Leadership Exam 1 Full Set

Answer: 2, 3, 4 Explanation: 1. Empowered scheduling is fictitious and is not an example of shared leadership. 2. Self-directed work teams are an example of shared leadership. 3. Shared governance is an example of shared leadership. 4. Co-leadership is an example of shared leadership. 5. Autonomous participation is fictitious and is not an example of shared leadership.

Shared leadership is based on partnership, empowerment, and understanding boundaries. Which examples exemplify shared leadership in nursing? Select all that apply. 1. Empowered scheduling 2. Self-directed work teams 3. Shared governance 4. Co-leadership 5. Autonomous participation

Answer: 3 Explanation: 1. The value statement concerns the beliefs or attitudes esteemed by the organization's leaders. 2. The mission statement is a broad statement of the organization's reason for existence. An example is "Our mission is to improve the health of the people of the Midwest." 3. A vision statement describes the goal to which the organization aspires-in this case, to be the hospital of choice in the Midwest. 4. A philosophy statement reflects the organization's values, vision, and mission, so it is all-

"We want to be the hospital of choice in the Midwest" is which type of statement? 1. Value statement 2. Mission statement 3. Vision statement 4. Philosophy statement

Answer: 1 Explanation: 1. Checking with the assistant while the tasks are being done is the best plan. If there is a misunderstanding or problem, this is the best time for the nurse to intervene. 2. Simply seeing an empty breakfast tray does not guarantee that the instructions were carried out correctly. 3. Checking with the clients does not allow for the nurse to amend the instruction or correct the actions being taken. 4. Waiting until the end of the shift does not allow the nurse to amend the instruction or correct actions being taken.

) In the morning care conference, the nurse instructs the assistant to feed breakfast to the clients in beds 2234, 2230, and 2241. The assistant indicates understanding of the assignment and repeats the bed numbers back to the nurse. What is the nurse's next step? 1. Check with the assistant to see how the assignment is going during the time breakfast is served. 2. Check the client's breakfast trays before they are returned to dietary. 3. Check with the clients to see if they had breakfast. 4. At the end of the shift, ask the assistant how the clients ate.

Answer: 2, 4 Explanation: 1. The manager should not accept a task until it is clear. 2. The manager should be clear about not having the required skill set but should indicate willingness to take the job if education is provided. 3. The problem is that the manager is not confident of his or her skills, not that time is unavailable. 4. The manager should clarify the task before accepting or refusing it. 5. Working on accreditation would help this nurse manager in career advancement.

) The nurse supervisor would like to delegate accreditation preparation activities to the nurse manager. The manager is unsure of what is expected and has no experience with accreditation. How should the manager respond? Select all that apply. 1. "I'll be glad to work on this task." 2. "I will need some education on the accreditation process before I can accept this task." 3. "I don't have time to add that to my work." 4. "Please tell me more about what this assignment entails." 5. "I'm not interested in working on this project."

Answer: 2, 3, 4, 5 Explanation: 1. This topic is diffuse and hard to understand. More precise topics should be used. 2. Understanding roles is essential to collaboration. It must include both roles. 3. Understanding roles is essential to collaboration. It must include both roles. 4. Communication is the key to collaboration. 5. Listening is an essential part of communication.

) The nursing supervisor is planning an education session on collaborative communication between nurses and physicians. Which topics should be on this agenda? Select all that apply. 1. Interdisciplinary respect 2. Understanding the role of the physician 3. Understanding the role of the nurse 4. Communication across disciplines 5. Active listening skills

Answer: 1 Explanation: 1. Intersender conflict occurs when a person receives two conflicting messages from different sources. 2. Intrasender conflict occurs when a verbal message differs from the nonverbal message; the recipient has difficulty interpreting the intended meaning. 3. Metacommunication is the combination of oral messages with nonverbal messages. 4. Downward communication occurs from manager to staff and is often directive.

) The staff nurse is unsure of the correct protocol for calling in sick to work. The nursing supervisor told the nurse to call the nursing office; however, the nurse manager told the nurse to call the unit. This issue is likely the result of which distorted communication? 1. Intersender conflict 2. Intrasender conflict 3. Metacommunication 4. Downward communication

Answer: 1, 2, 4, 5 Explanation: 1. The purpose of delegating attendance to a staff nurse is so the manager will not need to attend the meeting. When the manager does attend, the staff nurse's position is diminished. This is an example of underdelegation. 2. When someone of lower rank, in this case the unit clerk, delegates a task to someone of higher rank, in this case the nurse manager, a situation of reverse delegation has occurred. This is ineffective delegation. 3. The nurse manager has asked someone of lower rank to complete a task that is within that person's capabilities. This is effective delegation. 4. Provision of education requires nursing knowledge and judgment and cannot be delegated to a UAP. This is an example of over-delegation. 5. Bathing clients can be delegated to staff of lower rank. If the nurse is giving the bath for assessment purposes, this lack of delegation would be appropriate. If the nurse is not delegating baths because "I like to give bed baths," the lack of delegation is inappropriate.

) Which situations are examples of ineffective delegation? Select all that apply. 1. After delegating committee attendance to a staff nurse, the nurse manager also attends the meetings. 2. The unit clerk asks the nurse manager to "listen for the phones" so the clerk can go to the hospital's celebration of hospital week. 3. The nurse manager asks the staff nurse to collect information about a new type of hospital bed being considered for purchase. 4. The staff nurse asks the UAP to provide simple discharge instructions to a client. 5. The staff nurse often bathes clients because "I like to give bed baths."

*Answer: 2* *Explanation:* 1. This approach is too informal. 2. Applying for a job requires a high level of formality. A written cover letter and résumé are expected by most organizations offering employment opportunities. This submission would be done by email only if that is the organization's specific request. 3. This approach is too informal. 4. "Dropping in" to the manager's office is not professional. Any meetings generally occur at the request of the potential employer and would occur after the résumé and cover letter are sent.

2) A nurse plans to seek employment in an acute-care setting after graduation. Which form of communication would be most effective in applying for a position? 1. Send an email to the nurse manager, requesting a job interview. 2. Send a written letter and résumé in the mail. 3. Call the nurse manager to ask if any jobs are open. 4. Drop into the nurse manager's office to discuss employment options.

*Answer: 2, 3* *Explanation:* 1. Telling the client to make an appointment and get birth control takes the client's autonomy away and does not address the client's present need. 2. Allowing the client to talk through this decision and giving options is helping to address the client's needs. 3. Enquiring about if the client has talked to anyone helps to address the client's need for information. 4. Knowing whether the client has insurance does not address the client's needs. 5. This answer is incorrect; the nurse would not need to tell the parents because this information is confidential.

A 14-year-old client tells the nurse that she is going to have sexual activity with her boyfriend. What should the nurse say to the client? Select all that apply. 1. "You need to make an appointment to get birth control." 2. "Tell me more about this decision." 3. "Have you told anyone about this decision?" 4. "Do you have any insurance to pay for this visit?" 5. "I'll have to tell your parents about this."

Answer: 2 Explanation: 1. Wondering about a break in sterility indicates that the nurse is concerned about the process that might have contributed to this infection. 2. The nurse who focuses on taking care of the results of a potential medical mistake is not accepting the seriousness of the situation. 3. The Centers for Medicare and Medicaid Services no longer cover the costs incurred by medical mistakes. This urinary tract infection could cost the hospital the cost of treatment, including increased length of stay. 4. The nurse has identified that improper care may result in poor outcomes for the client.

A 70-year-old client develops a catheter-induced urinary tract infection. Which statement by the nurse would indicate to the nurse manager a need for additional understanding of this situation? 1. "I wonder if there was a break of sterility when this catheter was inserted." 2. "Thankfully we can treat this with an antibiotic." 3. "This could potentially cost the hospital a lot of money." 4. "I will talk to my unlicensed assistants about proper urinary catheter care."

Answer: 2 Explanation: 1. Nursing care delivery systems are in continual revision as nurses strive to find the perfect system for providing care to clients with varying degrees of need. 2. The nursing process reflects nursing care and consists of assessment, planning, implementation, and evaluation. 3. A comfortable and efficient system for delivery of care is important to client outcomes. 4. The system must be safe, efficient, and effective.

A change in nursing care delivery system is being considered by hospital administrators. Which information should the nurse executive add to this discussion? 1. "There has been little change in nursing care delivery over the last few years." 2. "We must look to the nursing process for guidance in nursing care." 3. "Too much time is spent deciding on a system of care." 4. "Any system is okay, as long as the nurses follow it."

*Answer: autonomy* *Explanation:* Autonomy is the ability of an individual to determine his or her own course of action.

A client has been diagnosed with leukemia and is scheduled to talk with the oncologist. After listening to the oncologist talk about treatment plans the client states, "God will take care of me. I don't want any treatment." The nurse knows the client has exercised the principle of ________.

*Answer: 2* *Explanation:* 1. Any incident that is unexpected or unplanned and that could potentially harm a client, family member, or staff is a reportable incident. 2. A medical-legal incident occurs when a client or family refuses treatment as ordered. 3. When a client or family member indicates general dissatisfaction with care and the situation cannot be resolved, an incident report is filed. 4. A medication error occurs when the nurse unintentionally omits a medication or fluid, gives the wrong dose, gives the dose at the wrong time, or gives the medication or fluid to the wrong client.

A client has been told that chemotherapy must be postponed until he is hydrated. The client refuses the IV hydration and demands to go home. How would the nurse best categorize this situation? 1. Non-reportable incident 2. Medical-legal incident 3. Client dissatisfaction with care 4. Medication error

*Answer: autonomy* *Explanation:* Autonomy is the ability of an individual to determine his or her own course of action.

A client is admitted for back pain and the client's family plans with the nurse what interventions will be initiated for the client. The issue with this plan of care is the lack of ________.

Answer: 4 Explanation: 1. This may or may not be the best choice of hospital for this procedure. 2. Just because a hospital is high volume does not mean it is high quality. 3. This may or may not be the best hospital for this procedure. 4. The Leapfrog Group focuses on quality indicators including the use of higher-performing

A client needs a high-risk surgical procedure. According to the Leapfrog Group, the client should choose which hospital for care during this procedure? 1. The hospital closest to the client's home 2. The hospital that has done the greatest number of these surgeries in the last two years 3. The hospital chosen by the client's primary healthcare provider 4. The hospital with the highest performance ratings for this procedure

Answer: 4 Explanation: 1. Long-term care facilities are used for rehabilitation and care needed for extended periods. There is no evidence that this client will be unable to care for self after recovery. 2. The public health department's focus is usually community health, not individual primary care. 3. Temporary service agencies are used to provide healthcare organizations with professional and nonprofessional personnel when the latter are short staffed. 4. With shorter hospital stays, home health agencies are frequently used to provide clients with intermittent or temporary follow-up care such as wound care and bathing.

A client who is being discharged from the hospital will need follow-up for wound care. The client's spouse is not capable of providing bed baths for the client. The nurse case manager who is planning care for this client should contact which agency? 1. Long-term care facility 2. Public health department 3. Temporary service agency 4. Home health agency

Answer: 2, 3, 5 Explanation: 1. The client can still voice concerns even after discharge. 2. These client satisfaction surveys are a good mechanism for discussing care issues. 3. Telephone calls are a means of discussing client care issues. 4. ANA is not a forum for complaints about care in a specific hospitalization. 5. The AHRQ has a mechanism for reporting care issues.

A client who was discharged yesterday is very upset about the quality of care received during hospitalization for gastric surgery. What options for reporting concerns does this client have? Select all that apply. 1. There is no mechanism for complaint because the client is no longer hospitalized. 2. The client can indicate dissatisfaction on the survey often sent to clients after discharge. 3. The client can call the hospital administration. 4. The client can make a formal complaint through the American Nursing Association (ANA). 5. The client can make a public report through the Agency for Healthcare Research and Quality (AHRQ).

Answer: 4 Explanation: 1. According to contingency theory, the manager adapts leadership styles in relation to changing situations; these styles range from authoritarian to permissive. This is not the best choice for this situation. 2. Quantum leadership focuses on outcomes, and employees are directly involved in decision making. This is not the best choice for this situation. 3. Transactional leadership is based on the premise that individuals engage in social interactions expecting to give and receive rewards. This is not the best choice for this situation. 4. Transformational leadership is concerned with effecting revolutionary change in organizations and human service, not with the status quo.

A community hospital has been purchased by a large healthcare conglomerate. Nursing administration has the task of changing the nursing practice model that has been followed for 50 years. To best achieve this change, administration should appoint a nurse executive whose leadership style follows which theory? 1. Contingency theory 2. Quantum leadership 3. Transactional leadership 4. Transformational leadership

Answer: 3 Explanation: 1. Classical organizational theory focuses on structure with a strong hierarchy. 2. Those who support chaos theory believe that organizational function and integrity must be guided by flexibility, fluidity, speedy adaptability, and cultural sensitivity. Change is inevitable and embraced. 3. Systems theory focuses on "input" or resources, "throughput" or the work done, and "output" or the product of the work. 4. Contingency theory posits that organization performance can be enhanced by matching an organization's structure to its environment.

A community-owned hospital has been purchased by a healthcare conglomerate. The staff is aware that the organizational theory governing the hospital is likely to change. Which statement indicates a lack of understanding of organizational theory on the part of a staff nurse? 1. "If our new bosses want a classical organization, we can expect a strong hierarchy." 2. "If we don't want to see lots of changes, we should hope our new bosses don't like chaos theory." 3. "If this new company is based on systems theory, there will be a lot of focus on how much work we can produce." 4. "If this new company is based on contingency theory, we will see lots of focus on how our environment impacts our work."

*Answer: 1, 2, 3, 4* *Explanation:* 1. Many situations resolve themselves with time. 2. Support from the manager is important and may lead to self-solving of the problem. 3. Depending on the problem, the nurses may need information, time off, or problem-solving practice. 4. The manager should intervene if client care begins to suffer. 5. The manager must manage this situation.

A disagreement has arisen between two staff nurses. Both have discussed the situation with the manager. The manager feels that that problem is likely self-solving. How should the manager approach this situation? Select all that apply. 1. Allow some time to pass to see if the situation resolves. 2. Support both nurses as they work through this issue. 3. Provide any resources the nurses may need to help solve the problem. 4. Intervene if the problem begins to impact client care. 5. Ignore the situation.

Answer: 3 Explanation: 1. Pediatric nursing is not likely to see as much growth as another specialty. 2. Psychiatric nursing is not likely to see as much growth as another specialty. 3. As baby boomers age, geriatric nursing will be needed more than any other specialty. Not only are the baby boomers a large segment of the population, but better health practices are resulting in people living longer. 4. Maternity nursing is not likely to see as much growth as another specialty.

A graduating nurse is deciding which nursing specialty would be a good place to begin a nursing career and ensure long-term stability. Which specialty is most likely to have the greatest growth in need? 1. Pediatric nursing 2. Psychiatric nursing 3. Geriatric nursing 4. Maternity nursing

*Answer: 4* *Explanation:* 1. This is a judgment statement. 2. This is a judgment statement. 3. "Getting sloppy" is a judgment statement. 4. A good problem statement reflects the facts without judgment as to cause.

A group of nurses has been convened to solve a problem. As the first step in this process, the group leader asks for a definition of the problem to be solved. Which statement reflects the best problem statement? 1. Emergency department nurses do not make professional client handoff reports. 2. Long-term care facility nurses lack the education to make complete assessments prior to client transfers. 3. Housekeepers are getting sloppy about cleaning rooms. 4. Unit clerks have made 10 transcription errors in the last 6 months.

Answer: 3 Explanation: 1. Team nursing evolved in the middle to late 1940s. 2. Functional nursing grew out of the nursing shortage caused by World War II. 3. The original model of nursing care delivery was total client care or the case method. During the 1920s, total client care was the typical delivery system, with much RN care being provided in the home. 4. Primary nursing was conceptualized and implemented during the late 1960s.

A group of nurses is developing a poster presentation titled "Nursing Care Delivery Through the Ages" for the hospital's annual Nurses' Day celebration. What form of nursing care delivery should they depict as occurring prior to 1930? 1. Team nursing 2. Functional nursing 3. Total client care 4. Primary care

Answer: 2, 3 Explanation: 1. Magnet status is focused on nursing excellence. Medical staff would be involved in the achievement, but not as primary players. 2. While much of the work will have been delegated to others, the nurse executive is a primary force in achieving Magnet status. 3. Magnet status focuses on nursing excellence. Staff nurses are the primary drivers of this excellence. 4. While these employees would be involved in this effort, Magnet status is focused on nursing excellence. 5. While these professionals would contribute to the achievement, Magnet status is focused on nursing excellence.

