with the current planning because trends come and go

b. engage in consultation to create innovative solutions that bridge the existing plans and the new directions Stability and total chaos are the ends of a continuum. Moving in some way between those two ends suggests that we live in a constant state of disequilibrium in which we strive toward stability while recognizing we experience chaos. As we continue to move from traditional practices to evidenced based ones and from a heavy focus on tertiary care to one that values primary care, we can assume that we might experience more chaos. Chaos can lead to new learning and new, innovative solutions. As nurses, it is important to be able to function in an evolving environment

To develop a curriculum vitae, or résumé, a nurse must develop a personal data file. The goal of a personal data file is to: a. create an opportunity to be interviewed b. have a listing of facts about your professional life c. have a tool in place for marketing yourself d. create a document that lists your skills

b. have a listing of facts about your professional life A personal data file enables storage and recall of career specific details that can be retrieved and shaped for a specific purpose using cut and paste approaches rather than creating whole new documents

The education consultant at St. Joseph's hospital is giving a workshop on cognitive reframing. The consultant explains that cognitive reframing reduces stress by: a. aiding individuals in identifying positive stressors b. helping people realize that negative thinking causes emotional distress c. eliminating negative stressors d. replacing positive self statements with negative irrational beliefs

b. helping people realize that negative thinking causes emotional distress Cognitive reframing is a therapy that aids individuals in discovering that their irrational thoughts can be replaced with responses that are more rational. it enables individuals to gain a sense of control over the situation and can change. It is an approach that allows individuals to replace negative thoughts and statements with others that are more realistic and helpful

After reviewing her monthly budget report, the nurse manager sees that she has a negative variance, which prompts her to change the staffing schedule. A negative or unfavorable variance in a monthly expense report may result from: a. overestimation of inflation b. higher than expected client acuity c. net revenue exceeding net expenses d. not replacing staff who called in sick

b. higher than expected client acuity Variance reflects the difference between what was projected and the actual performance in a budget. When the variance is negative or unfavorable, the amount spent is more than what was budgeted (expenses exceed revenue); this may be a result of higher acuity. To help managers interpret and use variance information better, some institutions use flexible budgets that automatically account for census variances

Nursing professionals in the twenty first century will accomplish most of their work: a. Through teams of internationally prepared professionals b. in teams and through group work c. through long term, secure jobs d. in competitive work environments and work groups

b. in teams and through group work The future is about teams and group work. Competition will be out and collaboration will be in. Job security will be out and career options will be in. Our brightest and best may leave more often than they do at present to pursue career options internationally

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

b. including items that are important from the patients perspective 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 judgements 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

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

b. involve the staff in resolving consumer issues quickly and effectively 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 blaming

Your unit has a number of patients who have undergone limb amputation. In working with the clients, you being to think beyond therapies such as pharmacotherapeutics and surgery and you explore biomechanics, robots, mid body approaches, and cognitive behavioral therapies as possibilities in working with these clients. You begin to amass information in a number of areas with which you previously had little familiarity. According to the Wise Forecast model, you are a. acting wildly b. learning wildly c. engaging in interprofessional care d. increasing your complexity compression

b. learning wildly The first step, learn widely, means that we must extend our sources of knowledge beyond our role and clinical areas of interest. In fact, we must extend our learning beyond nursing and health care. Widely might encompass another discipline such as architecture or engineering

A group of managers is meeting to discuss ideas related to the successful implementation of evidence based practice on their units. Susan has been asked by the director of care to assume leadership of these discussion groups. After two such sessions, Susan expresses disappointment to her mentor that the group seems disinterested in her ideas and that they are listening to Ken, who has much less experience with leadership. In discussing this with Susan, the mentor understands that leadership: a. Is a designated role b. must be earned c. is more likely to be taken by someone who is more talkative d. rarely is taken over by someone with less experience

b. must be earned A person can have an impressive title, but title or designation does not make the person a leader. A leader must have the ability to inspire others to follow.

A nurse is applying for a new position. This position is one in which she will serve as a liaison between a hospital and a school of nursing. The nurse has to update her resume to include her teaching experience. The goal of creating a curriculum vitae is to: a. Have a listing of facts about your professional life b. provide potential employers with information about where you are in your career c. respond quickly whenever a position becomes available d. be certain you can recall facts for a prospective position

b. provide potential employers with information about where you are in your career A curriculum vitae provides an all inclusive but not detailed listing of your professional life. This approach allows a prospective employer to find the most recent information quickly and gain a sense of where you are in your career

A young male nurse began in nursing asa staff at a hospital. After 3 years, he moved to a home healthcare agency. After 2 years, he was promoted to a managerial position and now has returned to another hospital as a new director of nursing. This career style is known as a. linear b. spiral c. steady state d. entrepreneurial/ transient

b. spiral The spiral career style, described by Friss, involve in and out and up and down approach to opportunities

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

b. two part time staff members are hired to work on a unit but the job expectations for them are not clear, and the head nurse expresses disappointment in their performance Role stress is an additional stressor for nurses. Viewed as the incongruence between perceived role expectations and achievement, role stress is particularly acute for new graduates. Failure to comply with expectations can lead to role conflict. Role conflict and role ambiguity are major sources of conflict for nurses

As an experienced nurse manager who is new to an organization, it would be important to: a. know the difference between operating and capital budgets b. understand the budget timetable and level of involvement expected of individual managers in budget preparation c. know why a budget is essential to the well being of an organization d. understand what factors drive up healthcare costs in the healthcare system

b. understand the budget timetable and level of involvement expected of individual managers in budget preparation Although all of the answers reflect knowledge that is critical to budgeting for nurse managers, an experienced nurse manager would likely be already familiar with general knowledge related to budgeting. The nurse manager, however, would need to become familiar with budget timetables and level of involvement expected in this specific organization because these elements of budgeting vary from work environment to work environment

As a nurse manager, you have to be effective in managing a culturally diverse staff. Which of the following nurse manager attributes would assist you in addressing the cultural needs of your staff? a. Stereotyping of others b.respecting others c. understanding the importance of language d. encouragement of potential in all staff e. age bias f. disrespect for others

b.respecting others c. understanding the importance of language d. encouragement of potential in all staff Cultural competence involves knowledge of diverse cultural and ethnic groups, including knowledge of staff members and respect for others and their cultural differences

Susan, an RN in the ED, would like to pursue leadership roles in her career. She is frustrated that others in her working environment seem to pay little attention to her creative ideas or place her in informal leadership positions. As her colleague, you want to provide her with helpful feedback. Which of the following statements will provide feedback as to how she might communicate power and demonstrate that she is capable of handling other leadership responsibilities? a. "I find your soft voice and manners very reassuring and calming to patients." b. "Try using a wider vocabulary and big words so that people will think that you are knowledgeable." c. "At times, you tend to slump and avoid eye contact when you are talking with colleagues and families." d. "Don't worry about what others think of you. If you feel like saying something, say it, even if it hurts other people's feelings."

c. "At times, you tend to slump and avoid eye contact when you are talking with colleagues and families." A powerful image comes from thinking of oneself as powerful and effective, and this is communicated through posture, maintaining eye contact, treating others with courtesy and respect, and using a firm, confident voice with vocabulary that is appropriate (which does not necessarily involve using big sounding words.)

On your curriculum vitae, which of the following is the recommended approach for listing employment and education history information? a. 1979 RN Diploma, 1985 BScN, 2002 MN b. 2002 Mount Rush Health Center Staff nurse, 1997 Cedar falls clinic staff nurse, 2007 Kilkarney rehab center case manager c. 2007 MN, 2005 BScN d. 1997 Sturgeon County Hospital Head Nurse, 2002 Sturgeon county supervisor, 2007 sturgeon county director

c. 2007 MN, 2005 BScN Information that is included in the body of the curriculum vitae should always be in reverse chronological order so that the most recent and presumably, most relevant job information appears first

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

The hospital administration is discussing the possibility of closing hospital beds in your unit because of a nursing shortage and the increased amount of overtime required to care for patients. As the leader on the unit, which of the following examples best demonstrates your transformational leadership style? a. Your entire staff walks out on strike b. Your staff sends an ultimatum to the clinic director demanding higher pay c. A group of your staff members goes to the administration to propose closing of a different unit d. A group of your staff members goes to the administration to request that they be allowed to work the overtime hours

c. A group of your staff members goes to the administration to propose closing of a different unit Commitment to the vision that has been created is seen in the ability of the leader to influence, motivate, and persuade others. The transformational leader can motivate employees by encouragement of novel, innovative thinking. Drenkard describes true transformational leadership as occurring when the leader created an environment that brought leaders and followers together to solve problems, create new ways of doing work, and manage change together

Scheduling is a function of implementing the staffing plan by assigning unit personnel to work specific hours and specific days of the week. To retain nursing staff, the nurse manager must schedule: a. All weekends off. b. All holidays off. c. A variety of scheduling options. d. Rotating shifts.

c. A variety of scheduling options. Creating a flexible schedule with a variety of scheduling options that leads to work schedule stability for each employee is one mechanism likely to retain staff, which is within the control of the nurse managers

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. Advocating for the patient. 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

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. Allowing professionals greater influence over their practices Facilitating greater control over practices implies trust and acknowledges expertise and performance

A grievance brought by a staff nurse against the unit manager requires mediation. At the first mediation session, the staff nurse repeatedly calls the unit manager's actions unfair, and the unit manager continues to reiterate the reasons for her actions. What would be the best course of action at this time? a. Send the two disputants away to reach their own resolution. b. Involve another staff nurse in the discussion so as to clarify issues. c. Ask each party to examine her own motives and issues in the conflict. d. Continue to listen as the parties repeat their thoughts and feelings about the conflict.

c. Ask each party to examine her own motives and issues in the conflict. Ury, Brett, and Goldberg outline steps to restoring unity, the first of which is to address the interests and involvement of participants in the conflict by examining the real issues of all parties.