A healthcare organization has just achieved Magnet status. During the award ceremony, the organization's chief executive officer should give primary praise for this achievement to which employees? Select all that apply. 1. Medical staff 2. Nurse executive 3. Staff nurses 4. Managers in support services such as laboratory and radiology 5. Administrative professionals overseeing services such as accounting, billing, and medical records

Answer: 1, 2, 4, 5 Explanation: 1. When delegation is appropriate, work gets done in a timely manner and overtime decreases. 2. Delegation helps get work done efficiently and effectively. Absences tend to decrease in this environment. 3. Delegation is permitted by state boards of nursing, but it is not required. 4. Delegation results in care that is efficient and effective. Efficient and effective care results in increased patient satisfaction. 5. Delegation results in each part of the team working at their designated skill level. Nurses are not doing tasks that could be done by assistants. This results in increased productivity.

A healthcare organization has provided intensive education to staff regarding benefits and correct methods of delegation. Why has the organization spent the time and money to sponsor these sessions? Select all that apply. 1. Good delegation helps to reduce overtime. 2. Absences decrease when delegation is used correctly. 3. Delegation is required by state boards of nursing. 4. Patient satisfaction scores increase when care is efficient and effective. 5. Good delegation increases productivity.

Answer: 3, 5 Explanation: 1. Decentralization empowers staff to implement process improvements. 2. Lean thinking focuses on the system rather than on individuals. 3. In lean thinking, the concentration is on interventions that improve outcomes. 4. This redesign strategy is called "big-dot focus" and may or may not reflect lean thinking. 5. Decentralization provides a quality improvement infrastructure that disregards only previous efforts that have not proven effective.

A healthcare organization is using the quality concepts of lean thinking and decentralization as part of their redesign efforts. Which initiatives would this organization undertake? Select all that apply. 1. Any changes to processes in the facility will be approved at the vice-president level. 2. Nurses who have made more than five medication errors in the last 12 months will be terminated. 3. Outcome data will be analyzed to identify successful interventions. 4. The primary focus will be on a few major initiatives. 5. Previous quality improvement efforts may or may not be discarded.

Answer: 14 Explanation: There are 14 qualities or "Forces of Magnetism" that must be demonstrated to achieve Magnet status.

A healthcare system is considering applying to the Magnet Recognition Program. The leaders of this health system should prepare to address ________ qualities or "Forces of Magnetism."

*Answer: 2* *Explanation:* 1. Lying to the supervisor is dishonest. 2. Research material provides rationales behind why a policy might need to be changed. This is the assessment phase and provides hard facts. 3. Encouraging others to violate policy is not ethical. 4. This strategy is unfair and coercive.

A home health agency has a policy requiring nurses to make routine visits at night. How might politics be used to change this policy? 1. Make visits during the day and tell the supervisor that the clients are not home at night. 2. Obtain research material to provide reasons why routine nursing visits at night are not as effective as during the day. 3. Encourage others to refuse to make routine visits at night so you will not be alone. 4. Take the supervisor to lunch and invite all the staff to join to talk the supervisor into changing the policy.

*Answer: 2, 4, 5* *Explanation:* 1. Increasing RN-to-client ratio generally increases costs. 2. Increasing RN-to-client ratio has been shown to decrease client mortality. 3. Increasing RN-to-client ratio generally decreases length of stay. 4. Increasing RN-to-client ratio generally increases quality of care. 5. Increasing RN-to-client ratio generally results in few infections.

A hospital increased its RN-to-client ratio one year ago. What effects is the hospital likely to see as a result of that choice? Select all that apply. 1. The cost of providing care has decreased. 2. There has been a decrease in client deaths. 3. The average length-of-stay for clients has increased. 4. The overall quality of care has increased. 5. The nosocomial infection rate has dropped.

Answer: 4 Explanation: 1. Total client care is costly and less efficient for nursing staff. 2. Functional nursing is cost-effective but lacks continuity of care. 3. Team nursing is cost-effective but may lack continuity of care, which can cause client dissatisfaction. 4. The focus of client-centered nursing is the promotion of efficiency, quality, and cost control.

A hospital is concerned about low customer satisfaction ratings and poor evaluation on quality indicators. The nurse managers are asked to implement a nursing delivery system that is cost-effective and improves both customer satisfaction and quality of care. Which nursing delivery system should the managers implement? 1. Total client care 2. Functional nursing 3. Team nursing 4. Client-centered nursing

Answer: 1, 3, 4 Explanation: 1. Critical pathways are designed to direct the care of many disciplines. There is no reason to believe that physical therapy will no longer be available to help with client ambulation. 2. Variances are written when the client is not making progress according to the critical pathway. 3. The critical pathway orients staff to the outcomes that should be achieved by the client each day. 4. If the client has variance from the critical pathway, it may be revised. 5. Critical paths use resources appropriate to the care needed, and thereby reduce cost and length of stay.

A hospital is considering implementing the use of critical pathways and case management. Which statements by a nurse would indicate to the nurse manager that more education should be provided? Select all that apply. 1. "If we use critical pathways, we won't have physical therapy to help us ambulate clients." 2. "If a client is not able to follow the critical pathway, a variance will be written." 3. "The critical pathway lists discharge outcomes but won't help us with day-to-day guidance of care." 4. "Once the client is on a critical pathway, we must follow it until discharge." 5. "Using critical pathways will help us reduce length of stay and costs to the client."

Answer: 3 Explanation: 1. The medical intern is not a hospitalist. 2. The physician's on-call group is likely a group of physicians from the same office or organization of physicians with office practices. They are not hospitalists. 3. A hospitalist provides care only to hospital inpatients. 4. Emergency department physicians are not the same as hospitalists.

A hospitalized client is complaining of abdominal pain that has developed since admission. The nurse says, "I am going to call the hospitalist." How should the client interpret this statement? 1. The nurse is going to call the medical intern to assess the client. 2. The nurse is going to call the client's physician's on-call group. 3. The nurse is going to call a physician who cares for inpatients. 4. The nurse is going to call the emergency department and request that a physician see this client.

Answer: 1 Explanation: 1. Total client care means that all the care for the clients or residents is provided by the RN. 2. Unlicensed assistants are not used in total client care. 3. While a strong nurse manager is always desirable, it is not strictly necessary to implement total client care. 4. 24-hour accountability is a part of primary nursing, not total client care.

A long-term care facility is considering implementing total client care. Prior to implementing this system, what must be available? 1. Enough RN staff to provide all the care to the residents 2. A group of licensed assistants who are good at taking direction 3. A strong nurse manager 4. RNs willing to assume 24-hour accountability for the care provided to residents

Answer: 1 Explanation: 1. In functional structure, individual departments are grouped and responsible for specific tasks. A weakness of the functional structure is that coordination of services across departments is poor. Nursing would find it difficult to write a comprehensive care plan without input from other departments. 2. In functional structure, individual departments are grouped and responsible for specific tasks. The dietary department would be responsible for nutritional assessment in this structure, so this is not a weakness. 3. In functional structure, individual departments are grouped and responsible for specific tasks. All nursing tasks would be grouped under the nursing department, so this is not a weakness. 4. In functional structure, individual departments are grouped and responsible for specific tasks. Physical and occupational therapy would logically coordinate and evaluate activities of daily living, so this is not a weakness.

A long-term care facility's organization reflects a functional structure. Which facility practice reflects a basic weakness in this organizational strategy? 1. The nursing department is responsible for writing the client's comprehensive care plan. 2. The dietary department is responsible for nutritional assessment. 3. All nursing tasks fall under the nursing department. 4. Physical and occupational therapy departments coordinate and evaluate activities of daily living.

Answer: 1, 3, 4 Explanation: 1. Communicating openly and honestly with those who support the change and those who oppose the change is the best strategy. 2. The pros and cons of the change should be openly discussed. 3. Change is constant in healthcare. 4. Emphasizing the positive outcomes of the change is a strategy to reduce resistance. 5. The nurse manager should maintain support for and confidence in all staff.

A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change? Select all that apply. 1. Disperse information about the change as quickly as possible. 2. Discourage any negative discussion about the change. 3. Remind staff that change is part of the healthcare environment. 4. Talk about the change in positive terms. 5. Withdraw slightly from those who oppose the change.

*Answer: shared visioning* *Explanation:* Shared visioning is an interactive process in which both leaders and followers commit to the organization's (unit's) goals.

A manager wants the unit to be known as the primary wound care unit for the organization. The manager achieves staff buy-in, and they work together to establish goals and share accomplishments. The nurse acknowledges that this power tool is called ________.

Answer: 4 Explanation: 1. Telling the staff that they have the final decision is a way of persuading. 2. The decision to adopt or reject a change occurs after the knowledge and persuasion steps. 3. Giving a personal endorsement of the change would be persuasion. 4. The first step of the diffusion of innovation occurs when the decision-making unit is introduced to the innovation and knowledge is gained.

A new IV pump has just been purchased by the facility. Which statement by the nurse manager reflects Rogers' first step in making the change to this new equipment? 1. "The nursing staff will have the final decision on whether to change to this IV pump." 2. "Before we make the final decision, we will do a three-month 'test run' of the equipment to make sure we like it." 3. "I have looked at the pump and I like it." 4. "I have information to share with you about the new IV pump we are considering for the unit."

Answer: 4 Explanation: 1. The nurse providing primary nursing must be very autonomous. This is not the best environment for a newly licensed RN. 2. The nurse providing total nursing care must be very autonomous. This is not the best environment for a newly licensed RN. 3. In functional nursing, the RN leads the team. The newly licensed RN does not have sufficient experience for this role. 4. Practice partnerships allow for two personnel to work together in giving client care. Ideally, a senior RN can be paired with a novice RN.

A newly licensed RN is beginning a job search. This nurse would be best served by working in an organization that provides which nursing care delivery system? 1. Primary nursing 2. Total nursing care 3. Functional nursing 4. Practice partnerships

Answer: 3 Explanation: 1. Whether or not other nurses delegate similar tasks is not as important as another question. 2. Experience is important, but is not the most important question. 3. The nurse should not delegate tasks that involve nursing assessment or judgment. 4. The nurse should consider if the delegate has sufficient time to complete the task, but this is not the most important consideration.

A newly licensed nurse is concerned about the legal aspects of delegation. What is the most important question for the nurse to consider prior to delegating a task? 1. Do other nurses in the facility delegate similar tasks? 2. How long has the assistant worked at the facility? 3. Does this task involve nursing judgment? 4. How busy is the delegate?

Answer: 3 Explanation: 1. All nurses are managers. 2. The nurse will use these skills on the first job. 3. The manager is an essential component in helping the new nurse transfer this learning into the "real" world of bedside care. 4. The newly licensed nurse does not have the skill set and experience to work as a manager.

A newly licensed nurse received specific knowledge of management skills while in nursing school. What does the nurse need now? 1. Nothing until the nurse has acquired enough bedside experience to become a manager 2. Time to see how these skills will be needed in the future 3. A manager who can help with skills transfer from school to work 4. A job working as a manager in a small hospital

*Answer: 2* *Explanation:* 1. This behavior is not inappropriate. 2. Challenging details is a part of the preparation portion of learning to be creative. 3. There is no indication that this is the belief of this nurse. 4. There is no indication that this nurse does not understand the work of the committee.

A newly licensed nurse working on a unit committee challenges every detail of a proposal the committee is developing. How should other committee members interpret this behavior? 1. This nurse is too inexperienced to realize the behavior is inappropriate. 2. This nurse is learning to be creative. 3. This nurse believes that new nurses are more knowledgeable than those who have worked several years. 4. This nurse misunderstands the work of the committee.

Answer: 3 Explanation: 1. Adaptability is flexibility in adapting to changing situations or overcoming obstacles. 2. Initiative is readiness to act and seize opportunities. 3. Transparency is displaying honesty, integrity, and trustworthiness. This nurse is not displaying these traits. 4. Optimism is seeing the up side in events.

A newly promoted nurse manager is fearful that previous coworkers will undermine her efforts to succeed in this new position. The new manager does not share information with these coworkers even though they may need the information to understand changes that are going to occur in the organization. Which emotional intelligence self-management competency is this nurse most clearly violating? 1. Adaptability 2. Initiative 3. Transparency 4. Optimism

*Answer: 3* *Explanation:* 1. Managers should not assume that only one opinion can be voiced and that others will be silent. 2. Managers should not assume that only one opinion can be voiced. 3. Good managers start out with a commitment to find out why others disagree. 4. Tunnel vision makes it difficult to see things from another perspective and will not encourage staff to avoid preconceived ideas.

A newly promoted nurse manager would like staff to solve problems without relying on preconceived ideas. How should the manager role-model this ability? 1. When disagreements occur on the unit, the manager privately asks the dissenters to be silent about the issue at meetings. 2. Tell staff members that they must present one opinion regarding the solutions they desire. 3. Demonstrate a genuine desire to find our why there is dissention. 4. Develop "tunnel vision" when it comes to problems on the unit.

Answer: 2 Explanation: 1. The nurse has ultimate responsibility to ensure that the client is ready for discharge, which includes packing the client's belongings as necessary. 2. Effective delegation occurs when the delegator gives specific information to the delegate about the requested task. The nurse request in the stem was not specific enough. 3. The nurse has the authority to delegate this task to the unlicensed assistant. 4. There is no need for the nurse to go with the assistant to oversee the packing process.

A nurse asks an unlicensed assistant to help with discharging clients because so many are going home at one time. The nurse states, "Can you help get these clients ready to go home by helping them pack?" Which option best describes the statement with regard to effective delegation? 1. The delegation is ineffective because the nurse has no responsibility to pack the client's belongings. 2. Delegation would have been more effective had the nurse been more specific about which clients and when it should be completed. 3. The delegation is ineffective because the nurse has no authority to ask the unlicensed assistant to help with client discharge. 4. Delegation could have more effective had the nurse gone with the assistant to ensure the assistant did the packing as requested.

*Answer: 2* *Explanation:* 1. Scientific evidence shows that milk is not tolerated by all adults. This action is not based in science. 2. The nurse's assumption is that milk is good for adults. 3. The nurse has not considered the alternative perspective that milk is not tolerated by some adults. 4. An inquiring attitude would lead the nurse to investigate research about adult tolerance to milk.

A nurse believes that milk is part of the healthy adult's diet. The nurse frequently offers milk to adults as a between-meal beverage. This action is based on which concept? 1. Evidence 2. An underlying assumption 3. An alternative perspective 4. An inquiring attitude

*Answer: 1* *Explanation:* 1. The nurse should use a professional manner in the letter. 2. The nurse should not assume familiarity with the senator in this professional matter. 3. The senator's correct title is Senator. 4. The letter should be addressed specifically to the senator.

A nurse cared for Senator Bill Smith while he was hospitalized last year. The nurse now wishes to send him a letter supporting a bill that will be voted on in the current legislative session. Which salutation should the nurse use in the letter? 1. Dear Senator: 2. Dear Bill: 3. Dear Sir: 4. To whom it may concern:

Answer: 1, 3, 4 Explanation: 1. Disgruntled employees may use the blog to air grievances. If the blog is open access, these grievances could quickly become community news. 2. Blogs are inexpensive and easy to use. 3. As blogs become more and more common, bloggers become more casual in their use. Violations of client confidentiality would not only be possible but could even be said to be likely. 4. The organization's reputation could be either enhanced or damaged by bloggers' comments. 5. Social media sites such as blogs have exploded in use. It is very likely that nurses would use a blog.

A nurse executive is considering initiating a blog to enhance communication among staff nurses, managers, and supervisors throughout the organization's different campuses. What serious considerations should the nurse make prior to starting a blog? Select all that apply. 1. Open access to the blog may damage recruiting efforts. 2. Blogs are difficult to use and expensive to maintain. 3. Users of the blog must be very careful not to divulge any information that would violate client confidentiality. 4. The organization's reputation may be altered by a blog. 5. Most nurses would likely not use the blog.

Answer: 1, 2, 5 Explanation: 1. Coordination across functions can be complex and poor in a functional structure. 2. Because so many day-to-day operation decisions are made by senior managers in this structure, these people may become overloaded and unable to be efficient in their work. 3. Typically, in a functional structure, promotion occurs from within. 4. Typically, response to changes in the external environment is very slow in organizations with functional structure. 5. Many managers in functionally structured organizations rise "up the ranks" to their position; there is often very little formal management training.

A nurse has accepted the position of vice-president in charge of nursing in an organization that has a functional structure. What issues should the nurse be alert for Select all that apply. 1. There may be lack of coordination of services across the different departments in the organization. 2. Senior nursing managers may be overwhelmed with work and decisions. 3. There may be unrest because of the high proportion of management positions filled from outside the organization. 4. There is continual upheaval as the organization responds rapidly to changes in the external environment. 5. Managers have limited knowledge of general management techniques.

Answer: 3 Explanation: 1. In 2009, healthcare costs consumed more than 17% of the country's gross domestic product. 2. Implementation of PPACA and its regulations have not been formulated. 3. The United States spends more than $2.5 trillion on healthcare annually, more than any other country. 4. While this act has been passed, it is not operationalized. Healthcare spending continues to rise.

A nurse has been invited to discuss healthcare costs at a senior citizens' club. What information should the nurse plan to include in this discussion? 1. While healthcare costs continue to rise, the percentage of the United States (U.S.) economy spent on healthcare has slowly declined to less than 12%. 2. Regulations brought about by the Patient Protection and Affordable Care Act (PPACA) should bring financial relief to healthcare consumers. 3. The United States spends more money on healthcare than any other country. 4. Healthcare spending in the United States is slowly declining due to passage of bills such as the Patient Protection and Affordable Care Act (PPACA).

Answer: 3, 4, 5 Explanation: 1. Thinking ahead in the conversation interferes with the ability to listen and comprehend. 2. Eye contact does not mean the nurse is listening. 3. When many people are talking at one time, it is difficult to listen and comprehend. 4. Being tired and stressed from too much time at work can cause energy to flag, resulting in difficulty listening. 5. Preconceived beliefs about what the speaker is going to say makes it more likely that the nurse is not going to listen effectively.

A nurse has made several "near errors" in client care in the last 2 months. The nurse manager says, "These are simple errors. You just aren't listening." How could the nurse improve listening skills in this situation? Select all that apply. 1. The nurse should try to think ahead about what the person talking is going to say. 2. The nurse should hold eye contact with the speaker at all times. 3. When listening to instructions, the nurse should ask anyone who interrupts to wait a moment. 4. The nurse should get sufficient time away from work to rest. 5. The nurse should be careful not to prejudge what the speaker is going to say.

*Answer: 2* *Explanation:* 1. Nurses are knowledge workers, but this is not the reason that many view power as unattractive. 2. The idea of having power "over" someone or "power-grabbing" is oppressive. Many nurses hold this view of power. 3. Having power with others is not perceived as unattractive by nurses, but having power over others is. 4. Power increases self-esteem.

A nurse is overheard saying, "I just don't want to be involved in this power struggle. I don't want power; I just want to do my job." What is a common reason nurses may feel power is not desirable? 1. Nurses are knowledge workers, not power workers. 2. Many nurses view power as oppressive. 3. Having power with others is a part of providing nursing care. 4. Remaining powerful reduces self-esteem.

Answer: 4 Explanation: 1. A leader may have no formal accountability or authority. The manager has that authority. 2. The unit manager has the authority. The experienced nurse in this scenario may or may not be the unit manager. 3. A leader is not necessarily a good manager and may not be efficient. 4. A nursing leader must be a visionary in order to empower others to make needed changes for the good of the group. This leader may or may not be the formal leader of the group.

A nurse is working in a unit with several less-experienced nurses. Which attribute displayed by the senior nurse would make the leadership of the less-experienced nurses most effective? 1. Strong belief that the leader is accountable for actions taken by those working on the unit 2. Authority to carry out actions necessary to move the work of unit staff forward 3. Efficiency in actions and in words 4. Ability to inspire the others to commit to the team's goals

Answer: 2 Explanation: 1. Defining costs/benefits are part of the second step. 2. The first step in the change process is to clearly define the problem. 3. Identify driving and restraining forces is part of the second step. 4. Selecting and analyzing data are part of the third step. 5. Developing a plan for change is a part of step four.

A nurse leader is contemplating change on the unit. Which is the first step in the change process? 1. Defining costs/benefits 2. The problem has been clearly defined 3. Identify driving and restraining forces 4. Select and analyze data 5. Develop a plan for change

Answer: 1, 2 Explanation: 1. This is an example of using "fogging," or agreeing with part of what is said. This technique may make the supervisor rethink the decision by offering some new information. 2. Asking about previous concerns is a type of negative inquiry. It helps the nurse manager understand the supervisor's position, but also requires the supervisor to rethink the issue. 3. Telling the supervisor it is unfair is the same as calling the supervisor unfair and is confrontational. 4. This approach is confrontational. 5. Threats, even veiled threats, are confrontational and should not be used.

A nurse manager approaches the nursing supervisor with a request for approval to incorporate 12-hour shifts into scheduling. The supervisor denies the request, stating this staffing pattern was used previously with poor outcomes. Which responses by the nurse manager may positively influence the supervisor? Select all that apply. 1. "I agree it was not effective years ago, but other units have now had success with it." 2. "What were your specific concerns about the 12-hour shifts?" 3. "I think it is unfair to refuse my unit this opportunity based on the past." 4. "Why are you always so opposed to change on my unit?" 5. "If we don't offer alternative staffing patterns, we aren't going to be able to attract new hires."

Answer: 4 Explanation: 1. Contingency theorists study the environment in which the organization will exist and create the structure to match that environment. 2. Closed systems are self-contained and do not exist in organizations dependent on the interplay of people. Examples can be found in the physical sciences. 3. Classical leadership theory focuses on developing a well-structured and stable environment where chain of command and control are valued. 4. Chaos theory posits that an organization is dependent on its adaptability and response to change in its environment. Nurse managers must create an environment that accepts change, tolerates conflict, and promotes creative solutions.

A nurse manager encourages nursing staff members to assist in developing a new creative staffing pattern that can respond quickly when staff resign or go back to school. This is an example of the use of which organizational theory? 1. Contingency theory 2. Closed-systems theory 3. Classical theory 4. Chaos theory

Answer: 1, 2 Explanation: 1. Grapevine communication is often rapid and complete. 2. Grapevine communication is often altered as is goes from person to person. 3. The grapevine is very prone to distortion-sometimes significant distortion. 4. Most people do believe or at least attend to the grapevine. 5. Grapevine communication crosses all levels of professionalism.

A nurse manager is aware that there is a strong "grapevine" communication system on the unit. The manager elects to use this grapevine to distribute information about an upcoming change in unit policy. In making this decision, the manager should consider which possibilities? Select all that apply. 1. The information may be rapidly disseminated. 2. The information may be altered as it moves across the grapevine. 3. Most people try to spread information accurately. 4. Most people do not pay any attention to the grapevine. 5. Professional nurses do not participate in grapevine communication.

*Answer: 1, 2, 5* *Explanation:* 1. Exposure to new ideas and a fresh environment outside the facility increases creativity. 2. Freedom is necessary to support the creative process. 3. Filling in a spreadsheet is a bureaucratic, regimented strategy that will not foster creativity. 4. Making creativity an assignment is a sure way to stifle it. 5. Being receptive to new ideas encourages creativity.

A nurse manager is committed to establishing an environment that supports critical thinking and creativity. What strategies would help in this effort? Select all that apply. 1. Provide opportunities for staff to interact with nurses from outside the facility. 2. Give the nurses freedom to design their work environment. 3. Create a spreadsheet for nurses to complete describing their creative efforts. 4. Assign each nurse 15 minutes during a staff meeting to talk about his or her creative efforts. 5. Be receptive to ideas even if they seem strange at the beginning.

Answer: 2, 3, 5 Explanation: 1. The manager should use a more direct "I" statement such as, "I need for you to take the lead on this project." 2. Eye contact helps to ensure that the secretary is attending to the information presented. 3. Face-to-face communication will be necessary for explanation and questions. 4. It is important to have all the critical information available so that the delegate can make a logical decision about the task. 5. It is important to let the delegate know the importance of the task.

A nurse manager is delegating a new, complex task to the unit secretary. Which strategies should the manager use? Select all that apply. 1. Begin the instruction with a statement such as "It would be good if you could help me with this project." 2. Make eye contact with the secretary when explaining the task. 3. Talk to the secretary in person rather than by telephone or in an email. 4. Introduce the generalities of the task with a promise that details such as a time line will follow shortly. 5. Discuss the importance of the task to the organization.

Answer: 3, 4 Explanation: 1. Studies using only one group of participants are done in a quasi-experimental design. This is not one of the two strongest forms of evidence. 2. An in-depth analysis used to translate information to other clinical situations is a case study approach. This is not one of the two strongest forms of evidence. 3. Using the scientific approach results in statistical evidence, which is one of the two strongest forms. 4. Studies that use both experimental and control groups are randomized control trials. This is one of the two strongest forms of evidence. 5. Evidence reported by an expert in the field is testimonial evidence. It is not one of the two strongest forms of evidence.

A nurse manager is directing a team of staff nurses working to solve a clinical problem using evidence-based practice (EBP). Which of the following statements would direct these nurses to the forms of strongest clinical evidence? Select all that apply. 1. "We may find studies that use only one group of participants." 2. "Look for articles that report on how to use evidence in other clinical situations." 3. "The studies we want are built around the scientific approach to solving problems." 4. "Our focus should be on studies that use both experimental and control groups to determine intervention effectiveness." 5. "Many articles will have information reported by someone who is an expert in the field."

Answer: 1, 4 Explanation: 1. Rejecters often respond with active opposition. 2. This statement is characteristic of an early or late majority resister. 3. Acknowledging that change is necessary is characteristic of an early adopter. 4. Making the change more difficult is a form of sabotage, which is characteristic of a rejecter. 5. Innovators love change and thrive on it.

A nurse manager is faced with the task of introducing an unpopular change to a staff that includes several nurses who have acted as rejecters to previous changes. The manager expects resistance but hopes to identify these rejecters early in the process. The manager should be particularly alert to which statements? Select all that apply. 1. "I don't care what they say; I'm not giving care that way." 2. "I don't think this is going to work, but I'll probably come around to it sooner or later." 3. "I'm not crazy about this idea, but we do need to change how we are providing care." 4. "I bet I can make it very difficult for this change to occur." 5. "It won't be so bad. I like change."

*Answer: 2, 5* *Explanation:* 1. The size of the hospital is not significant in selecting evidence-based practice interventions. 2. Evidence-based practice is most reliable when more than one study has confirmed the results. 3. Many evidence-based practice interventions are new, and the manager may have no previous knowledge about them. 4. While the manager must be certain the articles are from reputable sources, research is not limited to those who are already known in the field. 5. The research on which evidence-based practice is based must be rigorous in design and must have been executed according to its design.

A nurse manager is looking for evidence-based information regarding wound care. Which criteria should be used to evaluate the usefulness of an intervention? Select all that apply. 1. Is there evidence that the intervention has been used in hospitals of similar size to the one where the manager practices? 2. Can the manager find two or more research studies that support the use of the intervention? 3. Is the intervention one that the manager has seen used in the past? 4. Are the authors of the research articles well-known experts in the field? 5. Is the research study that recommends the intervention rigorous in design and execution?

*Answer: 1, 4* *Explanation:* 1. Internal customers include employees and departments within the organization. 2. Visitors are considered external customers. 3. Physicians are considered external customers. 4. Nurses are hospital employees and are therefore considered internal customers. 5. Vendors are not employed by the hospital and are considered external customers.

A nurse manager is orienting newly hired staff nurses to the organization's total quality management program. As part of orientation, the manager has assigned the nurses to interview the organization's internal customers. Which group would the nurses interview? Select all that apply. 1. Newly hired radiology technicians 2. People who are visiting clients admitted within the last two days 3. Physicians who have admitting privileges 4. Nurses who have worked at the facility more than five years 5. Vendors who supply disposable medical equipment to the hospital

Answer: 1 Explanation: 1. While all of the options given are driving forces in today's healthcare environment, the cost of providing care is still the primary issue. Cost of care controls access, availability, and quality. 2. Access to care is controlled by the ability to pay. 3. Care will not be available if it cannot be funded. 4. Healthcare providers do not like to correlate quality with cost, but the economic reality is that quality care must also be funded care.

A nurse manager is participating in the healthcare organization's strategic planning committee. Which factor is the primary driving force and controlling factor in new initiatives this committee might recommend? 1. Cost of care 2. Access to care 3. Availability of care 4. Quality of care

*Answer: 2, 3* *Explanation:* 1. With decisions made under certainty, there is little if any risk. 2. When a decision is made under certainty, the possible alternatives are known. 3. When a decision is made under certainty, the conditions surrounding possible alternatives are clear. 4. If possible consequences of alternatives are not known, the decision is being made under conditions of uncertainty. 5. Complex and dynamic decisions are those made under uncertainty.

A nurse manager who is retiring is helping the new manager learn about the position. As part of this education, the current manager has the new manager make all decisions that can be made under certainty. What conditions will these decisions have in common? Select all that apply. 1. There is risk associated with the decision. 2. The alternatives are known. 3. The conditions of each alternative are clear. 4. Possible consequences of alternatives are not known. 5. The decision is complex and dynamic.

*Answer: 1, 4* *Explanation:* 1. A history of ineffective trial-and-error solutions to problems tends to make the manager rigid. 2. Generally, fear of risk taking is characteristic of a rigid management style. 3. Rigidity in personality often translates to rigidity in management style. A rigid manager would be upset if staff members routinely came to work late. 4. Using old ways of thinking to solve new problems is characteristic of rigid management. 5. Rigid managers typically prefer to make decisions independently.

A nurse manager's supervisor reports that many staff members have complained about the manager's rigidity. What situations reflect this rigidity? Select all that apply. 1. The manager has historically used trial and error as a decision-making strategy. 2. The manager takes unnecessary risks when staffing the unit. 3. The manager is not concerned when staff members arrive late to work. 4. The manager uses old ways of thinking to solve the day-to-day issues of the unit. 5. The manager does not consider the advice of the assistant manager when making a decision.

Answer: 1, 3, 5 Explanation: 1. Check timing is a communication skill that will help the nurse to improve communication. 2. Expect respect is not a communication skill that will help the nurse to improve communication. 3. Consider relationship to receiver is a communication skill that will help the nurse to improve communication. 4. Find an interpreter is not a communication skill that will help the nurse to improve communication. 5. Reply appropriately is a communication skill that will help the nurse to improve communication.

A nurse often has difficulty explaining and getting a clear message through to the receiver. Which communication skills will help the nurse to improve communication. Select all that apply. 1. Check timing 2. Expect respect 3. Consider relationship to receiver 4. Find an interpreter 5. Reply appropriately

*Answer: 2, 3, 5* *Explanation:* 1. Communication is not included in the stages of the creative process. 2. Incubation is included in the stages of the creative process. 3. Verification is included in the stages of the creative process. 4. Innovation is not included in the stages of the creative process. 5. Insight is included in the stages of the creative process.

A nurse on a mission trip needs a urinary catheter for an infant. The nurse only has a pediatric feeding tube and must think creatively. The nurse knows the creative process includes which stages? Select all that apply. 1. Communication 2. Incubation 3. Verification 4. Innovation 5. Insight

Answer: 1, 3, 5 Explanation: 1. For medical homes to be most effective, EMR should be implemented. 2. A medical home is not the same as a long-term care facility. 3. One of the challenges in developing a medical home is the multiple needs of clients who have chronic conditions. 4. The medical home is not a bricks-and-mortar facility. 5. Problems with electronic delivery of data and information and compensation for primary care are challenges associated with developing a medical home.

A nurse practitioner and a physician are considering establishing a medical home. For this venture to be successful, these healthcare providers should ensure which resources are available? Select all that apply. 1. Electronic medical records (EMR) technology 2. A sufficient number of older adults who require long-term care 3. An understanding of the complexity of multiple-need clients 4. A robust marketing plan that describes the home's physical environment 5. A plan for compensation for the primary care provided

Answer: 4 Explanation: 1. Concentric diversification is expansion of services into new markets. 2. Conglomerate diversification is expansion into areas that differ from the original service. 3. Capitation is a fixed fee paid per enrollee for services in an HMO. 4. A joint venture is a partnership in which each partner contributes different areas of expertise or resources to create a product or service.

A nurse practitioner and a physician have opened an office together. The nurse regularly collaborates with the physician in client care and is a general partner in the business of the office. This is an example of which diversification method? 1. Concentric diversification 2. Conglomerate diversification 3. Capitation 4. Joint venture

Answer: 4 Explanation: 1. The RN does have liability associated with job responsibilities, but if delegation is done correctly, liability is minimized. This response is not supportive of the RN's need to delegate. 2. Hospital support is never a given when liability situations occur. This is not a response that would be supportive of the nurse's need to delegate. 3. This is not necessarily an accurate statement. 4. The five rights of delegation outline accepted measures to take when delegating tasks. If these rights are followed, the nurse has fulfilled job responsibilities. The delegate is responsible for his or her own care.

A nurse says, "I am always worried that I will be liable if someone I delegate a task to does something that hurts the client." What is the manager's best response to this concern? 1. "You have lots of liability in your position as an RN." 2. "The hospital will support you as long as you follow your job description." 3. "You are at greater liability if you try to do everything yourself." 4. "As long as you follow the five rights of delegation, your liability is minimal."

*Answer: 2* *Explanation:* 1. Calling a local beverage distributor is a "classic" way to address this problem and does not engage the creativity of the staff. 2. Asking others to think about different options opens up the possibilities beyond one individual's ideas. This is part of the preparation stage of creativity. 3. Finding out the drink preferences of the clients is part of the standard information gathering stage of providing drinks and does not reflect creativity. 4. Simply encouraging clients to bring a drink from home is not a creative approach to solving this problem.