Cultural diversity is the term used to describe a vast range of cultural differences. Events have symbolic meanings for the nurse manager and the staff. The event that would be most likely to provide symbolic meaning to a nurse manager and staff is a: a. Task force formed to commemorate a New Year's celebration in the Western tradition b. Project to provide Christmas gifts to the children in a daycare program c. Celebration of National Nurses Week with the focus on cultural care d. Task force to develop a poster for the unit depicting religions of the world

c. Celebration of National Nurses Week with the focus on cultural care Human cultures have material items or symbols such as artifacts, objects, dress, and actions that have special meaning in a culture. National Nurses week, with a focus on nursing interests, reflects the culture of nursing

You recently acquired a position as a unit manager. During your time on the unit, you have formed a strong social network among your staff, have promoted the development of relationships between your staff and workers in other areas of the organization, and have formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, you are engaging which principle? a. Empowerment b. Systematic thinking c. Development of networks d. Bottom-up interactions

c. Development of networks According to complexity theory, social networks evolve around areas of common interest and are able to respond to problems in creative and novel ways

Maintaining a culturally diverse staff and working with a culturally divers patient population is an important function of a nurse manager who works in the hospital of a large medical center. On your palliative care units, you have recently received complaints from families about ineffective pain management for their family members and you determine this occurs primarily when certain nurses are working. What approach might you take to resolve the concerns of the families, patients, and potentially, the staff? a. Reinforce to staff that practice guidelines support as needed analgesia for the terminally ill b. Ask staff input on the development of stricter guidelines to ensure that all terminally ill patients are given sufficient analgesia c. Encourage conversation with patients and among staff that facilitates learning about cultural beliefs and priorities in dying d. Advise families that the administration of analgesia is based on the expert clinical judgement of nurses who are familiar with care of patients in palliative care

c. Encourage conversation with patients and among staff that facilitates learning about cultural beliefs and priorities in dying The cultural and religions background of nurses influence their perceptions of dignity conserving care. For example, foreign born Catholic nurses stated the dying experience should not be altered by analgesics to relieve suffering or by attempts to hasten death by forgoing curative therapy or by other means. Approaches to working with differences in the diverse cultural and religious backgrounds of patients, families, and nurses alike include taking time to have conversational chats with patients in their end of life and with colleagues that will facilitate learning about each other and provide care that fits with the patients cultural beliefs about dying

A new graduate RN joins your unit. After a few weeks, she complains about some of her peers on the unit and compares their practices negatively to what she learned in her nursing program. She also is vocal about how she has learned so much here that she did not in her program. She is best described as: a. Having cultural sensitivity. b. Experiencing cultural diversity. c. Experiencing cultural marginality. d. Experiencing acculturation.

c. Experiencing cultural marginality. The new graduate is caught between two cultures at this point, work and education, and expresses feelings of belonging to neither

A family is keeping vigil at a critically ill patient's bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with people in such situations. In response to this situation, you approach the unit manager to apprise her of your concerns that the family dynamics of the patient involved may lead to staff-family and patient-family conflicts. You suggest that the physician may need to discuss the treatment plan with the family. The unit manager advises that he will arrange this discussion. If, after the meeting with family members, this is identified as a desired approach, you support the manager's decision. Your actions indicate that you are acting in what role? a. Leadership b. Management c. Follower d. Evidence-based

c. Follower in the followership role, you bring the manager your concerns about potential litigation and maximization of outcomes and accept the direction given by the manager in response to your concerns

Politics is usually: a. Confined to legislatures. b. Seen in dysfunctional workplaces. c. Found in all social organizations. d. A representation of self-interest.

c. Found in all social organizations. Politics involves social interaction among organizations and as such, politics permeates in all organizations, workplaces, legislatures, professions, and even families

As the nurse manager who wants to increase motivation by providing motivating factors, which action would you select? a. Collaborate with the human resource/personnel department to develop on-site daycare services. b. Provide a hierarchical organizational structure. c. Implement a model of shared governance. d. Promote the development of a flexible benefits package.

c. Implement a model of shared governance. Complexity theory suggests that systems interact and adapt and that decision making occurs throughout the systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts, and therefore, all levels of staff would be involved in decision making. This principle is the foundation of shared governance

You walk into Mr. Smith's room and find him yelling at the LPN, Miss Jones. He is obviously very upset and after you speak with him regarding his behavior, you determine that he has not slept for three nights because of unrelieved pain levels. The LPN is very upset with Mr. Smith and calls him an "ugly, old man." You acknowledge her feelings and concerns and then suggest that Mr. Smith's behavior was aggressive, but is related to lack of sleep and to pain. "Can you both, together with Mr. Smith, determine triggers for the pain and effective approaches to controlling his pain?" This approach demonstrates: a. Lack of empathy and understanding for Miss Jones. b. Concern with placating Mr. Smith. c. Leadership behavior. d. Management behavior.

c. Leadership behavior. The situation between Mr. Smith and Miss Jones is a complex situation involving unrelieved patient symptoms and aggressiveness toward a staff member. Providing engaged, collaborative guidance and decision making in a complex situation where there is no standardized solution reflects leadership

To retain supervisory staff members, the director of nursing develops a mentoring program. The best person to be a mentor for a new supervisor in a leadership position is someone who has: a. Been in exactly the same position and can relate to the new supervisors problems b. Had vast leadership opportunities and likes to talk about his or her past experiences c. Leadership experience and time to spend communicating with the new supervisor about his or her experiences d. People who can help the new supervisor get what he or she needs to make the organization grow quickly and prosper in the process

c. Leadership experience and time to spend communicating with the new supervisor about his or her experiences Mentors need to have experience and some success in the leadership area of interest, as well as interest in the future development of the novice. The mentor can be geographically distant or close and able to provide advice and feedback.

A nurse manager recognizes the need to expand her professional network as she begins a job search for a middle-management position. Which of the following actions is least likely to expand her job-searching network? a. Reviewing her address book or card file for names and phone numbers of former colleagues who are now in middle-management positions b. Making an appointment to meet with a former instructor from her graduate program in nursing administration c. Making a long overdue return call to a former colleague who is now a chief nurse executive d. Attending a state-level conference for nurse managers and executives and attending informal luncheons and receptions

c. Making a long overdue return call to a former colleague who is now a chief nurse executive Networking is the result of identifying, valuing, and maintaining relationships with a system of individuals who are sources of information, advice, and support. Many nurses have relatively limited networks within organizations where they are employed. Active participation in nursing organizations is the most effective method of establishing a professional network outside ones place of employment

As a manager, you are responsible for two separate units: a CCU and a cardiac stepdown unit. The organization and relationships on these units are distinct and very different from one another. Your decision has been to support the uniqueness of these units because each is effective in different ways in providing patient care. This approach is consistent with what principle? a. Transculturalism b. Cross-culturalism c. Multiculturalism d. Acculturation

c. Multiculturalism Multiculturalism refers to maintaining several different cultures, such as the uniqueness of different work units. Cross-culturalism means mediating between/among cultures, and transculturalism denotes bridging significant differences in cultural practices

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

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

A manager relies on his director (immediate supervisor) for advice about enrolling in graduate school to prepare for a career as a nurse executive. The director may exercise what kinds of power in the relationship with the manager in this advisory situation? a. Expert, coercive, and referent b. Reward, connection, and information c. Referent, expert, and information d. Reward, referent, and information

c. Referent, expert, and information Because the director is in a leadership role, he comes with knowledge or expertise that is required to assume a leadership role, and he has information that he is willing to share, which gives him the power of information. The employee sees him as credible and seeks his advice, which gives him referent power

Despite repeated invitations by his colleagues to become involved in regional and state nursing practice committees, Tom refuses. His reason is that "nursing committees rarely get anything worthwhile done because of politics and conflicts." According to the text, Tom's view of involvement: a. Is rare in nursing today. b. Reflects a fear of power. c. Reflects the essential process of power. d. Reflects empowerment and capacity to make his own decisions.

c. Reflects the essential process of power. Toms response reflects a distancing from other nurses related to discomfort with conflict associated with human interactions. The text defines human interactions within organizations as politics, a component of which is the essential process of power

As the clinical director of 24 employees, you have been asked to explain to staff members why they are not getting a raise this year, even though they have been working short-handed for many months and patient satisfaction scores have never been higher. Because you believe yourself to be a transformational leader, you will approach this problem by: a. Telling the assistant clinical director and asking her to share the bad news with the other staff members. b. Posting a note on the bulletin board that includes the phone number of the chief nursing officer, so anyone who has complaints may express them. c. Showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future. d. Meeting with a small group of seasoned staff members and asking them how to break the news.

c. Showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future. Transformational leadership involves engaging those being led and inspiring shared vision in moving toward a goal that all will accept as desirable. This involves enabling and empowering others to believe that their input and effort will make a difference in solving problems

In working with Cheryl, her mentor suggests that it is really important for Cheryl to engage in self appraisal and to know her strengths. This observation is based on an understanding that: a. Self confidence comes automatically out of leading b. Self confidence requires constant self affirmation of strengths c. There is little external motivation and affirmation in leadership d. Supervisors of leaders rarely provide feedback

c. There is little external motivation and affirmation in leadership Followers usually hold opinions about decisions that are made; these opinions can be favorable or not, which means that external motivation and affirmation are rare. Leaders have to be confident in their own abilities and enthused about the vision that they have created

At Health Center XYZ, staff members on the rehab unit have a head nurse who is intolerant of error and publicly chides anyone who makes a mistake. Over time, the rules on the unit dictate that mistakes are hidden and that areas of concern related to the functioning of the unit are discussed in tub rooms and are never openly discussed during periodic meetings. New staff members are quickly made to realize that silence is expected. The situation described is an example of: a. Ethnicity b. Work environment c. Work Culture d. Marginalization

c. Work Culture Culture develops over time, is essential to survival, is learned and shared by members, and changes with difficulty

During performance appraisal interviews, Joannes nurse manager notices Joannes excitement when she talks about how she has helped patients on a rehab unit understand the complexities of their regimens. When Joannes nurse manager asks her about her career path plans, Joanne says that she wants to become a nurse administrator. The best response to Joanne would be: a. Nursing administation is rewarding. What experiences would help you along this path? b. You do not appear to be excited about nursing administration. Unless you are excited by that career path, I wouldn't advise going in that direction c. You seem to find teaching others very rewarding. Have you considered that as a possible career path? d. You are too inexperienced to consider administration. Work for a few years, and then consider administration

c. You seem to find teaching others very rewarding. Have you considered that as a possible career path? Joanne evidences excitement about teaching patients, and although administration could be a rewarding path for her, education might be a better option for her to consider. Looking at job aspects that are rewarding is helpful in determining which career direction to pursue

Which of the following statements would best define stress? Stress is: a. The comfortable gap between how we like our life to be and how it actually is b. everyday life, both the highs and lows c. a consequence or response to an event or stimulus that can be positive or negative d. Identical to distress

c. a consequence or response to an event or stimulus that can be positive or negative Stress is defined as a gap between how we would like our lives to be and how they actually are and as a consequence of response to an event or stimulus. It is not inherently bad (distress), and whether highs and lows are seen as distress or eustress is dependent on each individuals interpretation of the event

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. acting on behalf of a patient to promote end of life wishes to an ethics committee Advocacy means making known and defending and protecting the rights and interests of others, as well as ensuring the dignity and respect due to others. Simply being employed in an environment where this might be a focus of practice does not necessarily ensure that advocacy is actually occurring

As a nurse manager, you observe a staff nurse who over the past few weeks has become withdrawn and has had several absences due to minor ailments. Your best action would be to: a. Ask the nurse if she is okay during report b. refer the nurse to the employee assistance program c. ask the nurse to meet with you for a few minutes before she leaves for the day d. Write a note to the nurse advising her that her work attendance must improve

c. ask the nurse to meet with you for a few minutes before she leaves for the day Stress can lead to emotional symptoms such as depression and a variety of ailments. Meeting with the nurse privately may assist in identifying stress and possible solutions

A factor evaluation system: a. utilizes financial data to determine number of staff to patient ratios b. utilized DRGs to determine acuity on a unit c. combines interventions and time required for interventions to determine levels of care required d. combines financial resources and nursing interventions to determine patient contact hours

c. combines interventions and time required for interventions to determine levels of care required A factor evaluation system considers tasks, thought processes, and patient care activities and gives them a time or rating. These are then used to determine the number of patient care hours required

In evaluating weekend mortality rates, the head nurse on the cardiac unit is surprised to find that they are higher than on weekdays. In exploring the reasons for this apparent anomaly, the head nurse focuses on: a. availability of diagnostic personnel b. availability of physicians c. communication with on call providers d. acuity level of patients

c. communication with on call providers Studies to date of off peak hours (weekends and nights) are limited, but those that have been done indicate increased mortality during weekends and nights, when staff work with fewer and often less experienced staff and when there may be strained communication among on call healthcare providers

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. complex compensatory systems and a variety of delivery systems 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

An example of a career is: a. employment in short term contract jobs in business and nursing and whatever is available b. involvement in an area of practice that is regulated c. continuous employment in the same position and the same arrangement for 20 years d. moving into and out of nursing positions in various cities while pursuing travel and education that develop understanding of global health

c. continuous employment in the same position and the same arrangement for 20 years d. moving into and out of nursing positions in various cities while pursuing travel and education that develop understanding of global health Career refers to progression of skills, consistency, knowledge, and/or status. This movement through nursing life is predicted on having a vision of a career as opposed to a series of jobs. Career styles can be defined as linear, steady state, entrepreneurial, or spiral. Deepening skills in one area is an example of a steady state career style, whereas moving into and out of positions in various cities can characterize an entrepreneurial style. Involvement in a regulated field defines a professional interest but not necessarily a career

A nurse manager discovers that the actual number of visits per patient in a home health service is 3.8 visits per day when the standard is 5 visits per day. Based on this information, the nurse manager: a. concludes that the complexity of care in each visit has arisen b. concludes that the patient volume has been decreased c. decides that more information is need before a conclusion can be reached d. initiates a training session regarding the importance of ensuring that visits are made

c. decides that more information is need before a conclusion can be reached Variance from measures of productivity or ratio of outputs to inputs does not necessarily offer an explanation of whether or not care was delivered as needed. Before proceeding to any further conclusion, the nurse manager will need to investigate reasons for the decreased output

The chief nursing officer has been developing her portfolio for years. What is the chief nursing officer modeling? a. her clinical expertise b. affection for tradition c. her employability d. her busy professional life

c. her employability Being employed is no longer sufficient; we must be employable. A portfolio outlines achievements and experiences that communicate employability

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

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

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

c. lack of health literacy 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 speciality practice area, when diagnosed with a serious chronic illness, may not have the appropriate background to make informed healthcare decisions

A well written letter of resignation is critical to: a. first announce your intent to resign b. formally signal discontent in your current position c. maintain a positive relationship with your former organization and colleagues d. fulfill your legal obligations as a departing employee

c. maintain a positive relationship with your former organization and colleagues A well written resignation letter outlines your intent to leave the organization and your appreciation of the organization but should follow an initial meeting with your manager to first discuss your intention. A well written letter maintains a positive relationship with the organization

Based on studies of workplace environments for nurses and future projections, the workplace of the future will be: a. less intense because of more technology b. about the same as it is now c. more intense because of more technology d. fluctuating between intense periods and less intense periods

c. more intense because of more technology Technology will continue to revolutionize health care and contribute to complexity compression. In additioin to access to knowledge, electronic records, and current applications of technology, technology will include robotics, which will change how chronic disease can be managed, and bioengineering will make possible interventions that do not yet exist

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. obtaining, processing, and understanding basic health information so appropriate decisions can be made 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

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

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

An experienced staff nurse applies for a distinct position of patient advocate at a new clinic. Based on the various tools available to her, which of the following should she bring to her interview to best present her skills? a. resume b. annual evaluations c. portfolio d. patient advocacy project

c. portfolio A portfolio enables prospective employers to view evidence of significant achievements and responsibilities that would be permanent to the position

Thomas has been a nurse in your ICU for 10 years. In facilitating Thomas professional development, you would focus on: a. certification for the ICU environment b. discussions about how Thomas can fit with role expectations and relationships c. possible specializations within the ICU environment d. encouraging him to lead changes that leave long term impacts after his retirement

c. possible specializations within the ICU environment d. encouraging him to lead changes that leave long term impacts after his retirement Thomas is a mid career professional. As such, you would expect him to be interested in honing areas of expertise (such as leadership or developing a deeper expertise in a particular area of the ICU nursing) as opposed to gaining skills necessary for his work environment such as certification or becoming comfortable with his role and relationships in ICU, which would be critical to an early career nurse. Legacy building is characteristic of mid career professionals

A unit manager recently graduated as a clinical nurse specialist with a focus in gerontology. She applied to take a certification exam. Certification is designed to recognize: a. basic knowledge in a specific area b. advanced practice in functional roles c. special knowledge beyond basic licensure d. continued competence as a registered nurse

c. special knowledge beyond basic licensure Certification is an expectation in some settings for career advancement in advanced practices or in specialized areas and goes beyond basic preparation