A nurse working in a rehabilitation center notices that clients frequently asking for something to drink. Which response indicates the use of creativity in finding a solution to this problem? 1. Calling local beverage distributors to inquire about service pricing 2. Asking all employees to write down their ideas about a solution 3. Determining what type of drinks most clients might want 4. Encouraging clients to bring a drink from home

Answer: 1, 2, 3, 5 Explanation: 1. The RN team leader is responsible for conducting the nursing care conference and reviewing the client's plan of care with the team. 2. The RN team leader guides the client care and helps to resolve any problems that may occur. 3. Developing and updating nursing care plans is the work of the RN team leader. 4. Typically, the team leader is involved in indirect client care activities. 5. Communicating and collaborating with physicians is generally the responsibility of the team leader.

A nursing team consists of an RN, two LPNs, and two UAP. Which work would be completed by the RN? Select all that apply. 1. Reviewing the client's plan of care with the UAP 2. Discussing the client's increasing shortness of breath with the LPN 3. Updating the care plan of a client who will undergo surgery tomorrow 4. Administering oral medications to clients 5. Calling the physician to discuss the client's response to a new treatment

Answer: 1, 3, 4, (5) ** according to the rationale 4 is wrong and 5 is correct** Explanation: 1. This statement exemplifies the willingness to take risks that is necessary to become a change agent. 2. The nurse should always expect that change will be met with resistance and possible conflict. 3. Nurses should always look for ways to improve client outcomes. 4. Change occurs when people become uncomfortable with the status quo. 5. Accepting that change is challenging is part of being a change agent.

A nursing administrator overhears nurses conversing during a break in a seminar on change. The administrator would interpret which statement as meaning that the nurse who made it is ready to become a change agent? Select all that apply. 1. "I know that suggesting this change may backfire on me." 2. "I don't expect too much conflict or resistance to this change." 3. "I see an opportunity to make a difference in the way this facility provides nursing care." 4. "I think the status quo is just fine for now." 5. "This change is certainly going to be a challenge, but that's okay."

Answer: 1, 3, 4 Explanation: 1. Where is an important question in planning. 2. Although it is important to ask "why" when planning, the correct "why" in this case is "Why are we providing this service?" 3. When is an important aspect of planning. The timeline for implementation is critical. 4. There are numerous possibilities for answering this question. It is important to consider when planning. 5. This question is not as essential for this committee. Finding money for the project would not be a nursing function.

A nursing committee has been organized to help plan a new intensive care service at the hospital. Which questions are essential for this committee to consider? Select all that apply. 1. Where will the service be housed? 2. Why were the nurses asked to participate? 3. When will the service begin? 4. Who will provide the services? 5. How will money for the project be raised?

Answer: 3 Explanation: 1. Critical thinking is still emphasized, but another aspect of care should receive much more emphasis. 2. Carnegie focuses on application of knowledge rather than its acquisition. 3. This is a Carnegie recommendation. 4. Carnegie recommends integration of clinical and classroom teaching.

A nursing curriculum includes integrated content on critical thinking. Which statement reflects movement toward designing the curriculum to meet Carnegie Foundation recommendations? 1. "We must find ways to increase our emphasis on critical thinking." 2. "The curriculum must focus on ways nurses can quickly and accurately acquire information." 3. "Our emphasis must change to improving nursing students' clinical reasoning skills." 4. "Our clinical practicums must be graded separately from our theory presentations."

*Answer: 3* *Explanation:* 1. The nurse should do further assessment before confronting the person. 2. Asking for clarification is not the strongest response to this statement. 3. The nurse should not take the statement at face value but should ask for evidence that it is correct. 4. By not saying anything, the nurse allows the rest of the committee to hear and perhaps believe the statement is true. The time to speak up is now.

A nursing leader wishes to maintain an image of power on a multidisciplinary committee. In a meeting, a committee member makes a statement that the nurse believes is in error. How should the nurse respond? 1. "I don't think what you are saying is correct." 2. "Would you clarify what you just said?" 3. "What evidence supports that statement as accurate?" 4. Say nothing and research the topic before the next meeting.

Answer: 1, 2, 4, 5 Explanation: 1. Modifying the change and compromising with resisters is a valid strategy. 2. Trying to change too much too fast can escalate resistance. 3. Abandoning the change is not a viable offer, as the supervisor has indicated that change is needed. 4. Overcoming resistance is often necessary for change to occur. 5. In some cases, change must proceed despite resistance. Those who can live with the change stay, and those who cannot leave.

A nursing supervisor has introduced a needed change in policy to the nurse managers. The managers have met maximum resistance when attempting to gain support for the change. Which options reflect valid strategies for the nurse managers? Select all that apply. 1. Meet with the supervisor and discuss modifications of the proposed change. 2. Slow down the change process. 3. Meet with the supervisor and suggest abandoning the change. 4. Work together to identify strategies to overcome resistance. 5. Proceed with the change.

Answer: 1, 2, 3 Explanation: 1. Fear of "rocking the boat" may prevent the manager from effectively leading the change. 2. Fear that no one will support the change may prevent the manager from effectively leading the change. 3. Recalling that previous efforts at change have failed may prevent the manager from effectively leading the change. 4. The ability to see the end result and what it will take to make the plan work is a sign that the manager could be an effective change agent. 5. The ability to handle resistance and a display of confidence are signs that the manager could be an effective change agent.

A nursing supervisor would like the nurse manager to serve as change agent for a needed revision to unit policy. Which statements would alert the supervisor that this manager is not the best choice for this assignment? Select all that apply. 1. "Well, we don't want to rock the boat too much." 2. "Do you think we can get enough support from the nurses to make this change?" 3. "We tried making a change like this before and it didn't work out well." 4. "To make this big change, we need to start making smaller changes now." 5. "There is going to be resistance, but I think it can be overcome."

*Answer: 2* *Explanation:* 1. Group problem solving implies that a problem exists, which is not the case in this situation. The task force is comparing two models of practice, not solving a problem. 2. Critical thinking is a higher-level cognitive process that involves the examination of assumptions, interpretation and analysis of arguments, and the development of a conclusion that can be justified. 3. Groupthink is a negative phenomenon that occurs in highly cohesive groups that become isolated. There is no evidence that groupthink has occurred in this situation. 4. Satisficing is a type of decision-making strategy that identifies a strategy that is minimally acceptable. There is no evidence that satisficing has occurred in this situation.

A nursing task force has been created to determine whether a new model of differentiated practice would be more effective than the current model. The task force analyzes data as a basis to examine alternatives. Which activity does this represent? 1. Group problem solving 2. Critical thinking 3. Groupthink 4. Satisficing

Answer: 1, 4 Explanation: 1. If the team leader does not delegate effectively or team members do not accept delegation well, team nursing will not be effective. 2. Problems with UAP skill sets can be overcome by education. This is not a common reason that team nursing does not work. 3. While LPNs can be "in the middle" between the UAP and the RN, there is no indication that this is a common problem. 4. Poor communication is a common problem and can make the team approach ineffective. 5. There is no indication that this is a common issue.

A nursing unit has just completed a 6-month trial of using team nursing to provide care. The overwhelming opinion of the staff is that the experiment was a disaster. What are the most common reasons that team nursing is not successful? Select all that apply. 1. There are problems with delegation. 2. There are problems with the skill set of the UAP on the teams. 3. The LPNs on the team do not accept their position of being "in the middle." 4. Communication on the team or with the nurse manager is flawed. 5. RNs and LPNs struggle with who is in control and has the power on the team.

Answer: 2, 3 Explanation: 1. Generation X members do not like group problem solving and decision making. This is more the style of Baby Boomers. 2. Generation X members would be more likely to read the information, formulate an opinion, and share it with the manager. They like decisions to be made without unnecessary discussion. 3. Generation X members do not like unnecessary discussion, so asking for input individually would be a good strategy. 4. Traditionalists are more likely to respond to a suggestion from someone higher in the chain of command. They also tend to be more formal. 5. Generation Y is more likely to want immediate feedback from emails or text messages.

A problem has arisen on a unit with primarily Generation X nursing staff. Which strategies should the nurse manager employ to get staff input into solving this problem? Select all that apply. 1. Schedule a staff meeting for discussion of the problem and its possible solutions. 2. Post a notice on the bulletin board explaining the issue. 3. Ask nurses individually for input. 4. Develop a possible solution and share it with nurses in a formal meeting. 5. Ask for input in text message and promise to respond to texts immediately.

Answer: 2 Explanation: 1. Empirical-rational strategy is used when little resistance to the proposed change is expected. 2. Normative-reeducative strategy uses collaboration as its primary decision-making technique. It is most likely to result in the greatest number of people being happy with the decisions made. 3. Power-coercive strategy is the least likely to result in everyone agreeing with the change. 4. This is not one of the change strategies.

A proposed change in a healthcare organization is controversial and will require cooperation from all parties involved. Which change strategy should the change agent use? 1. Empirical-rational 2. Normative-reeducative 3. Power-coercive 4. Empirical-reeducative

Answer: 2, 3, 4, 5 Explanation: 1. Each discipline determines its own interventions. The disciplines collaborate to design care. 2. Collaboration with other disciplines is a critical component of case management. 3. A main emphasis of case management is building consensus with physicians caring for the clients. 4. The nurse is responsible for defining expected nursing outcomes. The other disciplines involved will set expected outcomes for their work. 5. Essential baseline data, such as length of stay, cost of care, and complication information, are collected and analyzed by the nurse and other members of the team.

A registered nurse will be the case manager of a group of 10 clients. What will the nurse expect as part of this assignment? Select all that apply. 1. The nurse will determine interventions for all the disciplines needed as part of the clients' care. 2. The nurse will meet with other disciplines to agree on the choice of critical pathways for each client. 3. The nurse will work to build consensus with the physicians caring for the clients on the team. 4. The nurse will define the expected nursing outcomes for the clients on the team. 5. The nurse will collect and analyze data regarding the clients on the team.

*Answer: 1, 2* *Explanation:* 1. Professional disagreements often occur as root-cause analysis is being conducted. 2. Often the root-cause analysis takes up so much time and so many resources that no changes are ever made. 3. Root-cause analysis generally looks for the "sharp end" or the person who made the error, rather than looking for the system or process that allowed the error to occur. 4. Root-cause analysis generally does not result in widespread system improvement. 5. Root-cause analysis takes time and resources. Generally there is little management support for changes due to the length of time from the incident.

A risk manager generally uses root-cause analysis to investigate incidents. What are the likely outcomes of this action? Select all that apply. 1. There is disagreement over the cause of the incident. 2. There are insufficient resources to make needed changes to prevent similar incidents. 3. The system or process causing the incident is identified and corrected. 4. Improvements to the system are widespread. 5. Sufficient evidence is acquired so that management is comfortable in making needed changes.

*Answer: 2* *Explanation:* 1. Assessment is collecting the evidence. 2. Suspending judgment is equivalent to the diagnosis step. 3. Planning would occur when information is collected and analyzed and a course of action is being determined. 4. Deciding which hypothesis is correct is evaluation.

A serious disagreement has arisen between two staff nurses. The unit manager elects not to make a decision regarding the disagreement until more evidence is collected. Which part of the nursing process does this manager's critical thinking reflect? 1. Assessment 2. Diagnosis 3. Planning 4. Evaluation

Answer: 3 Explanation: 1. Organization takes many forms and is different for every nurse. Some nurses may use the time prior to shift report to organize. 2. Depending on the structure of the unit, assignments may be made by the charge nurse or the nurse manager. 3. Assignment is a bureaucratic function that reflects job descriptions and client or organizational needs. Daily work allotment from nurse manager to staff nurse is an assignment, not delegation. 4. Team assignments occur prior to shift report. In some institutions, all nurses working on the unit listen to shift report on all clients. In other institutions, the nurse receives report only on the assigned team.

A staff nurse asks the nurse manager, "What assignment are you delegating to me today? I would like to begin to organize my day before shift report begins." What is the error inherent in this statement? 1. There is no way for the nurse to know how to organize until the assignment is clear. 2. The nurse manager would not make assignments. 3. The nurse manager is not delegating but rather making daily assignments. 4. Assignment occurs after shift report.

*Answer: 1* *Explanation:* 1. Nurses can be politically aware and active in an organization or in the community. By being aware of issues and the people who can effect change, the nurse can influence those in the decision-making roles. 2. Running for political office is a way to be politically active, but it is not the reason to be politically aware for most nurses. 3. There is no guarantee that being politically aware and active will have any effect on wages and benefits. 4. A nurse can increase understanding of client rights without being politically aware and active.

A staff nurse says, "I have so much to do. Why should I spend time being politically aware and active?" Which response by the nurse manager would be most appropriate? 1. "Being politically active helps you influence events and the decisions of others." 2. "You might want to run for political office someday." 3. "It might help you increase your salary." 4. "It will give you a better understanding of client rights."

Answer: 2 Explanation: 1. Active following takes skill, self-direction, and energy. There is no evidence that it is easier than leading. 2. In any situation where people must work together, followership is a valuable skill. 3. There is no indication that this nurse is not effective in the followership role and may be a valuable employee without leadership skills. 4. Leadership skills can be learned.

A staff nurse tells the manager, "I don't want to be promoted. I am a much better follower than I am a leader." How should the manager interpret this remark? 1. Leadership takes more energy than followership, so this nurse is taking the easy way out. 2. Followership is a valuable skill in nurses. 3. A nurse who is not willing to work to master the skills of leadership should not be retained on the unit. 4. Most people have difficulty developing leadership skills.

Answer: 3 Explanation: 1. Developing staff competencies is very important but not the most important consideration. 2. Strategic planning is very important but not the most important consideration. 3. Although the nurse manager has a variety of roles and tasks, the most important role is assuring quality client care. The nurse manager is accountable for quality care. 4. Managing fiscal resources is a very important task of the nurse manager but not the most important consideration.

A successful nurse manager is mentoring a newly promoted nurse manager. Which comment by the mentor reflects the most important consideration of all nurse managers? 1. "You must work to develop your staff's competencies." 2. "Take your role on the strategic planning committee very seriously." 3. "Your most important role is to ensure client care accountability." 4. "Fiscal resource management is the most important aspect of your job."

Answer: 1, 3, 4 Explanation: 1. Behavioralists believe leaders are made, not born. Leaders become good at leading through formal education, experience in leadership roles, and training in leadership seminars. 2. Some researchers believe leaders are born with personality traits that make them successful in leadership. This is not part of behavioral theory. 3. Behavioralists believe leaders are made, not born. Leaders become good at leading through formal education, experience in leadership roles, and training in leadership seminars. 4. Behavioralists believe leaders are made, not born. Leaders become good at leading through formal education, experience in leadership roles, and training in leadership seminars. 5. Abilities may develop in a variety of ways. This is not a part of behavioral theory.

According to the behavioral view of leadership, how are leaders formed? Select all that apply. 1. By being educated 2. From inborn traits 3. With training 4. Through life experiences 5. Through abilities

Answer: 3 Explanation: 1. This statement sets up an "us against them" mentality. This mindset does not support respect for the physicians and could make communication more difficult. 2. This statement sets up an "us against them" mentality. This mindset does not support communication. 3. The nurse manager should ensure that the nursing staff is competent in the procedures that are causing problems by reviewing the steps of the procedures with them. 4. The preconceived notion that the problems are the fault of the physicians would make open and honest communication more difficult.

After several near-incidents during procedures, the nurse manager is increasingly concerned about how nursing staff members communicate with physician staff. Which advice from the manager would be most beneficial to the nursing staff? 1. "Don't forget, you are just as good as they are." 2. "Physicians just don't listen as well as nurses." 3. "Let's review the steps of the procedures that we know are the biggest problems." 4. "I'm going to listen to the physicians, but I think most of the problem is with the physicians, not the nurses."

*Answer: 1* *Explanation:* 1. The documentation in the chart should be a statement of the facts as well as the client's physical status after the incident. 2. The word "accidentally" should not be used to document incidents. 3. The nurse is not certain the IV was turned off by the previous shift, so that entry should not be used. 4. The fact that an incident report was completed should not be documented.

After shift change the nurse discovers that a client's IV heparin has been turned off at the IV controller. The amount of fluid left in the IV bag indicates that the client received half of the dose ordered. Which statement should be documented in the client's medical record? 1. IV heparin restarted. Physician notified. Client's vital signs unchanged. 2. IV heparin restarted at a rate to catch up dosage accidentally deleted. 3. IV heparin turned off by previous shift. Restarted. 4. IV heparin restarted and incident report completed.

*Answer: 2, 4* *Explanation:* 1. Experimentation involves testing a theory to produce a prediction. 2. Intuition and past experiences enable the expert nurse to make clinical judgments based on wisdom, sensitivity to the client, and a "gut feeling" that a change in the client is imminent. 3. Satisficing involves choosing a solution to meet minimum standards of care. 4. Intuition and past experience enable the expert nurse to make clinical judgments based on wisdom, sensitivity to the client, and a "gut feeling" that a change in the client is imminent. 5. The trial-and-error method is not based on prior experience; rather, one approach after another is tried until the problem is solved.