A nurse manager has been employed in the same facility for 20 years and has held the same position. This career style is known as: a. Linear b. spiral c. steady state d. entrepreneurial/ transient

c. steady state Career styles that are marked by selecting and staying in a role throughout a career are characterized by a steady state

Your organization is in the middle of redesigning patient care units, with decisions based on best practices and various other sources of evidence. In the middle of the transition, there is a temporary halt called to the transition because of a redesign of the health care system and greater emphasis on primary care. As a manage in this situation, your staff experience a gap between what they expected (the original redesign of the units) and what is actually happening (a need to integrate primary care in some way). According to Selye, the nurses on your nursing team are likely experiencing what? a. Eustress b. Distress c. stress d. compression

c. stress Selye described stress as being on a continuum between stress that is positive (eustress) and stress that is negative (distress). Because individuals perceive the same event differently, from the information that is given, it is not possible to determine whether the nurses experience the events as eustress or distress; what is most likely is that the nurses are experiencing stress, which is what occurs when there is a gap between expectations and what is actually occurring

Nathan tells you that he has selected nursing as a career because many jobs are available and he will have job security. Your best response to Nathan is: a. with many young people going overseas, many jobs and options will be available. Stable jobs and job security will be part of thee nursing employment market b. the job market for nurses will be diminished wit funding cuts to hospitals c. the employment prospects for nurses are positive with many options to choose from. Flexibility and adaptability are essential to income security d. it is unlikely that nursing will survive in the long term with funding cuts and a declining population of seniors

c. the employment prospects for nurses are positive with many options to choose from. Flexibility and adaptability are essential to income security Employment for nurses continues to be positive, although roles will change in a rapidly changing environment, which will increase options. With the number of options available and sporadic work opportunities, nurses will need to be flexible and able to adapt rapidly. Job security will be out; career options will be in

You notice that wait times in your Emergency Department are growing longer, because of factors such as increases in the numbers of persons with chronic disorder, discharge of patients into the community at a higher level of acuity, and limited resources for transfer of inpatients. You begin to think about an application that would use your knowledge of the Emergency Department but also software and business applications and wonder if this reduce wait times. You have not encountered anything similar to this idea. According to the Wise Forecast Model, you are in what phase? a. wild thinking b. act widely c. think wildly d. learn widely

c. think wildly The second step in the Wise Forecast model is to think wildly. Step two is designed to create connections among disparate thoughts. This thinking might be seen as the start of innovations

During an interview for a managers position, you find the supervisor and staff unfriendly. Responses to questions are met with vague responses. After the interview, you decide not to pursue the position. What follow up, if any, is most appropriate? a. there is no need for you to do anything further. you will likely not be offered the position anyway b. you should file a complaint with human resources about the supervisors lack of interviewing skills c. you should send a thank you note to the interviewer, indicating appreciation for her time d. you should call and leave a voicemail indicating your disinterest in the position

c. you should send a thank you note to the interviewer, indicating appreciation for her time Even if you are disinterested in the position or think the interview has gone badly, an appropriate follow up is a thank you note to the interviewers. This recommended follow up creates a positive impression and may leave open the possibility of future interactions

Sarah, one of your RNs, tells you that she can't understand why Jim, an Aboriginal patient, wants to do a smudge. In coaching Sara, you suggest which of the following? a. "Explain to Jim that there is no smoking in the hospital." b. "Inform Jim that fires are not allowed in the hospital." c. "Insist that he give you his tobacco because it is unhealthy for him." d. "Ask him what he means by a smudge and what meaning it has for him."

d. "Ask him what he means by a smudge and what meaning it has for him." By talking with Jim, Sarah is able to step outside her circles of familiarity and find and enhance her understanding of personally held prejudices. Prejudice enables Sarah to find meaning in situations, but it also limits understanding. Paradox describes this tension. We have the responsibility to acknowledge the possibility of tension as a potential for new and different understandings derived from our communication and interpretation. Possibility, therefore, presumes a condition for openness with a person from another culture

As the manager, you have been asked to implement an evidence based approach to teach ostomy patients self management skills postoperatively that is being operationalized throughout your organization. Which of the following illustrates effective leadership? a. The training modules are left in the staff room for times when staff are available b. The current approach is continued because it is also evidence-based and is more familiar to staff c. You decide to implement the approach at a later date because of feedback from the RNs that the new approach takes too much time d. A RN who is already familiar with the new approach volunteers to take the lead in mentoring and teaching others how to implement it

d. A RN who is already familiar with the new approach volunteers to take the lead in mentoring and teaching others how to implement it Followership occurs when there is acquiescence to a peer who is leading in a setting where a team has gathered to ensure the best clinical decision making and actions are taken to achieve clinical or organizational outcomes. Followership promotes good clinical decisions and use of clinical resources

You are offered an opportunity to take a temporary leave from your position as a nurse manager to lead a technology implementation project. Which of the following reasons for accepting the opportunity is most consistent with developing a solid career path? a. You are pressured to do so by your supervisor b. the organization has no other suitable candidate for the position c. you have limited knowledge of information technology and no real interest, but this will increase your knowledge d. Accepting a position outside of your established skill set may establish you organizationally as an innovative, adaptable leader

d. Accepting a position outside of your established skill set may establish you organizationally as an innovative, adaptable leader Although giving into organizational or supervisory pressure may bring an enhanced learning and organizational profile, what is to be gained needs to be assessed against your career goals, interest, and aspirations. Increasing and expanding your skill set within defined career interests is a valid reason to consider a chance opportunity

During a unit meeting, you notice that Vivian listens attentively when Mary is speaking and offers support and advice when Mary presents ideas to the group. You are surprised because Vivian has often confided that she does not like Mary. Vivian's behavior is best described as: a. Insincere. b. Networking. c. Politically sophisticated. d. Collegial.

d. Collegial. Collegial behavior requires respect, not friendship

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. Coordination of care, services, advocacy, and access for patients within the healthcare system. As gatekeepers to the system, nurses advocate for and coordinate care, services, and access for patients across all providers, settings, and levels of care

The nurse manager of a unit is asked by a family member of a dying Native American patient if it is possible to have the patients eight member family recite the rosary by the bedside. The manager responds affirmatively. The nurse manager is most likely exhibiting behavior related to: a. Acculturation b. Ethnocentricity c. Cultural Diversity d. Cultural sensitivity

d. Cultural sensitivity Cultural sensitivity involves the capacity to feel or react to ideas, customs, and traditions unique to a group of people

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. Developing rules that support inferences. 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

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

d. Educate the nurse on how to provide an apology to the patient. 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 patietn

John is interested in leadership positions within his nursing organization. Although he has been on the same unit for 10 years, he has attended two workshops during that time and has steadfastly refused opportunities to engage in leadership development opportunities or other learning offered as part of the hospital's succession planning strategy. He says that he is interested in a leadership role primarily because it will give him a more stable work schedule and will enable him to spend more time with his family. In coaching John, it would be important to: a. Affirm that his years of service and stability on the unit are the most important attributes for assumption of a leadership role. b. Reinforce that his concern with maintaining balance outside work would be a key factor in selecting him for a leadership position. c. Encourage him to consider the financial rewards of the position, as well as the positive effect on his work schedule. d. Encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in life-work balance.

d. Encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in life-work balance. According to Covey, effective leaders continually engage in learning and self renewal, as well as in maintaining a balanced life, radiating positive energy, believing in other people, being concerned with the common good, and being synergistic

When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidates lack of eye contact reflects the candidates: a. Lack of confidence b. Professional behavior c. Cultural sensitivity d. Ethnicity

d. Ethnicity Ethnicity refers to groups of people who are classified according to common racial, tribal, religious, linguistic, or cultural backgrounds

The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility. While making rounds on the units, the staff development coordinator overhears RN staff complaining that they feel it is insulting to be required to participate in a competency program. Which behavior by the staff development coordinator is most appropriate in this situation? a. Disregard staff concerns and continue with the development of the program b. Inform the nurses that this program is a requirement for JCAHO accreditation c. Schedule a meeting with the chief nursing executive to apprise her of the situation d. Facilitate a meeting so nurses can articulate their values and concerns about a competency program

d. Facilitate a meeting so nurses can articulate their values and concerns about a competency program The manager role involves guiding others through a set of derived practices that are evidenced based and known to satisfy preestablished outcomes such as participation in a competency program. This involves engagement of staff through sharing of concerns and ideas. A close analysis of the IOM report and the summary of the PPACA suggests that no health reform can unfold without active nursing engagement. Each document emphasizes that nurses must lead, manage and behave as active collaborators with other members of the health team and with those being served

the clinic nurse has just accessed a client's chart on the computer. The resident comes over and asks her to stay logged on because he needs to add a note to that clients chart. She should say: a. No problem. Just log me off when you're done b. I'll put the note in for you. What do you want to say? c. Just make sure that you sign your note because its under my password d. I'm sorry, but you will have to enter the information using your own password

d. I'm sorry, but you will have to enter the information using your own password System users must never share the passwords that allow them access to information in computerized clinical information systems. Each password uniquely identifies a user to a system by name and title., gives approval to carry out certain functions, and provides access to data appropriate to the user. All users must be aware of their responsibilities for the confidentiality and security of the data they gather and for the security of their passwords

Sondra, a new graduate, recently began a position as a registered nurse in a rural hospital, where she is the youngest and newest staff member. Although she has limited experience, she has a strong knowledge base, is confident, and was considered to have strong entry level skills on graduation. Sondra meets with her former instructor and confides that she is very frustrated that others do not seem to accept her leadership. What might you suggest that would help Sondra to understand what is happening in terms of power and influence? a. As a new graduate, it is unlikely that she has acquired the experience and knowledge of other staff, including aides and practical nurses b. Rural settings tend to be closed systems and therefore, are not welcoming of those who are not from their community c. Morale on her unit can be improved by engaging in shared decision making d. Identify the informal leaders on her unit and how they affect care decisions

d. Identify the informal leaders on her unit and how they affect care decisions Developing organizational savvy includes identifying the real decision makers and those persons who have a high level of influence with decision makers. Recognize the informal leaders within any organization may have more power than the formal leader because of more knowledge of the organization, more informational power, or more expertise

Which of the following is the best example of skilled negotiation? a. Linda, the manager on pediatrics, takes a proposal to her supervisor, outlining the benefits of a walk in preoperative area for children b. Kim, RN, asks for leave to pursue a semester of full time study in her graduate program. She proposes to accept less popular rotations during peak vacation time in return c. George, the head nurse in the ER, asks for additional staff for his department and points out the benefits of being able to keep patients for longer periods d. Jerry speaks with his supervisor about his supervisors concerns related to bedside reporting before presenting a proposal to change the process

d. Jerry speaks with his supervisor about his supervisors concerns related to bedside reporting before presenting a proposal to change the process Successful negotiators are well informed about not only their own positions but also those of the opposing side. Negotiators must be able to discuss the pros and cons of both positions. They can assist the other party in recognizing the costs versus benefits of each position

Which of the following interactions is most consistent with the idea of networking? a. Meet with the same colleagues daily to have coffee and share concerns about the workplace and stories about colleagues b. Join an online workplace forum to gain ideas about how to handle workplace conflict c. Suggest that you and a new team member meet after work for coffee to review unit guidelines d. Join a nurse executive interest group to meet other executives for support and for sharing ideas of expertise

d. Join a nurse executive interest group to meet other executives for support and for sharing ideas of expertise Networking is the result of identifying, valuing, and maintaining relationships with a system of individuals who are sources of information, advice, and support. Many nurses have relatively limited networks within the organizations where they are employed. Active participation in nursing organizations is the most effective method of establishing a professional network outside ones place of employment. Successful networking involves sharing similar ideas and maintaining relationships within a system of individuals who serve as sources of information, advice, and support

Susan, a new graduate on the dialysis unit (Question 18 above), appears to take Kari's remarks very seriously and works even harder, often volunteering for extra assignments. She also is often in Kari's office, advising of successes with her patients and of the extra effort that she is committing. This behavior suggests that Susan: a. Is fearful of losing her job. b. Lacks understanding of Kari's leadership style. c. Is not intimidated by Kari's leadership style. d. Knows how to "play the game."

d. Knows how to "play the game." Followers under transactional leadership feel secure about what will happen next or what is needed to be rewarded; therefore, they learn to play the game

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. Email distribution to staff home email 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. Linking policies and procedures to the network for access when required at the point of care 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 the utilization of what is already available in the work environment, such as the systems that provide CDS

The senior executive praises John for the positive patient evaluations that his unit has received. As an effective leader, John: a. Thanks the senior executive for having confidence in him and celebrates by going out to a special restaurant b. Points out the impact that the changes he has initiated have had on the unit c. Advises the senior executive that the mission statement and goals are important to him d. Points out the contributions of his staff to the outcomes and shares the praise with his staff

d. Points out the contributions of his staff to the outcomes and shares the praise with his staff An effective leader is eager to share the glory with those who have worked with him or her to achieve outcomes and success. The act of acknowledging the achievement to the senior executive and of sharing the positive feedback with his staff empowers the staff and builds a support base for the leader

A nurse belongs to several professional organizations, serving on a state-level committee of one group and on two task forces at work. The nurse is committed to a range of health issues. This nurse exemplifies which level of political activism in nursing? a. Gladiator b. Buy-in c. Self-interest d. Political astuteness

d. Political astuteness Political involvement is a professional responsibility and nurses perspectives of the critical issues for improving the healthcare system can shape the policy agenda of the nations political leadership. This nurse exemplifies several of the skills associated with political astuteness

According to the complexity theory, which of the following should be the focus of measurement? a. Cost per hospital day b. Bed utilization c. Infection rates d. Staff morale and budgets

d. Staff morale and budgets According to complexity theory and the principle Think systematically, you cannot ignore objective data or nonmeasureable data, as both inform decisions

While explaining the importance of developing leadership skills among nurses to a group of first year nursing students, Natalie, a nursing unit manager emphasizes that: a. Most nurses are not expected to assume leadership roles. b. The role of nurse leadership is only at the bedside, ensuring that patient care is performed according to established standards. c. Only individuals in formal leadership roles are expected to be leaders. d. The public depends on nurses to assume leadership in moving consumer advocacy concerns forward.

d. The public depends on nurses to assume leadership in moving consumer advocacy concerns forward. The complexity of nursing and the healthcare environment demands that all nurses assume roles of manager, leader, and follower, depending on the situation. Nurses are involved in providing leadership in direct patient care, in leading others at a unit or organizational level, in moving the profession forward, and in participating in legislative and policy arenas. Consumers depend on nursing leadership to carry the healthcare agenda forward

A nurse is participating in a baccalaureate course. For the class, she has to attend the legislative session regarding the new role of medication assistants. Nurses should be involved in shaping public policy primarily because: a. Involvement will enable nurses to take over the healthcare system at some point in the future. b. Other healthcare professions are less concerned about the essential needs of the client c. Such activities are important career builders for nurses who seek top level executive positions d. They are closest to the front line of health care and see how it affects clients and families

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

As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas. You are employing _____ leadership. a. Situational b. Trait-based c. Contingency-based d. Transformational

d. Transformational Transformational leadership involves attending to the needs and motives of followers, which results in creativity, improvement, and employee development

After a newly hired director of nursing has reviewed the hospital's strategic plans, she develops a timeline for achieving those plans. The new leader is: a. Not expecting that novice leaders would have a vision. b. Inviting a seasoned leader to come and share a vision with the group. c. Getting to know staff members, so they can work together for a few months. d. Translating a global document into realistic plans for nursing.

d. Translating a global document into realistic plans for nursing. Followers need three things from leaders: direction, trust, and hope. Developing timelines for the strategic plan involves translating a vision into reality and being able to communicate a vision meaningfully, which is an example of a leaders influencing behavior

A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled but must often care for his wife, who is undergoing treatment for breast cancer. According to Maslow's need hierarchy theory, what would be the best approach to satisfying the needs of this nurse, other staff, and patients? a. Line up agency nurses who can be called in to work on short notice. b. Place the nurse on unpaid leave for the remainder of his wife's treatment. c. Sympathize with the nurse's dilemma and let the charge nurse know that this nurse may be calling in frequently in the future. d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife's treatments.

d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife's treatments. Placing the nurse on unpaid leave may threaten the nurses capacity to meet physiologic needs and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect patient care and threaten the needs of staff to feel competent. Arranging the schedule around the wifes needs meets the needs of the staff and of patients while satisfying the nurses need for affiliation

Which of the following strategies is most important in developing a strong vision? a. seeking out evidence to support trends and out of the box thinking b. spending time with others with whom we discuss ideas c. setting up focus groups to provide information on current realities d. being honest and open about what we think for the future

d. being honest and open about what we think for the future Regardless of how we go about developing our vision (gathering evidence, testing ideas with others), honesty and openness are foundational to a strong vision

Time management is very essential for the nurse manager. Which of the following is not a good time management technique? a. decide what not to do b. learn to say no c. learn to delegate d. break down your workload into large manageable tasks

d. break down your workload into large manageable tasks To manage time successfully, it is important to break down your workload into smaller manageable tasks. Developing PERT and Gantt charts will aid in dealing with larger, complex projects. Both charts can be used to outline how an individual will approach a large project

To move beyond stereotypical thinking and toward thinking about the future, which of the following would be most consistent with thinking wildly in the Wise Forecast Model? a. listing everything that we know about our current situation b. defining which practices will remain unchanged and which will change c. asking someone with a great deal of experience to share ideas about best practice d. challenging current and future practices with questions of what if?

d. challenging current and future practices with questions of what if? Thinking wildly includes creating wild questions. Sometimes they lead to a wild idea