Although the postoperative assessment of a client reveals no abnormalities, the nurse believes the client's condition is deteriorating and orders frequent vital signs. This intervention was made on the basis of which type of problem solving? Select all that apply. 1. Experimentation 2. Intuition 3. Satisficing 4. Past experience 5. Trial-and-error method

Answer: 2, 5 Explanation: 1. Assessment is a responsibility for the RN. 2. The LPN is permitted to turn and reposition the patient with an ulcer. 3. Although the LPN is permitted to change dressings, the RN is responsible for assessment. 4. Assessment is a responsibility for the RN. 5. The LPN is permitted to administer oral medications.

An RN prepares for the day and makes a list of what should be delegated to the LPN. Which tasks should the nurse delegate to the LPN? 1. Assess a surgical incision. 2. Turn and reposition the client with a decubitus ulcer every two hours. 3. Dressing change and assessment of newly debrided wound. 4. Assessment two new admissions. 5. Administer all oral medications to clients on the unit.

Answer: 4 Explanation: 1. Nurses working in groups managing themselves are an example of self-directed work teams rather than shared governance. 2. Servant leadership arises from a desire to serve and share. This leadership may or may not be shared. 3. Two nurses sharing the management role are an example of co-leadership. 4. Shared governance is a formal process. Decision making is done by designated nurse representatives.

An accreditation visitor observes the following situations in a healthcare organization. Which situation would this visitor interpret and document as evidence of the shared governance type of shared leadership? 1. Nurses working in groups and managing themselves 2. Nursing leadership originating from a desire to serve and share 3. Two nurses sharing the management role 4. Nurses formally organized to make decisions regarding practice standards

Answer: 1 Explanation: 1. Acknowledging the person's frustration validates his or her feelings, and asking for input helps make him or her part of the solution. 2. This statement is confrontational and is unlikely to result in a positive response from the employee. 3. Threatening the employee, no matter how veiled the threat, is confrontational and is unlikely to result in a positive response. 4. Patronizing remarks are condescending and are not likely to result in a positive employee response.

An employee is sabotaging the work of a newly oriented charge nurse, and the charge nurse has not been successful in addressing the problem. When the nurse manager addresses the issue, which is the most appropriate statement? 1. "I know it must be frustrating working with a new charge nurse, but how can we make this situation better?" 2. "This is not professional behavior, and you need to stop it or you will lose your job the next time I hear about it." 3. "I know the charge nurse is new to the role, but you should get used to it or there will be more changes." 4. "I know the new charge nurse is difficult to work with, but please help make the job easier to do."

Answer: 4 Explanation: 1. Eye contact can assist in keeping the message clear. 2. Repeating the message can assist in keeping the message clear. 3. Tailoring the message can assist in keeping it clear. 4. It does not matter how uncomplicated the topic is; misunderstandings and distortions can still occur.

An inexperienced speaker is practicing delivering a speech. Which statement indicates a lack of understanding about how easily communication is distorted? 1. "I know I can better connect with my audience with good eye contact." 2. "If I repeat a complicated section in another way, comprehension is improved." 3. "If I know the background of the audience, it can help with tailoring the content." 4. "The topic is not complicated, so I don't have to worry about misunderstanding."

Answer: 4, 5 Explanation: 1. Decreasing the time from admission to assessment is an objective. There is no indication of how this is to be accomplished. 2. Increasing client satisfaction with better meals is an objective. There is no indication of how this would be accomplished. 3. Decreasing the number of medication errors is an objective. There are no strategies given for how this would be accomplished. 4. Initiating IV therapy within a specific time is a strategy. It is specific to the task and specifies an action to take. 5. Using scanning mechanisms is an example of how something would be done, so it is a strategy.

As a part of the strategic planning process, nursing units have been asked to develop strategies to meet designated objectives. Which statements represent strategies? Select all that apply. 1. "Decrease the amount of time from client admission to the room to completion of the admission assessment." 2. "Increase client satisfaction survey scores regarding meals." 3. "Decrease the number of medication errors on the unit." 4. "Initiate intravenous therapy within 30 minutes of the order being taken." 5. "Use scanning mechanisms to record the numbers of supplies used."

Answer: 3 Explanation: 1. There is no evidence that this nurse lacks foundational thinking skills. 2. There is no evidence that this nurse lacks personal and professional accountability. 3. To effectively manage a high-acuity unit, the nurse must have sufficient experience to develop clinical practice knowledge. Three months is not long enough for that to occur. 4. There is no evidence that this nurse does not have effective communication skills.

As a result of retirements, resignations, and reorganization, a nurse became nurse manager of a high-acuity unit three months after being licensed. The manager struggles with the responsibilities of the position and is often unable to make decisions. Which component of the AONE management competencies does this nurse probably lack? 1. Foundational thinking skills 2. Personal and professional accountability 3. Clinical practice knowledge 4. Effective communication skills

*Answer: 2, 3, 4, 5* *Explanation:* 1. Reward power is not a source of personal power. 2. Technical competence and knowledge are part of expert power. Expert power is a personal power. 3. Ability to access data is information power. Information power is a personal power. 4. Formal and informal links with people of influence are the basis of connection power. Connection power is a personal power. 5. Admiration and respect for an individual is based partly on the person's friendliness, helpfulness, and likability. Admiration and respect result in referent power. Referent power is a personal power.

As part of a career advancement strategy, the nurse has identified a need to increase personal power in the organization. Which abilities should the nurse focus on improving? Select all that apply. 1. Ability to reward others 2. Technical competence and knowledge 3. Ability to access data 4. Relationships with people who are influential in the organization 5. Remain friendly, helpful, and likable

*Answer: 4* *Explanation:* 1. During a transition, there is a time when it is easier to go back to the way things were done prior to the change. This is not a strong argument for abandoning the change. 2. Physician and nurse preference is not a strong argument for abandoning the change. 3. Nurse preference is not a strong reason to abandon the change. 4. When taking action within an organization, it is more powerful to be prepared with data. This statement focuses on why there is a need for action to address a problem.

As part of a shared visioning initiative, a new medication administration system has been adopted. A staff nurse has been chosen to relay the unit's dislike of the system to the evaluation committee. Which would be the most effective method to communicate the unit's disapproval? 1. "More than 75% of the nurses on unit 3M want to return to the previous process for passing meds." 2. "The physicians have complained about the new system, and the nurses on 3M have voted to return to the old medication passing routine." 3. "The nurses on 3M do not like the new system. Do other units agree?" 4. "Medication errors have increased 40% on 3M since the new system began. We believe there is a problem."

*Answer: 1* *Explanation:* 1. Benchmarking is the comparison of data with other reliable sources internally and externally with the goal of quality improvement. 2. Standards are written statements that define a level of performance. An outcome standard involves the end results of care given. 3. An indicator is a tool to measure the performance of structure, process, and outcome standards. 4. Standards are written statements that define a level of performance. Process standards are those connected with the actual delivery of care.

As part of the process of promoting quality improvement, the nursing manager is comparing data between two hospitals on average length of stay for a total hip replacement. This comparison is an example of which process or step? 1. Benchmarking 2. Outcome standard 3. Indicator 4. Process standard

Answer: 1, 2, 4 Explanation: 1. Continuity of care may suffer when care is given by more than one individual. 2. Team nursing requires excellent communication skills in all team members, who must communicate with clients, families, and each other. 3. Team nursing does save on personnel costs. 4. The RN must be careful to delegate only tasks that are appropriate for the skill level and licensure of the designated personnel. The RN is ultimately responsible for all client care. 5. Team nursing does reduce the number of professional staff required.

As the RN team leader, identify potential disadvantages of using team nursing to deliver care to assigned clients. Select all that apply. 1. Continuity of care may suffer. 2. Client/staff communication may be an issue. 3. There is little cost savings to the institution. 4. Delegation is necessary. 5. Not as many professional staff are required.

Answer: 3 Explanation: 1. Client-centered care as a practice model is not the same as centering care around the client. 2. There would be fewer RNs in the client-centered care model. 3. The nurse manager's role in client-centered care requires considerable time. The nurse manager must be a strong leader. 4. Client-centered care is actually decentralized. Many of the tasks traditionally done by a central office, such as admission, are unit based.

At a strategic planning meeting the nurse executive recommends instituting client-centered care as a model of care delivery in the hospital. Which statement by the hospital CEO indicates understanding of this concept? 1. "We have always had the client at the center of everything we do." 2. "We can't afford to hire more RNs." 3. "I'm concerned about the increased time and leadership our nurse managers will have to provide." 4. "I like the idea of centralizing all our care."

*Answer: 3* *Explanation:* 1. Although all organizations are governed by a budget, what is "prohibitive" to one committee member may not be so to another. All solutions should be presented. 2. Sometimes an "old" solution is workable. 3. Brainstorming is for idea generation only. Idea critique will follow in another session. 4. The idea of brainstorming is to generate many ideas quickly. It would be better to limit the time than to limit the number of ideas.

At the beginning of a brainstorming session, the manager lists the rules to be followed. Which rule should be included and enforced? 1. Do not suggest any solution that is prohibitively expensive. 2. Suggest only ideas that the group has not already tried. 3. Do not critique any ideas presented. 4. Limit the session to the first 15 ideas.

Answer: 3 Explanation: 1. Normative-reeducative strategies focus on people's roles and relationships, perceptual orientations, and attitudes that influence their acceptance of change. 2. Lippitt's phases of change are a seven-step process of change that involves participants in every step of the process. 3. The assumption of the empirical-rational model is that people are rational and will follow their rational self-interest if that self-interest is made clear to them. In this instance, when the nurses have the knowledge to use the charting system and have a chance to try it, it will become clear that it is in their best interest to adopt the new system. 4. Power-coercive strategies are based on the application of power by legitimate authority, economic sanctions, or political influence.

Computerized charting will be initiated on select units of the hospital. Orientation to this new system will be provided to each nurse by a team of nurses educated in nursing informatics. This is an example of which type of change strategy? 1. Normative-reeducative strategies 2. Lippitt's phases 3. Empirical-rational model 4. Power-coercive strategies

*Answer: 1, 2, 4, 5* *Explanation:* 1. This is an underlying assumption about why this change is being considered. 2. This speaker assumes that everyone likes to bathe right before bed, not taking into consideration that some like to bathe in the morning. 3. A research article report is not an assumption but based on evidence. 4. This is an assumption that might well be erroneous. 5. This is an assumption.

Currently, clients on a unit are bathed in the morning between 8:00 a.m. and 11:00 a.m. The nursing staff is contemplating changing that routine to bathing clients in the evening between 7:00 p.m. and 9:00 p.m. Which statement reflects an underlying assumption that might affect the staff's ability to think critically about this change? Select all that apply. 1. "The day shift just wants to shift work onto the evening shift." 2. "Everyone likes to bathe right before bed." 3. "I read a research article that reported that clients sleep better if they have been bathed right before bedtime." 4. "The physician staff will be upset if we change our morning routine." 5. "If we let them change this, they will want to make lots of other changes, too."

Answer: 3 Explanation: 1. The nurse is not passively participating. There is an indication that the work will be done. 2. The active follower would express ideas on how to achieve the goal. 3. This dependent "you make the decision and I'll do it" statement is characteristic of an ineffective follower. 4. An independent follower would express constructive criticism of plans.

During a discussion of how to proceed on a project, a team member says, "I don't care how we do it. Just tell me what to do and I will get it done." What kind of followership is this nurse exhibiting? 1. Passive 2. Active 3. Dependent 4. Independent

Answer: 1 Explanation: 1. An HMO is a geographically organized system that provides an agreed-upon package of health maintenance and treatment services. Providers must be chosen from those in the HMO. 2. The HMO system will not pay for services provided "out of network." 3. The ability to choose a provider who is "out of network" for an additional premium is a feature of point-of-service plans. 4. The HMO provides an agreed-upon package of health maintenance and treatment services. Treatment and services are not unlimited.

During a nurse's interview for a new job, the health benefits are described as being provided by a health maintenance organization (HMO). What should the nurse expect from this coverage? 1. The nurse will have to choose a provider from within the HMO. 2. The nurse can obtain services from a nonparticipating provider and the HMO will pay for a portion of the charges. 3. For an additional premium, the nurse can choose any provider. 4. By joining this HMO, the nurse is entitled to unlimited treatment and services.

Answer: 2 Explanation: 1. Span of control is not directly related to the number of duties expected. 2. Span of control addresses the number of employees a manager can effectively supervise. 3. Span of control issues may result in burnout, but there is no indication from this scenario that this is the case. 4. There is no indication that the nurse manager's level of education is insufficient for the role.

During a performance evaluation the nurse manager states, "My span of control is just too large." How should the unit supervisor interpret this statement? 1. The nurse manager is not capable of performing all the duties expected of the role. 2. The nurse manager may have too many staff members to manage. 3. The nurse manager is burned out and needs time away from the unit. 4. The nurse manager is not educationally prepared for the role.

Answer: 1 Explanation: 1. Metacommunications are nonverbal messages conveyed by body language and environmental factors. 2. Intrasender conflict occurs when there is a difficulty in the interpretation of an intended message due to disparity between verbal and nonverbal communication. 3. Fogging is a communication technique in which one partially agrees with what was said. 4. Intersender conflict occurs when there is a difficulty in the interpretation of an intended message due to disparity between different sources.

During an evaluation conference, the nurse manager observes nonverbal messages, including nodding in agreement and smiling. These behaviors are examples of which aspect of communication? 1. Metacommunication 2. Intrasender conflict 3. Fogging 4. Intersender conflict

Answer: 1, 2, 3, 5 Explanation: 1. The manager may be able to delegate some tasks to nurses if the nurses are not overloaded with client care that could be completed by UAPs. 2. If delegation is done effectively, unit efficiency is increased. 3. If the manager can get more done because delegation is effective, there is a greater chance for career advancement. 4. There is no evidence that this is the case. 5. Development is stifled when the staff members are doing the wrong tasks.

During the first staff meeting, a newly promoted nurse manager says, "I would like a commitment from all the nurses to review and improve the way delegation is done on the unit." Why would the manager be interested in delegation? Select all that apply. 1. Effective delegation allows the manager to focus more time on management tasks. 2. Efficiency is increased by effective delegation. 3. If the manager has more time to focus on managerial duties, there is more chance of career advancement. 4. The nurse manager thinks unlicensed assistive personnel (UAPs) provide better bedside care than nurses do. 5. The manager is interested in developing the entire staff to its maximum potential.

*Answer: 2, 3, 4, 5* *Explanation:* 1. Lack of interest on the part of nurses is not a reason EBP is not used. 2. Lack of time is a barrier to using EBP that is consistent across settings. 3. The need for autonomy over the nurse's own practice can be a barrier to using EBP. 4. Inability to find and assess evidence is a barrier to using EBP. 5. Lack of support from administration is a barrier to using EBP.

Efforts to increase nurses' use of evidence-based practice (EBP) to improve client care in the hospital have failed. Which answers are nurses likely to give when asked why this is occurring? Select all that apply. 1. "I'm not interested in this program." 2. "I don't have time to finish everything I already have to do each shift." 3. "I don't want to practice nursing just like everyone else." 4. "The library at our hospital doesn't have many journals." 5. "If administration wanted us to use EBP, they would get us some more nurses to share the work."

*Answer: 1, 3, 4, 5* *Explanation:* 1. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. 2. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. Defamation is not an element that must be present. 3. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. 4. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met. 5. For malpractice to exist the elements of duty, breach of duty, causation, and injury all must be met.

For malpractice to exist, which of the following elements must be present? Select all that apply. 1. Causation 2. Defamation 3. Breach of duty 4. Duty 5. Injury

Answer: 3 Explanation: 1. The ANA Bylaws do not set out legal rules or regulations for delegation. 2. NCSBN does not set the legal rules and regulations of delegation. 3. Nurses in each state are governed by their own state's nurse practice act, and these regulations must be consulted and followed. 4. Specialty organizations do not set the legal rules and regulations of delegation.

For the nurse to effectively and legally delegate, which document must be consulted and followed to reduce the likelihood of liability? 1. The American Nurses Association Bylaws 2. The National Council of State Boards of Nursing 3. The regulations of the state nurse practice acts 4. The rules of the governing specialty organization

Answer: 3 Explanation: 1. There is no reduction of the hospital's liability for errors. 2. Residency programs for nurses are not being established to mimic physician education. 3. The IOM has made this proposal. 4. There is no assurance that nurses who participate in residency programs will engage in lifelong learning.

Hospital administration is working with a university school of nursing to establish a nursing residency program. Why is this a desired action? 1. A residency program eliminates the hospital's liability if a novice nurse makes an error. 2. A residency program is established to make nursing education more like physician education. 3. The Institute of Medicine (IOM) has proposed residency programs for nurses. 4. A residency program ensures that nurses participate in lifelong learning.