A stroke unit experiences numerous changes related to implementation of new technology, a changed nursing care delivery model, and staff turnover within a period of 6 months. Staff members begin to show signs of reluctance to implement any more changes. The phenomenon experienced by the staff is termed: a. Eustreess b. care process c. stereotypical thinking d. complexity compression

d. complexity compression Complexity compression refers to many changes occurring simultaneously before time is sufficient to assimilate the change

A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the units staffing needs. An external variable to be considered is: a. organizational staffing policies b. staffing models c. changes in services that will be offered d. department of health licensing standards

d. department of health licensing standards Licensing regulations of the state can determine staffing models. Staffing regulations can dictate the number of professional nurses required on a unit at any given time

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

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

A nurse manager has decided that she must institute some personal time management steps to survive work and home life. Her first step should be to: a. determine what takes up so much of her time and energy b. organize her personal and work spaces c. purchase a handheld personal digital assistant to help remind her of important meetings d. determine her personal and professional goals

d. determine her personal and professional goals Personal time management refers, in part, to the knowing of self. Self-awareness is a critical leadership skill, and being self aware and setting goals helps managers determine how their time is best spent

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 counselors 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 healthcare

d. development of services that have been identified by the women and neighborhood advocates as necessary for their healthcare 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

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 client concerns c. identifying community support groups d. empowering others by promoting self determination

d. empowering others by promoting self determination Advocacy involves empowering and promoting self determination in others

After assessing an older adult patient in long term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. The nurse managers decision and actions are based on: a. an established clinical pathway b. confirmatory scientific evidence c. unit protocol d. experience

d. experience The nurse manager is employing knowledge and experience in determining that the patient is dying, because the course of dying is not standardized and cannot be determined by clinical pathways.

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

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

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

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

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

d. heavy sedation Nurses need to be sensitive to the teaching needs of 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

The nurse manager is implementing a shared governance model to help with communication and decision making. Although staff members like the concept, change is difficult. Staff nurses feel: a. more empowered b. more communicative c. less stressed d. more powerless and devalued

d. more powerless and devalued Change can lead to feelings of being overwhelmed and powerless, especially if complexity compression or rapid, intense changes have been involved

The number of adverse events such as falls and pressure ulcers on your unit is increasing. An ideal staffing plan to address this issue would include which of the following? Increasing the: a. Total number of staff on the unit b. staff and RN hours per patient c. total number of staff and implementing 12 hour shifts d. number of RNs and number of RNs with experience on the unit

d. number of RNs and number of RNs with experience on the unit A number of studies have identified that adverse events such as falls and pressure ulcers can be reduced by increasing the number of RNs on a unit (relative to personnel) and utilizing experienced RNs. Overtime and 12 hour shifts are linked to greater incidence of errors

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

d. outcomes for clients and their perceptions of care Trend setting organizations such as Magnet organizations need to demonstrate excellence in outcome data such as patient satisfaction. Patient satisfaction and perception of the quality of care are affected by the quality of the nurse patient relationship. Valid measurement of patient satisfaction is an evolving science; nurses do not always accurately gauge what factors are most important to patients. Satisfaction measures are often skewed in a positive direction with scores clustered at the top of the scale

In preparing for a fair interview process as a hiring manager, you should: a. put water out for candidates b. ensure that you know the names of all candidates c. dress comfortably and professionally d. prepare a schedule of questions to be asked of all candidates

d. prepare a schedule of questions to be asked of all candidates Although providing water, knowing names, and dressing appropriately sets a professional and respectful tone for the interview, developing a schedule of questions to be asked of all candidates is important for gathering comparative data and ensuring equitable treatment

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

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

Social stressors are considered a major factor in the stress nurses experience in the healthcare system. Which of the following is not considered to be a social stressor? a. high amounts of stress in the nursing home environment b. changes in the current healthcare system such as nursing strategies c. disruptive behavior coming from physicians and other healthcare workers d. stress triggers such as self criticism and overanalyzing

d. stress triggers such as self criticism and overanalyzing Personal stress triggers, such as self criticism are considered intrapersonal stressors; environmental factors such as change, work environment, and interactions with others are considered social stressors

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. strong interdisciplinary cultures 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 various disciplines work together collaboratively to transform the data into meaningful knowledge

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

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

The institution where you are a nurse manager has resisted the adoption of a new document management software, citing cost as a concern. You meet with other nurse managers who are in favor of the software and prepare a proposal to take to the senior executive with the goal of persuading the executive to adopt the software. This is an example of: a. Collaboration. b. A coalition. c. Networking. d. Policy building.

b. A coalition. The formation of temporary groups to achieve particular goals involves the development of coalitions

During managers' meetings, Lindsay is surprised by the forthrightness of male managers. She finds that, during discussions, she would be more likely to say: a. "I wonder if we should consider changing our policy on performance appraisals? What do you think?" b. "Sean, your approach to appraisal is completely off track and does not reflect available evidence." c. "The system that has been developed needs to be implemented. We have already spent enough time in discussion." d. "Forget about change in this policy. It is fine as it is."

a. "I wonder if we should consider changing our policy on performance appraisals? What do you think?" Males and females in the workplace are likely to have different management styles, and although not all males are authoritative or females more participatory, women are likely to use more participatory and inclusive methods

You are in the process of designing a patient education program that will provide education and monitoring for patients with hypertension. To support your planning, you draw out and present patient data from: a. A clinical database b. Biomedical technologies c. email d. internet sources

a. A clinical database Clinical databases are collections of elements organized and structured for the processing, organization, and presentation of data for interpretation as information, which, in this particular instance, includes outpatient data

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. Enable detection of variations in clinical outcomes from well-researched standards that are supported by confirmatory evidence. 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

As the unit manager, you post the staffing plan and compliance reports. This initiative is aimed at: a. Maintaining unit morale. b. Complying with national requirements. c. Demonstrating patient outcomes. d. Inviting staff participation in decision making.

a. Maintaining unit morale. Hospitals are responsible for monitoring the extent to which actual staffing matches the staffing plans, making revisions as necessary. The Joint Commission accreditation reviews staffing plans against any obvious staffing deficiencies and patient care concerns. Posting of the staffing plan is required in some states so that staff may view it. Adequate staffing, as demonstrated through a staffing plan, and compliance reports contribute to staff morale

The adage "leaders are born and not made" reflects which of the following ideas around leadership? a. Management can be taught; leadership depends on abilities. b. Mentorship is important in developing innate skills of leaders. c. Leadership is a natural skill that cannot be refined and developed. d. Succession planning and formal education related to leadership are ineffective.

a. Management can be taught; leadership depends on abilities. Leadership is an abilities role that is reflective of rich personal experience. It can be developed and refined through such strategies as coaching, mentorship, and reflection. Management can be taught and learned

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. Participating in organizational information technology committees. 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 effectively with the processes for providing patient care

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: 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. Reduction in incidents of medication error b. immediate documentation of care c. comparison of patient data with previous data Point of care devices that allow documentation of assessment, care, and teaching at the 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

The staff development educator presents a series of programs on stress management to the nurse managers. Research has indicated that an individuals ability to deal with stress is moderated by psychological hardiness. Psychological hardiness is a composite of: a. commitment, control, and challenge b. commitment, powerlessness, passivity c. commitment, control, passivity d. decreased isolation, challenge, passivity

a. commitment, control, and challenge Some people have the capacity to accept changes in life with good humor and resilience, which, in turn, influences behavior that prevents illness. Hardiness involves the capacity to manage time and stress, to reframe situations positively, and to commit

The primary difference between a resume and a CV is that a resume: a. Reflects your skills, knowledge, and background in relation to a specific position b. offers a detailed listing of positions held and where positions were held c. includes a long and detailed explanation of academic and work experience d. provides contact information and focuses on your background, in general

a. Reflects your skills, knowledge, and background in relation to a specific position A resume is a short, customized overview of your professional life that relates to the qualifications of specific positions and how you are able to match your background to the qualifications that are desired. Provision of contact information is common to both the resume and CV. Resumes are more effective if details of particular positions that have been held are highlighted as compared with a detailed listing of positions held

Steady state styles would be most likely in which of the following situations? a. Small hospital, in an isolated rural setting, with limited hierarchy b. large urban teaching hospital c. health network with several organizations d. travel nurse agency

a. Small hospital, in an isolated rural setting, with limited hierarchy steady state career styles (career-long commitment to a particular position) are more likely in rural settings, where commitment to community is high and alternative career opportunities are limited

Physicians in a small urban hospital are reluctant to discharge older adult patients because many of the patients lack private insurance and the resources to travel distances for follow-up care. The hospital administration pressures the physicians to discharge patients sooner and to be more consistent with the number of hospitalization days specified within the DRGs. Which of the following would most likely prompt the action of administrators? a. The hospital is incurring a deficit related to a gap between the PPS and the DRGs and costs of care b. Local home services are expressing concern about the increased acuity of patients being discharged into their care c. The resource based relative scale for physicians does not account for the increased length of stay d. Acute care patients are being denied entry to the hospital because of the increased stay of patients

a. The hospital is incurring a deficit related to a gap between the PPS and the DRGs and costs of care Length of stay (LOS) is the most important predictor of healthcare costs and extra days are a cost to the organization in terms of both extra days and decreased patient volume. The situation, as outlined, does not indicate that there is a bed shortage and therefore, there is no evidence that other patients are being denied access to services or that additional patient volume is not being captured. The hospital would be concerned about the impact on its income because of the additional, uncompensated care costs incurred for patients who exceed the usual length of stay explicitly calculated under PPS and DRGs

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

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

The difference between a nurse practitioners charge of $45 for an office visit and the insurance company's payment of $34 is: a. a contractual allowance b. a profit c. a flat rate d. revenue

a. a contractual allowance Because the amount that is allowed for an office visit is less than the amount that the NP charges, this is known as a contractual allowance or discount. If the allowed amount were more than what the NP charges, then a profit would be realized. All of the answers represent sources of revenue

Sources of occupational stress in nursing include all except which of the following? a. authoritarian leadership b. concern about moral wrongdoing by colleagues c. multiple changes in a short time d. rotating shifts

a. authoritarian leadership Ethical distress, complexity compression, rotating shifts, high acuity levels, rotating shifts, and workload are all sources of work related stress for nurses

Which of the following activities would represent a customer friendly approach in a health care setting? a. using a local anesthetic before inserting a needle into a childs 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 when a laboring mother comes in d. providing support to families when a family member is brought into trauma

a. using a local anesthetic before inserting a needle into a childs arm c. ensuring that birthing preferences are on file and available when a laboring mother comes in d. providing support to families when a family member is brought into trauma 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 importantf

To project staffing needs and to avoid understaffing, it is important that nurse managers consider which of the following? a. Maximum productive hours b. Average nonproductive hours c. Minimum benefit hours d. Maximum vacation time

b. Average nonproductive hours To avoid understaffing, average nonproductive or benefit hours need to be taken into account, so the unit is properly staffed when staff members are off

At a newly built outpatient surgery 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. Central data repository 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 form both within and among organizations. Data from all patient encounters with thee 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 nurse manager was orienting new staff members to 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. Data, information, and knowledge 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

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

b. Fragmentation of care results in lack of respect and trust. 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

As a nurse manager, it is important to become a future thinker. Which is an example of a future thinker? a. keeping traditional practices b. moving toward evidenced based practices c. finding less need for more knowledge d. believing that macromarketing will be a necessity

b. moving toward evidenced based practices Future forecasts include evolutions in power, structure, and knowledge; rapid change in the healthcare system; the demise of macromarketing; and increased evidenced based practice

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

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

The starfish analogy is exemplified in which of the following? a. A unit manager resigns after continued tension between the administration and her regarding implementation of primary nursing. The primary nursing project dies b. Nurses try to establish a clinic that provides ambulatory care to parents and young children in an impoverished neighborhood. Community members advocate for funding from political leaders and insurers. c. Alana, a new graduate, promotes continence care based on evidence. When she presents her ideas, senior staff refuses to consider it d. The head of a community health service moves on to another position. Programs are disbanded

b. Nurses try to establish a clinic that provides ambulatory care to parents and young children in an impoverished neighborhood. Community members advocate for funding from political leaders and insurers. The starfish analogy points to the connectivity that we have with one another and how we influence and are influenced by others all the time. This affords many opportunities for leadership that are dependent not on formal titles but on opportunities to shape the work at hand

Staff members on your unit raise concern that there is rising acuity on the unit and lack of responsiveness in addressing these needs through appropriate staffing. They point to increased incidences of adverse and sentinel events on the unit. To address this concern, your hospital organization would do best to: a. Implement a patient classification system immediately. b. Participate in databases that compare the outcomes and staffing levels versus those of institutions similar to yours. c. Provide increased numbers of staff to the unit. d. Ignore such concerns because acuity is variable.

b. Participate in databases that compare the outcomes and staffing levels versus those of institutions similar to yours. Staff morale suffers both when acuity models indicate a gap between staffing and acuity and when there is no model but perceived acuity that is not being addressed. A truer approach is to monitor patient outcomes and participate in national databases that measure staffing levels through comparison with like institutions

A primary care clinic in a small urban center sees a high volume of cardiology patients. Patients who attend the clinic have smart cards that they use at hospitals, clinics, and emergency departments within that region of the state. A primary benefit of the smart card for these patients would be: a. Rapid and accurate treatment in emergency situations b. Reduced wait times to see specialists c. Email notification of test results d. Readily available information regarding medications

b. Reduced wait times to see specialists Credit cardlike devices called smart cards store a limited number of pages of data on a computer chip and serve as a bridge between the clinician terminal and the central repository of the electronic health record (EHR), making patient information available to the caregiver quickly and cheaply at the point of service. Smart cards provide information to healthcare providers regarding the patients demographic and contact information, allergies, immunizations, lab results, and past patient care encounters and are presented at the point of service

Jeff, an RN in his 30s, has lost a parent, just purchased a new home, and is laid off with 6 months' severance pay. A the same time, Jerry, an RN in his 50s, is financially secure and is asked to take early retirement with a buyout. How will the two men react to the emotional and physical influences and the sequence of stress? a. The younger man will feel more stress b. The two men may or may not feel the same amount of stress c. The older man will feel more stress d. neither man will experience any stress

b. The two men may or may not feel the same amount of stress The response to similar stressors does not always result in a similar experience of stress in individuals. Responses are mediated by appraisal of the event as well as by factors such as gender, personality, lifestyle, and age

A nurse manager uses many sources of data when planning the unit's workload for the year. Which of the following data must be considered in the planning? a. Hours of operation of the unit b. Trends in acuity on the unit c. Maximum work stretch for each employee d. Weekend requirements

b. Trends in acuity on the unit Acuity levels are determined through classification systems, which determine the nursing resources required

The chief nursing office continues to seek ways to improve healthcare services to clients and to save the hospital money. However, with the federal guidelines of paying agencies based on capitation, the chief nursing office faces a challenge. Capitation provides incentives for healthcare providers to control costs by: a. Providing fewer services per client b. Using fewer services per client c. using high technology treatments d. requiring second opinions

b. Using fewer services per client In a capitated environment, a single fe is paid for all services provided. To be financially viable under this reimbursement model, organizations would be interested in decreasing the volume of services used and increasing the volume of patients. High technology treatments and second opinions may increase the number of services used

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. Using high-tech-high-touch approaches. 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 high tech is used, the more patients also desire high touch

A number of changes are introduced to a unit, including changes to familiar clinical procedures and the use of PDAs to enable bedside documentation. You, as a unit manager, anticipate which of the following will contribute most to complexity compression? a. meaning of the change b. pace of changes c. previous experience with change d. confidence of the leader in the value of the change

b. pace of changes Complexity compression is a term that means that many changes are happening almost simultaneously and before one practice can be firmly implanted in our minds, we are already addressing some other change

The chief nursing officer listens to nurse managers verbalize their feelings of internal stress. One common source of internal stress seems to be: a. the death of a loved one b. perfectionism c. getting married d. losing a job

b. perfectionism Losing a job, the death of a loved one, and getting married are examples of external stress

As a nurse manager, the one activity you should not overlook is: a. posting the yearly rotation schedule b. reviewing vacation requests c. scheduling staffing for holidays 6 months in advance d. anticipating staff sick days

b. reviewing vacation requests Free time and vacation time are needed for individuals to recharge. If time for work is more than 60% of wake time, or when self time is less than 10% of wake time, stress levels increase

In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year. The nurse manager determines that RN 1 has 5 weeks of vacation and 3 days of education, and has averaged 3 sick days a year. RN 2 has 6 weeks vacation, has asked to attend a 3 day conference and a 2 day workshop, and has no history of sick time. RN 3 is new, and you anticipate 3 weeks of orientation, as well as 4 weeks of vacation. RN 4 has 6 weeks of vacation and has an ongoing health condition, so you anticipate 2 weeks of sick time, as well as 3 days for education. RN 5 has 5 weeks of vacation, has no education planned, and averages 5 sick days per year. RN 6 has 6 weeks of vacation, has no educational opportunities planned, and has been off ill for 4 weeks. How many hours of productive paid time can be anticipated for the budget? a. 12480 b. 11200 c. 10848 d. 10688

c. 10848

In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year. Based on a 40-hour week, this means that the nurse manager has determined that the budget will provide for _____ hours. a. 12480 productive b. 10820 productive c. 12480 paid d. 10800 patient care

c. 12480 paid From the information given, it is not possible to determine how many nonproductive hours (vacation, holiday, sick time, education) the nurse manager has accounted for in her budget calculations and therefore whether the total number of hours (40 hours/52 weeks 6 staff= 12480 paid hours) is productive (paid time that is worked) or nonproductive hours. 12480 accurately reflects the total number of hours of work paid per year