Answer: 2 Explanation: 1. The nurse must still complete the six rights of medication administration to ensure client safety. 2. Robots should be able to get medications to the floor more quickly. 3. The administration of medication cannot be delegated to the nursing assistant. 4. There is no assurance that medication administration will be easier.

Hospital administration is considering the purchase of a robotic pharmacy system. What would be the advantage of this system to the nurses who work in the hospital? 1. The nurse will be able to leave out some of the six rights of medication administration because the robot checks the medications. 2. The nurse should get medications more quickly because the robot can work more consistently without breaks. 3. The nurse can delegate medication administration to the nursing assistant because the medications have already been checked. 4. The nurse can expect that medication administration will be easier and carry less potential for error.

Answer: 2 Explanation: 1. Power-coercive strategies are used when much resistance is anticipated, time is short, and the change is critical for organizational survival. This strategy may meet with resistance from the nursing staff. 2. In most cases, the normative-reeducative approach to change is effective in reducing resistance and stimulating personal and organizational creativity. 3. The empirical-rational strategies are most often effective when little resistance to the proposed change is expected, and the change is perceived as reasonable. This is likely not the case with the change described. 4. A driving force is a behavior that facilitates change by pushing participants in the desired direction in spite of restraining forces.

Hospital administrators are considering changing from the traditional method of creating work schedules to a system in which the nurses will choose their own workdays. Choices will be made according to seniority. Which change strategy would likely be best for this endeavor? 1. A power-coercive strategy 2. A normative-reeducative strategy 3. An empirical-rational model 4. A driving force

Answer: 1 Explanation: 1. Close examination of the political process shows that it closely follows the nursing process. The nurse will assess the situation, create a plan of action, implement that plan, and evaluate and revise the plan. 2. Reacting to problems as they occur shows a lack of planning. 3. Connecting with the outside community may be necessary, but if the nurse is trying to influence the policies of an organization, the bulk of the work will be done within the organization. 4. The nurse cannot remain passive and expect administrators to create all the policies.

How can a nurse best influence policies in an organization? 1. Follow the nursing process. 2. React to problems as they occur. 3. Connect with the outside community. 4. Look to administrators to be the policy makers.

*Answer: 3* *Explanation:* 1. A medication error occurs when a medication or fluid is omitted, the wrong dose is administered, or the medication is administered to the wrong client. 2. A medical-legal incident occurs when a client or family refuses treatment as ordered. 3. Any incident occurring before, after, or during a procedure is categorized as a diagnostic procedure complication. 4. Complications from diagnostic or treatment procedures are a high-risk area in healthcare and are reported as incidents.

Immediately following a barium swallow, a client noticed hives and a feeling of shortness of breath. Although there were no known allergies to food or drugs prior to this incident, the diagnosis was an allergic reaction to the preservatives in the barium. Which is the correct risk category for this incident? 1. Medication error 2. Medical-legal incident 3. Procedure complication 4. This incident does not fall into a risk category.

Answer: 3 Explanation: 1. Although the leader can show no favoritism, leaders can have friends among the group of followers. 2. The caring demonstrated in the leadership-followership relationship must be authentic. 3. Authentic caring in relationships is an important method of improving respect and competence as a leader. 4. Authentic leaders are willing to take risks and are not afraid to do any task.

In a leadership training class, which statement by a student indicates learning has been successful? 1. "If I am to be successful in leadership, I should make sure no followers are friends." 2. "Most people would not be able to tell if I only pretend to be interested in them." 3. "Relationship building is essential to successful leadership." 4. "Leadership means I can delegate tasks I do not want to do."

Answer: 1, 2, 3, 5 Explanation: 1. The delegator and delegate share accountability to accomplish the task. 2. The delegator and delegate share accountability to accomplish the task. 3. The delegator must have the authority to assign the task. 4. The delegate takes on the responsibility for completion of the task. 5. Effective delegation transfers authority to the delegate to empower the delegate for success.

In order to delegate, what must be present? Select all that apply. 1. Accountability for the assignment on the part of the delegate 2. Accountability for the assignment on the part of the delegator 3. Authority by the delegator to assign the task to the delegate 4. Responsibility for task completion on the part of the delegator 5. Authority of the delegate to accomplish the task as assigned

Answer: 3 Explanation: 1. Functional nursing does not focus on specific outcomes. 2. Practice partnership does not focus on specific outcomes. 3. Case management organizes client care by major diagnoses and focuses on attaining predetermined outcomes within a specific time frame. 4. Primary nursing does not focus on specific outcomes.

In order to organize services needed to achieve specific client outcomes, hospital administrators should consider what type of client care delivery system? 1. Functional nursing 2. Practice partnerships 3. Case management 4. Primary nursing

Answer: 4 Explanation: 1. Just because this child is adopted does not mean that the admission history will not be correct or that communication with the child or parents will be impaired. 2. Just because a person is older does not mean that communication is impaired. 3. Just because the person is from another country does not mean that communication will be distorted. 4. Communication will be most affected by the confusion of the client because the nurse cannot be sure of anything the client said or that the client understood anything the nurse tried to communicate.

In which situation should the nurse be most concerned that communication was distorted? 1. The nurse obtains an admission history from the parents of an adopted child. 2. The nurse gives discharge instructions to a couple in their early 80s. 3. The nurse manager hires a new nurse originally from the Philippines. 4. The emergency nurse receives a confused client who was transferred in an ambulance.

*Answer: 1, 3, 4, 5* *Explanation:* 1. By investigating a complaint, the nurse manager may discover a true issue in the delivery of care. The manager may also gain a greater understanding of any underlying tensions that caused the spouse to make the complaint. 2. Cutting corners is a very real temptation in the high-paced environment in which nurses practice. The manager should not encourage this behavior as it is often risky and dangerous. 3. The nurse manager is in a position to discuss improvement of client care across disciplines. 4. The nurse manager can help make work more efficient by keeping staff members on task throughout the workday. 5. When staff members are tired from working overtime, they are more likely to make errors.

In which ways can nurse managers reduce risks for the organization? Select all that apply. 1. Investigating a complaint about nursing care from a client's spouse 2. Encouraging nurses to cut corners when possible 3. Talking to physicians about ways to improve client care 4. Keeping staff members on task throughout the workday 5. Making sure staff members work minimal overtime

*Answer: 2, 4, 5* *Explanation:* 1. A leader may not have reward power unless the leader is also the manager. Leaders can be formal or informal. 2. A leader may have information power. 3. A leader may not have legitimate power unless the leader is also the manager. Leaders can be formal or informal. 4. A leader may have expert power. 5. A leader may have referent power.

Leaders and managers often exercise power differently. Select the powers most frequently used by leaders. Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Reward power 2. Information power 3. Legitimate power 4. Expert power 5. Referent power

*Answer: false imprisonment* *Explanation:* Restraining clients without consent or sufficient justification may be interpreted as false imprisonment. In addition to legal rights, the use of restraints involves ethical issues such as autonomy and beneficence.

Restraining clients without consent or sufficient justification may be interpreted as ________.

Answer: 1 Explanation: 1. Moral agency is "doing the right thing." Reporting a medication error is the right thing to do. 2. Collaboration is a desirable characteristic but does not describe moral agency. 3. Systems thinking is a desirable characteristic but does not describe moral agency. 4. This is a description of clinical inquiry, not moral agency.

One of the nurse competencies of the synergy care delivery model is "moral agency." Which action is an example of that trait? 1. The nurse commits a medication error and reports it to the charge nurse. 2. The nurse collaborates well with the rest of the healthcare team. 3. The nurse is able to think ahead to the client's next need. 4. The nurse who does not have good baseline knowledge of a client's disease process researches it on a day off work.

*Answer: 1* *Explanation:* 1. Coercive power is based on penalties a manager might impose on an employee. A negative evaluation is a penalty. 2. Information power is based on information a manager has and employees want. 3. Referent power is based on the respect the followers have for the manager. 4. Reward power is based on the inducements a manager can give to the employees.

One of the nurses often fails to attend educational offerings available to the staff. The nurse manager implies the nurse may receive a negative evaluation, which is a use of which type of power? 1. Coercive power 2. Information power 3. Referent power 4. Reward power

*Answer: 1, 2, 3* *Explanation:* 1. Routine decisions are based on policies and rules. 2. Routine decisions are based on procedures. 3. Adaptive decisions are often modifications of well-known problems or solutions. 4. Solving unusual or unclear problems requires innovative decision making. 5. Novel situations require innovative decision-making abilities.

Part of the facility's performance evaluation is based on the nurse's strength in the three types of decisions. During a nurse manager's performance evaluation, the supervisor says, "You are very good at adaptive decisions, but you need to be more precise in routine decisions. When the situation calls for really innovative decisions, you do not seem sure of yourself." How should the manager interpret this information? Select all that apply. 1. "I am not following the policies and rules well." 2. "I should review the procedure manual." 3. "I'm good at using my previous experiences to guide my decisions." 4. "I am strongest in making decisions when the problems are very unusual or unclear." 5. "I make good decisions when the situation is novel."

Answer: 2 Explanation: 1. The staff nurse will be instrumental in carrying out the changes but is not the most influential in directing them. 2. The nurse manager is situated on the front lines but is also responsible to upper management. The manager can be supportive of the staff's feelings while adequately and appropriately representing the needs and wants of the administration. 3. The CFO will certainly have some say in the financial support of any changes made but is unlikely to have sufficient knowledge of the daily operations of the unit to handle changes at that level. 4. The CEO is unlikely to have enough information about the daily unit activities to be effective in instituting these changes.

Procedural changes are being planned on the unit as a direct result of client satisfaction surveys. Which individual is most strategically placed to handle how these changes are initiated? 1. Staff nurse 2. Nurse manager 3. Chief financial officer (CFO) 4. Chief executive officer (CEO)

Answer: 2, 3, 4 Explanation: 1. Factors that occur in changing environments are part of contingency theory. 2. Focusing on the nature of the work is part of reductive theory. 3. Focusing on structures to achieve work is part of reductive theory. 4. Factors that divide work into parts are part of reductive theory. 5. Focusing on the desire for social relationships is part of humanistic theory.

Reductive theory focuses on which factors? Select all that apply. 1. Factors that occur in changing environments 2. The nature of the work 3. Structures to achieve work 4. Dividing work into parts 5. Desire for social relationships

Answer: 1 Explanation: 1. Flexibility is a skill imperative when choosing a delivery system(s) for nursing care. The system must meet client and staff needs and organizational and unit-specific goals, as well as remain within cost constraints. If not, flexibility allows for change to occur to alter the system as necessary to achieve the desired effects. 2. Strict adherence to a set of rules or structure is not appropriate in today's healthcare environment, where adaptability is essential. 3. The nurse should be persistent in learning new roles, but persistence is not the best answer to this question. 4. Resistance to change is not a desirable skill in today's healthcare environment.

Regardless of which delivery system or combination of delivery systems is appropriate, which skill is required for effective use? 1. Flexibility 2. Strict adherence 3. Persistence 4. Resistance to change

Answer: 2, 4 Explanation: 1. Clarification of organizational structure is part of the manager's job. 2. A leader uses interpersonal skills to influence others to accomplish a specific goal. 3. Negotiating pay is a role of the manager. 4. Leaders help to forge links among the organization's members. 5. Making assignments is a part of the manager's role.

Staff nurses have been asked to comment on the work of a nurse manager as part of the manager's performance review. Which comments by the staff nurses would indicate to the supervisor that the manager is also a leader? Select all that apply. 1. "The manager helped me to understand the structure of the hospital's organization." 2. "I hope to be as good a manager." 3. "The manager negotiated a pay increase for the RNs on the unit." 4. "The manager's example has encouraged me to get to know people in other departments in the hospital." 5. "The manager's assignments are always fair and appropriate for the client census."

Answer: 3 Explanation: 1. Critical pathways are a set of strategies used by healthcare providers to attain expected outcomes. Critical pathways are not a nursing care delivery system, and there are insufficient data to determine if they are used in this scenario. 2. Total client care is given by one nurse. 3. The RN in this case is leading a team. A variety of skilled caregivers cares for a group of clients. 4. Functional nursing breaks down the assignments into tasks.

The RN receives reports on eight clients in the morning. Client assignments are then delegated to an LPN and two nursing assistants. The morning is busy, with physician visits and new client orders, and the RN communicates these new orders to the LPN and nursing assistants. The RN also meets with the case manager to discuss nursing home placement for a client. What type of nursing care delivery system is in place in this hospital? 1. Critical pathways 2. Total client care 3. Team nursing 4. Functional nursing

Answer: 3 Explanation: 1. It is hard to prove that nurses thrive on transition. 2. Nurses have not always reacted positively to change. 3. Nurses are client advocates who routinely interact with multiple disciplines in the provision of quality care. 4. Nurses do act in the client's best interest, but this option is not as strong as another.

The CEO of the hospital approaches the chief nurse with a request that the nurse act as the primary change agent in the implementation of a new hospital-wide policy. Why would the nurse be a good choice for this assignment? 1. Nurses thrive on transition and work best in such circumstances. 2. Nurses are role models for reacting positively to change. 3. Nurses routinely interact with multiple disciplines. 4. Nurses are always acting in the client's best interest.

*Answer: 2* *Explanation:* 1. Negligence means failure to take proper care in doing something. 2. When an individual does not desire what others determine to be in that person's interest, the principles of beneficence and autonomy conflict. When in conflict situations involving client care decisions, the principle of autonomy overrides the principle of beneficence. 3. Non-maleficence means non-harming or inflicting the least harm possible to reach a beneficial outcome. 4. Distributive justice is giving a person that which he or she deserves and it implies that benefits and burdens are distributed equally and fairly.

The RN recognizes that in cases of conflict involving client care decisions which principle overrides beneficence? 1. Negligence 2. Autonomy 3. Non-maleficence 4. Distributive justice

Answer: 1, 2, 3, 5 Explanation: 1. Engaging in lifelong learning is an IOM recommendation that will help nursing lead change. 2. Removing scope of Practice barriers is an IOM recommendation that will help nursing lead change. 3. Implementing nurse residency programs is an IOM recommendation that will help nursing lead change. 4. Changing the structure of the organization is not an IOM recommendation that will help nursing lead change. 5. Leading change to advance health is an IOM recommendation that will help nursing lead change.

The Institute of Medicine (IOM), has made recommendations for the nursing profession in its report "The future of nursing: Leading change, advancing health." Which recommendations will help nurses lead change? Select all that apply. 1. Engage in lifelong learning 2. Remove scope of Practice barriers 3. Implement nurse residency programs 4. Change the structure of the organization 5. Lead change to advance health

Answer: 2 Explanation: 1. The RN must focus on the work that requires RN skills. In some cases, this work consumes much of the shift. The RN should not ignore that work to placate the UAP. 2. Resentment against the team leader for not doing "real nursing" is a common drawback of team nursing. 3. Reporting the UAP for unprofessional behavior will not make the resentment go away and may make the situation worse. 4. There is no indication that this UAP is not educated or does not work well on a team. The UAP may not understand the roles on the team.

The RN leader of a team overhears one of the UAP on the team say, "I'll sure be glad when I get my RN license. All they do is sit around doing paperwork." How does the RN interpret this comment? 1. As a need to be more involved in direct client care when this UAP is on the team 2. As a common disadvantage of the team approach to nursing 3. As an indication that this UAP should be reported for unprofessional behavior 4. As confirmation that UAP are poorly educated and do not work well on teams

Answer: 1, 4 Explanation: 1. The CNA is permitted to help clients with activities of daily living. 2. The CNA is not permitted to start IVs. 3. The CNA is not permitted to administer oral medications. 4. The CNA is permitted to collect vital signs. 5. The CNA is not permitted to discontinue IV's. The tip of the catheter must be assessed by the RN.

The RN plans to delegate responsibility of client care to a certified nursing assistant (CNA). 1. Assist a client to shower. 2. Start an IV. 3. Administer oral medications. 4. Take vital signs. 5. Discontinue an IV.

Answer: 3 Explanation: 1. Ordering an increase in physical therapy is not within the scope of nursing and would not be the priority action. 2. The family may have important information about the client's mobility, but this is not the priority action. 3. The case manager tracks all variances, reports to the collaborative team, and may revise the critical pathway. 4. Discussing the problem with the surgeon is not the priority action.

The RN working on an orthopedic unit is caring for a postoperative client with a hip replacement who is not transferring well from bed to chair. The client is behind on the mobility training program. What action is the nurse's priority? 1. Instruct physical therapy to increase treatments to four times daily. 2. Contact the family to discuss preoperative mobility problems. 3. Inform the case manager of variance in the critical pathway. 4. Discuss the problem with the client's surgeon.

Answer: 1, 2, 3, 5 Explanation: 1. The collaboration characteristic of a healthy work environment is "true collaboration." Lobbying for physician support is not true collaboration. 2. Effective decision making is a characteristic of a healthy work environment. If the staff nurse was comfortable making a decision without input, the nurse would not ask for help. 3. Recognition should be meaningful. Recognizing two nurses from each unit each week is not meaningful. 4. Appropriate staffing is a tenet of a healthy work environment. 5. While email is a convenient method of communication, it should not be the only method employed.