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. Informatics competencies The Quality and Safety Education for Nurses (QSEN) project identifies 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 data management, decision support, and expert systems programs to access information and analyze data from disparate sources for use in planning for patient care processes and systems

In a job interview for a staff position, which of the following indicates your knowledge of patient safety? a. Will I be able to get overtime hours on your unit? b. If there is an opportunity to work extra shifts, I would really like that c. Is there a strategy in place to reduce the number of overtime hours on the unit? d. I see no reason why I wouldn't be able to work overtime

c. Is there a strategy in place to reduce the number of overtime hours on the unit? Overtime, whether voluntary or mandatory, to fill staff vacancies is seen as a risk to both patients and nurses because it is more likely to lead to compromised decision making and technical skills because of fatigue

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

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

Which of the following situations is most likely to result in a productive, whole work situation? a. Amy, RN, 5 years experience in the emergency department. Amy accepts a position working with older clients in a home health agency because she has relocated and this is the only full time position available b. Adam, RN, 8 years experience in various nursing positions, including that of a nurse manager. Adam accepts a new nurse manager position because he has a family and wants more regular hours. He is most comfortable working id direct client care c. Louise, RN, 10 years experience in an emergency department. She accepts a position as a case manager in home health care, working with older clients. She especially enjoys working with older adults and want to take on leadership and management challenges d. Courtney, RN, a new graduate. Courtney is getting comfortable with delivering nursing care as an RN. She is offered a position on surgery as a permanent team leader. The unit has had a great deal of turnover recently, and only limited mentorship is available

c. Louise, RN, 10 years experience in an emergency department. She accepts a position as a case manager in home health care, working with older clients. She especially enjoys working with older adults and want to take on leadership and management challenges The whole of any work situation is composed of two elements: person and position. A productive, whole work situation results when a persons talents and strengths are successfully blended with expectations of the position. Of the situations described previously, the one most likely to result in a productive whole work situation is that of Louise, who, although her experience has not been in home health, is interested in both the roles and responsibilities of the position, as well as the target group being served. She also considers the group being served as an area in which she demonstrates strength

In order to plan long term, you consider what the client of the future will look like. Which of the following client profiles would best capture shifting demographics and trends in health care? a. younger, knowledgeable about your options b. female, uses emergency care services for parents and children c. Older, one or more chronic disorders, diverse background d. Male, various occupationally generated, diverse ethnic background

c. Older, one or more chronic disorders, diverse background The client base is aging and more people will be living with chronic disorders. Persons will travel more and there will be increased need to speak two or more languages to address the needs of mobile global population

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 two 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 the agreed upon time and discuss her progress. The home health nurse assesses whether or not the client needs to be seen that day and is able to view the colostomy site. This type of technology is called: a. Distance learning b. Knowledge software c. Telecommunications d. Biomedical technology

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

To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time. When calculating paid nonproductive time, the nurse manager considers: a. Work time, educational time, and holiday time. b. Paid hours minus worked hours. c. Vacation time, holiday time, and sick time. d. Paid hours minus meeting time.

c. Vacation time, holiday time, and sick time. Nonproductive hours are hours of benefit time and include vacation, holiday, and personal or sick time

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 anytime. To ensure that he receives the message, what type of technology is most effective? a. Internet b. Telecommunications c. WL pager d. CDS

c. WL pager 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

Professional associations: a. set regulatory requirements and establish entry requirements for nursing b. offer graduate programs for clinical and career advancement c. provide opportunities for career networking and support d. are open to all individuals who meet the criteria for membership

c. provide opportunities for career networking and support Professional associations are frequently, although not always, voluntary groups whose members provide leadership in issues and policies of interest to nurses. Professional associations also offer networks of nurses with similar interests

A rural-urban health consortium enables physicians in a rural remote setting to consult with specialists in care through electronic conferencing, which includes consultation using itranet radiology images. This system may be in which phase of electronic medical technology adoption, according to the Healthcare Information and Management Systems Society (HIMSS)? a. 0 b. 1 c. 3 d. 6

d. 6 According to the HIMSS, this healthcare organization may be in phase 6, which includes the capacity to transmit all radiology images through intranet or another secure source. Level 1 refers to the installation of major ancillary clinical systems (such as radiology) and level 3 to retrieval of radiology images from picture archives and communication systems

In the past year, you have noticed an increase in patient falls on your unit. In reading studies related to staffing and patient outcomes, you realize that you will need to plan for: a. Higher patient care hours. b. Safer facilities. c. Institution of a patient classification system. d. An increased number of RN positions.

d. An increased number of RN positions. Lower fall rates are shown to be related to higher total nursing hours and a higher percentage of nursing hours supplied by RNs

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. Physiologic monitoring systems enable detection of early changes before an adverse event occurs. 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 aids in early detection of changes

Your healthcare organization has a decentralized system for scheduling. As part of this process, after you have developed a draft schedule, you may need to: a. Seek budgetary approval. b. Balance personal schedules against institutional needs. c. Negotiate the schedule with unit staff. d. Submit the schedule to a centralized staffing office for review.

d. Submit the schedule to a centralized staffing office for review. In a decentralized model, you may be completely responsible for approving all schedule changes and for development of the schedule, or you may need to submit a draft to a centralized office for review and determination of supplemental staff. Balancing personal schedules and negotiation describes staff self scheduling models

Which of the following needs revision on a resume or CV? a. John Jones; 87 Highway Drive; City, MI 79110 [email protected] b. M. Howes Anyway highway, City MI 77700 (H)777-777-0000 email [email protected] c. Dr. L. Jones, 99 Carway Dr., City, NY 84003 (H) 999-999-0000; (C) 999-000-9999 d. Tanya Jones 67 Honeywell Dr. CIty, MO 66907 [email protected]

d. Tanya Jones 67 Honeywell Dr. CIty, MO 66907 [email protected] When including web or email addresses, it is important to use addresses that are not overly casual or that communicate personal information

You have just hired a recent graduate. The graduate is thrilled with the opportunity that she has been given, as well as with the idea that working means no more essays, tests, or assignments! She indicates that she has no intention of touching a book, journal, or health information Website for a long time. Which of the following would be your best response? a. The expectations and design of educational programs means that new graduates are better prepared for the workforce b. The new graduate will still have to learn, but it will be job specific learning c. An ideal learning plan for nurses emphasizes followership d. The amount and intensity of knowledge demands lifelong learning that includes assessment of relevancy of knowledge for practice

d. The amount and intensity of knowledge demands lifelong learning that includes assessment of relevancy of knowledge for practice Knowledge will change dramatically, requiring that we all be dedicated learners. With or without state law, continuing education will be mandatory and essential. Knowledge will evolve from the intensity of the current information evolution so that wee will access content with meaning and applicability for our work

Which of the following exemplifies a service orientation? a. Staff members on the unit are encouraged to chart details about family support networks b. chart audit reveals that details related to assessment of family history are missing c. the palliative care unit organizes a tree of light fundraiser each year to highlight the importance of palliative care d. a childrens preoperative holding area is initiated in response to requests from families and nurses who care for them.

d. a childrens preoperative holding area is initiated in response to requests from families and nurses who care for them. A service orientation needs to translate caring into appropriate, timely action that meets the needs of patients. Activities such as documentation of details and 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

Nursing research has indicated that the foundation for becoming a nurse leader is the ability to: a. write effectively b. speak two or three languages c. focus on day to day priorities d. think futuristically

d. think futuristically Whether you are a leader, a follower, or a manager, being able to visualize in your mind what the ideal future is becomes a critical strategy. A vision can range from that of an individual to that of a group or whole organization

The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are angry and ask for a meeting to discuss the change. After hearing their concerns related to reduction in professional autonomy and care quality, you: a. Acknowledge the loss b. Explain the reasons for change, emphasizing the need to reduce costs c. Repeat the information several times, giving detailed budget overviews d. Adjourn the meeting and provide explanation through email

a. Acknowledge the loss Visioning involves engaging with others to assess the current reality, specify the end point, and then strategize to reduce differences. This requires trusting relationships that acknowledge the differences in values and ideas. When done well, the nurse and the nurses within a unit experience creative tension that inspires working in concert to achieve desired goals

Because an increasing number of Hispanic patients are being admitted, a nurse manager designs a staff development program to help her staff understand the Hispanic culture. A nurse should understand that culture is determined by which of the following? a. Behavior b. Love for people c. Shared vision d. genetic dispostion

a. Behavior Culture is determined by behaviors and beliefs and develops slowly

In caring for a patient from an East Indian culture, the staff expresses frustration that many people are in the room at any one time, which interferes with care. As the nurse manager, you provide leadership in understanding that this behavior of the family and friends network reflects: a. Lack of understanding of the seriousness of the patients illness b. lack of communication between family members c. the social organization of friendships and family networks in East Indian culture d. Lack of caring about the hospital environment by the friends and family

c. the social organization of friendships and family networks in East Indian culture The Giger and Davidhizar Transcultural Model identifies six phenomena to assess provision of care for patients who are from different cultures, including social organizations, which include how relationships are formed and expressed in different cultures