The administration of a healthcare system advertises that it promotes "a healthy work environment." Which events would cause a nurse working in this system to question this statement? Select all that apply. 1. The nurse collaborating with physical therapy to establish mutually agreeable treatment schedules lobbies physicians to support nursing's position in any disagreements. 2. When staff nurses ask for the nurse manager's opinion on client care issues, the response is frequently, "I'll leave that decision up to you." 3. Administration has developed a plan in which each week two nurses from each unit are recognized as "best nurse of the week." 4. The nurse managers of each unit make a true effort to provide adequate staffing on each shift. 5. The nurse executive communicates with managers mostly by email.

Answer: 1, 5 Explanation: 1. One of the primary focuses of a disaster plan is how to care for the influx of clients. 2. Prevention of internal disasters is the focus of physical plant planning and safety planning. It is not the primary focus of the disaster plan. 3. Funding in a disaster is problematic. It is not possible to plan for the extent of the disaster or its impact on funding, or to predict who will pay. 4. There may be physical, mental, and emotional impact on clients and staff. Planning is a way to reduce this impact. 5. Risk identification is part of a safety plan.

The administrators of a small hospital are revising its disaster plan. What should be the primary focus of this plan? Select all that apply. 1. Preparing for a surge of casualties in case of a disaster 2. How to prevent disasters from occurring 3. How to fund disaster management 4. How to reduce disaster impact on clients and staff 5. How to identify risks for disasters

Answer: 4 Explanation: 1. Demonstration of management skills is not the priority expected outcome. 2. Agreement and presentation of a united front is not the priority expected outcome. 3. It is hoped that the changes will guide nursing practice, but this is not the priority expected outcome. 4. All nursing responsibilities and changes have the expected outcome of improving client care.

The nursing committee is planning a change in the unit's organization. Which statement reflects the priority expected outcome of these change agents' work? 1. The nurses involved will demonstrate management skills. 2. The nurses will agree with the change and present a united front for its adoption. 3. The change will guide nursing practice on the unit. 4. The change will lead to improved client care on the unit.

*Answer: 4, 5* *Explanation:* 1. The charge nurse must determine the nurses' purpose for being in the chart. 2. The question does not address whether the nurse is planning care for this client. 3. It is not a certainty that the nurse is breeching confidentiality unless the nurse does not need to know the client's healthcare coverage. 4. The charge nurse must ascertain the nurses' purpose for being in the chart. 5. This is a correct statement by the charge nurse. If the nurse is not giving or preparing care for the client, the nurse should not access the record.

The charge nurse observes another nurse access a client's medical record. When asking about this behavior the nurse responds, "As a nurse I have the right to know what type healthcare coverage my clients have." What are the best responses to this nurse? Select all that apply. 1. "Are you assigned to this client?" 2. "You are not planning care for this client." 3. "This is a breach of confidentiality." 4. "What is your purpose in accessing the clients' healthcare coverage?" 5. "If you are not giving any type of care to this client, you should not be accessing the client's record."

Answer: 2, 3, 4, 5 Explanation: 1. Experts in hospital physical design are considered a resource rather than stakeholders. 2. Employees of the hospital are considered stakeholders. 3. Physicians are considered stakeholders. 4. Administrators are considered stakeholders. 5. Community representatives are considered stakeholders.

The community hospital is considering a redesign initiative. As part of a SWOT analysis, nurses on the strategic planning committee have been asked to distribute surveys to stakeholders. The nurses will contact which groups? Select all that apply. 1. Experts in hospital physical design 2. Other nurses who work at the hospital 3. Physicians 4. Hospital administrators 5. Representatives from local insurance offices

*Answer: 1, 2, 4, 5* *Explanation:* 1. The measure must be based in research that shows the process leads to improved outcomes. More than one research study is required for documentation. 2. Quality measures should document that evidence-based practice was given. 3. Anecdotal information or single-nurse-practice information is not sufficient evidence for writing a quality measure. 4. The monitor is written in the "positive," meaning that the process is desirable. 5. The process should have minimal or no unintended adverse effects.

The continuous quality improvement (CQI) coordinator is establishing quality measures for a unit. These measures would be written according to which criteria? Select all that apply. 1. The CQI coordinator has read two research studies that show the process improves client outcomes. 2. The CQI coordinator has evidence that a particular practice is effective in decreasing length of stay. 3. The CQI coordinator has used the process in practice for more than two years. 4. The process being measured produces a desirable outcome. 5. There are very few unexpected bad effects from the process.

*Answer: 2* *Explanation:* 1. The manager should collect more information before contacting the nurse from the previous shift. 2. The nurse manager must first assess the situation. 3. The manager should not tell the daughter that the shift was understaffed. This is a liability and does not address the daughter's concerns. 4. Until the manager has assessed the issue, intervention cannot be provided.

The daughter of a hospitalized client comes to the nurse manager's office with a complaint about the care provided on the previous shift. What is the manager's first action? 1. Call the nurse from the last shift to participate in a conference call about the complaint. 2. Ask the daughter to explain what happened. 3. Tell the daughter that the last shift was understaffed and apologize for any problems that might have occurred. 4. Ask the daughter what can be done to improve the situation.

*Answer: 2* *Explanation:* 1. Referent power is based on admiration and respect for an individual. 2. The nurse manager possesses information that employees desire. The only means of getting the information is through the manager, so the manager has information power. 3. Legitimate power stems from the manager's right to make a request based on the authority associated with the job. 4. Connection power is based on an individual's formal and informal links to influential or prestigious persons.

The local hospital has recently been acquired by a larger hospital corporation. The nurse manager hangs a poster announcing that the new wage scale and benefits package will be discussed in the next unit meeting to encourage staff to attend. This is an example of which type of power? 1. Referent power 2. Information power 3. Legitimate power 4. Connection power

*Answer: 2* *Explanation:* 1. The "dashboards" in this scenario are not associated with automobiles. 2. Dashboards are electronic tools that provide ease of access to real-time or retrospective data. 3. Dashboard is not an acronym. 4. Dashboards are not part of the electronic medical record.

The director of quality improvement reports that the hospital will soon be using "dashboards" as part of the quality management process. How should the staff interpret this information? 1. Surveyors are driving to clients' homes to collect data on hospital visits. 2. This electronic tool makes it easy to aggregate and display data. 3. "Dashboard" is an acronym for the topics covered in client satisfaction surveys. 4. The "dashboard" is a screen on the electronic medical record that can be accessed for quality improvement information.

*Answer: 1, 3, 4, 5* *Explanation:* 1. To increase power, the nurse must first identify what she really wants. 2. Focus should be on the entire organization, not just the specific unit where the nurse currently works. 3. The nurse should prioritize her needs and goals in the order of their importance to her and to the organization. 4. The nurse must be aware of what resources exist and how she can obtain the resources she needs. 5. The nurse should identify who or what stands in the way of her achieving what she wants.

The female nurse identifies that many of the power positions in her organization are held by male nurses. Which strategies should the nurse use to improve her image and increase her power? Select all that apply. 1. Identify what she really wants. 2. Keep her focus on her unit, not the entire organization. 3. Prioritize her needs in order of importance. 4. Identify her current resources. 5. Determine who stands in the way of what she wants.

*Answer: 2* *Explanation:* 1. Documentation in the chart following an incident should be a statement of the facts; no blame should be placed. 2. The documentation is not appropriately written because it implies that someone was to blame for the incident. 3. The documentation must indicate that the physician was notified, not that the client's family was notified. 4. The documentation is not appropriately written; no blame should be placed.

The following documentation was entered in the client's medical record: "The client was found lying on the floor. Dr. X was notified. Apparently, the restraints were improperly applied." Which statement best describes this documentation? 1. Appropriately written 2. Inappropriate because it places blame on an individual 3. Inappropriate because it does not include that the client's family was notified 4. Appropriately written because it only documents the facts

Answer: 1, 3, 4, 5, 6 Explanation: 1. The nurse manager may be placed in the role of disciplining staff members who are impeding the work of the organization. 2. Once the decision to make a change has been made, the nurse manager should not act as a resister. 3. The nurse manager may be in the role of one who supplies information about the needed change. 4. The nurse manager may act as a liaison between the committee and the staff. 5. The nurse manager fulfills the role of support person for staff adapting to the change. 6. The nurse manager may act as discussion leader, both in formal and informal discussions.

The healthcare facility has elected to make a significant change in organization strategy. The change has been thoroughly researched and all levels of leadership have been included in the decision. Which roles are commonly undertaken by the nurse manager when such a change is necessary? Select all that apply. 1. Disciplinarian 2. Resister 3. Fact manager 4. Liaison 5. Support person 6. Discussion leader

Answer: 4 Explanation: 1. This statement specifies an outcome to be achieved. This is a goal. 2. This statement is specific to a particular unit and is an objective. 3. This is a statement of the organization's values. 4. The philosophy is a written statement that reflects the organization's values, vision, and mission. It is broader than a value statement.

The healthcare institution has organized a committee to review and revise the strategic plan. As part of this work, committee members have been asked to submit a philosophy statement for consideration. Which statement meets the requirements of a philosophy? 1. "We will increase client satisfaction by 15 percent." 2. "We will increase productivity by 10 percent on the surgical floor." 3. "We believe in honest communication." 4. "We believe clients are most important."

Answer: 2 Explanation: 1. Leadership is not unit specific. 2. The organization cannot promote someone to the position of leader. A leader uses interpersonal skills to influence others to accomplish a specific goal. The organization can promote a person who may become a leader. 3. A leader cannot be "hired." 4. Nurses often develop strong leadership over other healthcare providers, including other nurses.

The healthcare organization's monthly newsletter has a headline reading "Nurse Promoted to Leader of Specialty Care Units." What is the error inherent in this headline? 1. One person cannot be the leader of all the specialty care units in an organization. 2. A person cannot be promoted to the role of leader. 3. Leaders have to be hired from outside the organization. 4. Nurses cannot serve as leaders over other nurses.

Answer: 1, 3, 5 Explanation: 1. If a client requires transfer between units, a new primary nurse will be assigned in each unit. In some cases, this could result in multiple primary care nurses during one hospitalization. 2. Physician, nurse, and client satisfaction is generally increased with primary care. 3. The premise of primary nursing is that the nurse holds 24-hour-a-day accountability for client care. Legally, nurses cannot be accountable for care provided outside their work hours. 4. Requiring a knowledge-based nursing practice model is seen as an advantage of primary nursing. 5. Excellent communication must exist between the primary nurse and associate nurse. This is often difficult.

The hospital administration is considering adopting primary nursing as its model of nursing care delivery. Which of the following are disadvantages of this method? Select all that apply. 1. The client may have multiple primary nurses if transfers within the facility are necessary. 2. Physician satisfaction is decreased. 3. Staff nurses cannot be held legally liable for care provided outside their work hours. 4. It requires a knowledge-based nursing practice model. 5. All individuals caring for the client must have excellent communication skills.

Answer: 3 Explanation: 1. Lateral communication involves discussion among individuals at the same hierarchical level (e.g., all nurse supervisors). 2. Downward communication involves direction given by management to the staff. 3. Diagonal communication involves dialogue among individuals at different hierarchical levels (e.g., staff nurses to chief executive officer of nursing). 4. Grapevine communication is an informal channel among individuals at all hierarchical levels and has the potential to generate misinformation.

The hospital chief operating officer holds monthly focus groups with the purpose of gaining ideas and insights from nursing administration and staff nurses. Which type of communication does this indicate? 1. Lateral communication 2. Downward communication 3. Diagonal communication 4. Grapevine communication

Answer: 1, 2, 3 Explanation: 1. Collaboration and work sharing are more closely identified with systems theory. 2. In the classical approach, work is divided into departments and specialties. 3. Standardization is a means of control of work, which is common in the classical organizational approach. 4. Specialization of labor is a common finding in classical theory. 5. Chain of command and line authority are characteristic of classical theory.

The hospital has a very formal organizational structure and culture. Which conditions or events would indicate that a counterculture is developing within this hospital? Select all that apply. 1. Collaboration and work sharing are becoming more common among nurses in specialty care units. 2. An informal group of nurses, radiology technicians, and physical therapists have been discussing how to better care for clients with hip replacements. 3. Nurses have begun questioning the wisdom of standardizing some nursing procedures. 4. Staffing has become less flexible as more nurses specialize in one aspect of care. 5. A recently updated organizational chart indicates the line authority for each position.

Answer: 3 Explanation: 1. Functional nursing has the disadvantages of less continuity of care and potentially less skilled personnel caring for the client. 2. Team nursing has the disadvantage of not having a professional nurse attending to all client care needs. 3. In total client care, one nurse cares for a client and is totally accountable for the client. This way the nurse can give continuous, holistic, and expert care. 4. Primary care is considered the client's first encounter with the healthcare system.

The hospital is opening its first intensive care unit. The nurse executive should plan to staff this unit according to which model of care? 1. Functional nursing 2. Team nursing 3. Total client care 4. Primary care

*Answer: 2* *Explanation:* 1. CQI is the actual process, not the philosophy, used to improve quality and performance. 2. TQM is a management philosophy emphasizing a commitment to excellence throughout the organization. It is founded on four core concepts: client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. 3. The PDCA cycle is a scientific method used to build knowledge, make decisions, and improve quality outcomes within an organization. It is a process, not a philosophy. 4. Six Sigma is a quality management program that uses measures, goals, and management involvement to monitor performance and ensure progress. It is a process, not a philosophy.

The hospital organization has developed a philosophy based on the client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. In which quality management process are these characteristics typically seen? 1. Continuous quality improvement (CQI) 2. Total quality management (TQM) 3. Plan, Do, Check, Act (PDCA cycle) 4. Six Sigma

Answer: 2 Explanation: 1. Case management is used for high-volume diagnoses. 2. Case management is used with high-risk diagnoses. 3. Case management is used with high-cost diagnoses. 4. The number of providers associated with a diagnosis is not a criterion for case management.

The hospital's management team wishes to institute case management to improve the quality of nursing care. As a beginning step, the team is choosing specific medical diagnoses on which to focus. What criteria should the team use when choosing these diagnoses? 1. Diagnoses given to only a few clients 2. Diagnoses that carry high risk for the client and the provider 3. Diagnoses that have low reimbursement rates 4. Diagnoses that involve as few providers as possible

Answer: 4 Explanation: 1. Even the novice nurse manager should realize that delegating is part of the role. 2. Fear of decreased personal satisfaction should be diminished by the increased opportunity to explore new challenges and gain other skills and experiences. 3. The novice nurse manager would not fear increased liability if delegating to competent, more experienced nurses. 4. The novice nurse manager may be insecure and fear that another staff member could perform the task more effectively. Fear exists that a successful delegate could threaten the nurse manager's credibility as a leader.

The novice nurse manager is hesitant to delegate tasks to competent, experienced staff nurses. Fear of which factor is most likely to explain this hesitancy? 1. Overburdening others 2. Decreased personal satisfaction 3. Increased liability 4. Competition and criticism

*Answer: 2, 3* *Explanation:* 1. The CQI coordinator is appointed by a member of the resource group. 2. The resource group is made up of senior management and establishes overall policy, vision, and values associated with CQI. 3. The resource group is made up of senior management such as the CEO and vice-presidents. 4. Team members are not part of the resource group. 5. The team leader is not a part of the resource group.

The leader of a continuous quality improvement (CQI) team has asked that an information packet be distributed to members of the resource group. The secretary would prepare packets for which people? Select all that apply. 1. The CQI coordinator 2. The hospital CEO 3. The vice-president in charge of finance 4. Members of the CQI team 5. The team leader

Answer: 4 Explanation: 1. Thinking about the goals is assessment. 2. Developing an appropriate response is an implementation. 3. Deciding how to say what you want conveyed or how to deliver your response is an implementation or plan. 4. Ensuring all parties understand the communication is the last step as it involves evaluation.

The nurse has been concentrating on improving personal communication skills. Which option represents the final step in this nurse's work to improve communication? 1. Think about the goals of the communication. 2. Develop an appropriate and thoughtful response. 3. Decide how to say what you want conveyed. 4. Ensure the communication is understood.

Answer: 4 Explanation: 1. Making out a schedule with no input from nursing is authoritative leadership. 2. Transformational leaders appeal to individuals' better selves rather than their self-interests. 3. Transformational leaders appeal to individuals' better selves rather than their self-interests. 4. Transactional leadership is based on the principles of social exchange theory. The primary premise is that individuals act in their own best interest.

The mother of a staff nurse is critically ill and the nurse must miss several shifts of work. If the leadership style of the nursing manager is transactional, which approach to covering these shifts is most likely? 1. "I have made out a schedule of who will work to cover these shifts." 2. "I can work an extra shift tomorrow night. Who can cover tonight?" 3. "How can we work together to cover these shifts to help our coworker?" 4. "If you work overtime tonight I will authorize double your hourly pay rate."

Answer: 2 Explanation: 1. Bringing in an expert to talk to the faculty would be ineffective until the faculty is beginning to "unfreeze" their current beliefs about teaching. Introducing an expert at this time might do more harm than good. 2. The first step is to unfreeze the existing equilibrium by asking staff to become part of the process of change, particularly in the first phase. 3. Asking the staff to assist in developing a plan is incorrect because the planning part of the process occurs after the problem areas have been identified. 4. The faculty will likely not be receptive to new strategies until they have identified a need to change.

The new chairperson of the nursing department has determined that the faculty's teaching is stagnant and outmoded. The chairperson would like to encourage the faculty to adopt more innovative teaching strategies. According to Lewin, what is the first step in initiating this plan? 1. Bring an expert on innovative teaching strategies to campus for a meeting with faculty. 2. Include the staff in identifying problems related to teaching strategies. 3. Ask staff to assist in the development of a plan for implementing new teaching strategies. 4. Implement interventions to improve the teaching strategies currently used.

Answer: 4 Explanation: 1. The ability to retain a big-picture focus while dealing with each part of the change is a desirable trait for a change agent. 2. The change agent must have sufficient flexibility to modify ideas when this will improve the change, but enough persistence to resist nonproductive tampering with the planned change. 3. It is likely that those who are resistant will adapt to the change if given enough time and support. 4. Staying available the whole time is not realistic and will make it difficult for the change agent to maintain the energy it will take to make the change more successful.

The novice nurse manager is acting in the role of change agent for the unit. Which statement indicates that this manager needs further training in regard to change? 1. "I must not get so bogged down in details that I lose focus on the ultimate goal." 2. "As we go through this process, I think I need to be flexible but persistent." 3. "Those who are resistant will probably accept it sooner or later with my support." 4. "I think the implementation will go much better if I stay available the whole time."

*Answer: 1, 3, 4* *Explanation:* 1. In each state nursing practice is regulated and defined by the State Board of Nursing. 2. Nursing practice is meant to protect the public from unsafe practice. 3. Each nursing graduate must apply to the appropriate State Board of Nursing to take the National licensure exam. 4. In each state nursing practice is regulated and defined by the State Board of Nursing. 5. Not all State Boards of Nursing require continuing education (CE) credits but in the future all states may require CE credits to maintain competence of practice. The number of CEs required are dependent on the individual state's requirement.

The nurse acknowledges the job of the State Boards of Nursing is to secure the safety of the public by which of the following? Select all that apply. 1. Practice defined by each state 2. Practice protecting the client's privacy 3. National licensure exam 4. Regulation of practice 5. Nationwide continuing education credits

*Answer: 1, 2, 3, 5* *Explanation:* 1. Beneficence means action that is done for the benefit of others. 2. Distributive justice means socially just allocation of goods in a society. 3. Autonomy means the ability of an individual to determine his or her own course of action. 4. Negligence means failure to take proper care in doing something. 5. Non-maleficence means non-harming or inflicting the least harm possible to reach a beneficial outcome.

The nurse acknowledges which principles are most directly related to nursing care and play a role in solving ethical dilemmas? Select all that apply. 1. Beneficence 2. Distributive justice 3. Autonomy 4. Negligence 5. Non-maleficence

Answer: 1 Explanation: 1. Assessment is always the first action for a nurse in any situation. 2. This constitutes an intervention and is not the first action. 3. This constitutes an intervention and is not the first action. 4. This constitutes an intervention and is not the first action.

The nurse administrator has been asked to work with other administrators to make a change in a long-standing hospital policy. What should be the nurse's first action? 1. Research the options that will work best for the nursing staff and the hospital. 2. Speak positively of the change to ensure the most "buy-in" from the nurses. 3. Encourage the other administrators to choose the option that is easiest for the nurses. 4. Ensure that each nurse is aware of the change and why it is necessary.

Answer: 1, 4, 5 Explanation: 1. A functional structure is a traditional organizational structure. 2. Shared governance is a new, more relationship-based organizational structure. 3. A service-line structure is a new, more relationship-based organizational structure. 4. A parallel structure is a traditional structure, even though it is more modern than a functional structure. 5. Matrix is a traditional structure.

The nurse applying for a position is told, "This hospital has a very traditional organizational structure." The nurse would expect the organization to use which structure? Select all that apply. 1. Functional 2. Shared governance 3. Service-line 4. Parallel 5. Matrix

Answer: 3 Explanation: 1. Fogging is a technique used when the person is in partial agreement with what was said. 2. Negative assertion involves some acceptance of blame for what was said. 3. Negative inquiry is a statement of "I don't understand." Negative inquiry is an effective technique, provided the person to whom it is directed does not become defensive or distraught. 4. Compromise implies that an agreement has occurred between the nurse manager and the nurse.

The nurse asks the nurse manager if he can go home early because the census is low. When the request is denied, the nurse states, "I don't understand why I can't leave early. I will use vacation time, and this will help minimize personnel costs for the shift." This statement is an example of which technique of influencing the supervisor? 1. Fogging 2. Negative assertion 3. Negative inquiry 4. Compromise

*Answer: 1, 3* *Explanation:* 1. The DNR is a medical order that no resuscitative measures be administered to the client. 2. Tort is divided into unintentional (professional negligence) and intentional (intent to harm is present). 3. A living will is when the competent adult signs a form indicating what healthcare the person does and does not want in the event of terminal illness. 4. A will is a legal declaration by which a person, the testator, names one or more persons to manage his or her estate and provides for the distribution of his or her property at death. 5. The DPOA is for healthcare decisions permitting a competent adult to appoint a surrogate or proxy to make decisions in the event that the individual becomes unable to do so.

The nurse completes an admission assessment with the client. The client hands the nurse two documents. The documents state the treatment the client wants withheld if permanently unconscious, in the event of terminal illness, and the primary physician's order for no heroics. The nurse communicates in report that copies of which documents are located in the chart? Select all that apply. 1. Do-Not-Resuscitate order (DNR) 2. Tort 3. Living will 4. Will 5. Durable power of attorney (DPOA)

*Answer: 1, 3, 5* *Explanation:* 1. Information must be furnished to clients in a manner that is understandable to them. Includes explanation of treatment, expected results, description of anticipated risks and discomforts, potential benefits, disclosure of alternatives, offer to answer questions, and a statement that the client may withdraw consent at any time. 2. No one can assure probability of success; the client must be informed of expected results. 3. One must be an adult in the technical and legal sense in order to consent to treatment. 4. The consent form must be signed after detailed information is given and all questions are answered. 5. Individuals act voluntarily when they exercise freedom of choice without force, fraud, deceit, duress, or any other form of coercion.

The nurse discerns that the responsibilities essential in obtaining informed consent include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Determine that the client receives and understands information. 2. Probabilities of success 3. The client exercises freedom of choice without coercion. 4. Get consent signed before discussion of treatment. 5. Sign consent form as a competent adult.

*Answer: 4* *Explanation:* 1. One of the rules of using power is to use as little as possible to get the results desired. 2. One of the rules of using power is to focus the power on the problem instead of individual people. 3. Coercion is rarely the best type of power to use. 4. Being polite is an essential part of using power effectively.

The nurse manager realizes that power must be used to influence a change that is needed on the unit. What should this nurse remember when exerting this power? 1. The best strategy is to overwhelm opposition by exerting a great deal of power. 2. The best strategy is to focus the use of power on the individuals who are slow to make the desired change. 3. The best type of power for these situations is coercion. 4. The best strategy is to undertake all power interactions in a polite manner.

*Answer: 2* *Explanation:* 1. The nurse preceptor needs power to be effective in the teaching role. 2. Nurses must use power to influence others. 3. Nurses must use power to influence others. Power in this situation does not have a negative connotation. 4. This statement about who really does the work is not an appropriate use of power.

The nurse educator has recruited nursing preceptors to work with senior nursing students. The educator is teaching the preceptors about power and the education process. Which statement by a preceptor indicates learning has been effective? 1. "I am only showing the student how to take care of patients, so I have no need for power." 2. "I can use power to teach the student how to motivate, communicate, and achieve outcomes." 3. "I do not want to give the student the idea that nurses are all about who has the most power." 4. "I can use power to ensure that other disciplines know that I am the one who really does the work."

Answer: 1 Explanation: 1. This response may indicate that the RN is not able to provide the skilled care needed. There may be a lack of RN presence in client care. 2. This statistic indicates the RN is providing discharge instructions, which is correct use of RN knowledge. 3. Most invasive procedures are done by RNs, so this indicates correct use of skill sets. 4. The nurse will sometimes be rushed. This low percentage is likely not an indicator of problems.

The nurse executive is reviewing client satisfaction surveys. Which trend would the nurse evaluate as indicating the nursing care delivery system in use is not effective? 1. More than 60% of respondents replied with the name of an unlicensed assistant when asked the name of the RN who cared for them. 2. Almost 70% of respondents accurately listed their discharge medication. 3. Close to 88% of respondents reported that invasive interventions were performed by an RN. 4. More than 30% of respondents reported that the nurse sometimes seemed rushed.

Answer: 2 Explanation: 1. The average age of nurses is 46. 2. The number of nurses younger than age 30 is increasing. 3. This does not reflect national statistics. 4. This does not reflect national statistics.

The nurse executive is reviewing statistics about the nursing staff. Which statistic shows that the staff reflects national trends? 1. The average age of the nursing staff is 40. 2. The number of nurses under age 30 has increased in the last two years. 3. There are no nurses older than age 55. 4. All nurses older than age 45 are managers.

Answer: 2, 3 Explanation: 1. Making the environment better for nurses may not be the most cost-effective strategy. 2. Research indicates that a better nursing environment is associated with lower mortality rates. 3. An environment that is better for nurses is associated with greater nurse satisfaction. 4. There is no evidence that improving the environment for nursing improves the environment for other disciplines. 5. There is little that can be done in a hospital environment that does not entail at least some cost.

The nurse executive of a for-profit hospital continually works to provide an environment that is better for the nursing staff. Why is this effort so important? Select all that apply. 1. It is the most cost-effective way to manage a hospital. 2. An environment that is better for nurses is associated with lower mortality rates. 3. Nurses are more satisfied working in an environment that is better for nursing. 4. When the environment is better for nursing, it is also better for other disciplines. 5. Most of the strategies that improve the environment for nursing do not cost anything.

Answer: 1, 3, 4 Explanation: 1. Empathy is a characteristic of a servant leader. 2. The ability to sustain high energy is common in many leaders and is not particular to a servant leader. 3. An awareness of others and their needs is a characteristic of the servant leader. 4. The use of persuasion is characteristic of the servant leader. 5. A long history of leadership success is not unique to a servant leader.

The nurse executive wishes to hire nurse managers who embody the service leadership mission of the organization. Which specific attributes should this nurse look for in applicants? Select all that apply. 1. The ability to be empathetic to clients and staff 2. Ability to sustain high energy for long periods of time 3. Awareness of the needs of clients and the organization 4. Use of persuasion as a leadership technique 5. Long history of leadership success

Answer: 2 Explanation: 1. The medium of the message is not the first consideration. 2. The first consideration is the relationship with the receiver of the message. This will guide the remainder of the choices the nurse will make. 3. Timing is essential, but it is not the first consideration. 4. In this situation, the nurse likely has numerous points to express. It might not be the best plan to include them all in the initial conversation.

The nurse has a concern regarding the quality of care being provided in the hospital. What should the nurse consider first before communicating this concern? 1. The medium of the message 2. The relationship between the nurse and the receiver of the message 3. The timing of the message 4. What to include in the message

Answer: 1 Explanation: 1. Delegation can benefit every level of the organization. 2. Delegation can be successfully used in any unit. 3. Delegation does not consist of just telling other people what to do. 4. The "regular work" of the staff is done by assignment, not delegation. Delegation is more than just telling staff when to have work done.

The nurse has attended a "how to" refresher course on successful delegation. Which statement indicates successful learning has taken place? 1. "I knew that effective delegation made my job easier, but I never thought about how it could benefit the hospital." 2. "The clients on our unit come and go so frequently that delegation is of little benefit." 3. "I just don't understand why people think delegation is difficult; all you have to do is tell other people what to do." 4. "Now I know that effective delegation means telling my nursing staff when they need to have their regular work done."

Answer: 1 Explanation: 1. Managers can affect motivation by developing strategies and possible incentives. The other options are true management functions. 2. Being available for consultation or help with assignments is one of the roles of the first-level manager. 3. First-level managers are responsible for supervising the work of non-managerial personnel and the day-to-day activities of a specific work unit or units. Clarity of assignment is part of this supervision. 4. First-level managers are responsible for attending meetings and may be away from the unit while retaining responsibility for the care being provided.

The nurse has been asked to assume a first-level management role on the nursing unit. Which statement indicates that this nurse will need further mentoring in the new role? 1. "I won't be able to increase my team's motivation. That has to come from within them." 2. "As a manager, I will be available for my team if problems with clients arise." 3. "One of my roles will be to make sure assignments are clear and understandable." 4. "I will still be responsible for the care being provided even if I am off the unit during the day to attend meetings."

*Answer: 4* *Explanation:* 1. Watching others implement creative solutions would be helpful in improving the nurse's creativity, but it is not the best of these choices. 2. Working with a group to implement a creative solution would be helpful in improving the nurse's creativity, but it is not the best of these choices. 3. Evaluating the effectiveness of creative solutions would be helpful in improving the nurse's creativity, but it is not the best of these choices. 4. The most effective of these methods would be practicing the steps. Creativity is a skill that can be learned and improved through practice, just like technical skills.

The nurse has determined that in order to provide the highest quality care it is important to become more creative. What is the most effective way for the nurse to increase creativity? 1. Watch others implement creative solutions. 2. Work with a group to implement a creative solution. 3. Evaluate the effectiveness of creative solutions. 4. Practice the steps of the process as often as possible.

*Answer: 1* *Explanation:* 1. A person who portrays an image of success and trust will be politically effective. 2. Age is not the reason people will follow this nurse. 3. Beliefs alone are not enough to make people politically effective. Without other attributes, the nurse would not influence others to follow those beliefs. 4. Affiliation with a particular political party is not enough to make someone politically effective.

The nurse has established a reputation for advocating for clients through honesty and hard work. The nurse has worked in the organization for 30 years and often volunteers in local and national political campaigns. This nurse is using which attribute to increase political effectiveness? 1. Image 2. Age 3. Beliefs 4. Political party

Answer: 4 Explanation: 1. Experience as a nurse manager is not essential to the CNL role. 2. The CNL role is a unit-based role. 3. The CNL role is to coordinate care at the bedside and supervise the healthcare team. 4. CNLs are educated at the master's level.

The nurse has set a goal of becoming a clinical nurse leader (CNL). What actions should this nurse plan to reach this goal? 1. Obtain experience as a nurse manager. 2. Learn as much as possible about the hospital's organization. 3. Take a class in hospital administration. 4. Return to school to obtain a master's degree.

Answer: 3, 5 Explanation: 1. Saying "I'm sorry" discounts the message. 2. The nurse should focus on one point at a time. 3. This is a direct statement. 4. This statement is weak. Avoid "uh" and "um." 5. This is a direct statement, and it starts with a "name" that gets the physician's attention.

The nurse is always intimidated when asking a physician to clarify orders. Which statements should the nurse use to help counteract this feeling? Select all that apply. 1. "I'm sorry, doctor, but I need for you to repeat the dosage on that medication order." 2. "Doctor, what was the dosage on that medication you ordered, and do you want the client up in a chair today?" 3. "How often did you want the furosemide given?" 4. "Uh, can you tell me if you need for this client to be NPO today?" 5. "Doctor, what rate did you want for the IV?"

*Answer: 1, 3* *Explanation:* 1. Any reaction or injury associated with a diagnostic test must be reported as an incident. 2. The nurse manager can address the client's expectations related to meals. If no satisfaction can be obtained and the family continues to complain about meals, an incident report would be filed. 3. The physician and healthcare team are responsible for deciding if the client is ready to be discharged, based on the client's medical condition. 4. The physician and healthcare team are responsible for deciding if the client is ready to be discharged, based on the client's medical condition. 5. The physician and healthcare team are responsible for deciding if the client should be transferred from the ICU, based on the client's medical condition.

The nurse is assigned to the Risk Management Team. Which events would be addressed by this team? Select all that apply. 1. A client's hand is injured during an arterial blood gas draw. 2. A client's family is dissatisfied with the breakfast just served. 3. A client leaves the hospital against medical advice (AMA). 4. A client claims he is not ready to be discharged. 5. The family does not want a client to be transferred from the intensive care unit (ICU).

Answer: 1, 3, 4, 5 Explanation: 1. Empowerment is a skill that should be developed for leadership. 2. Participation is not a skill developed for leadership. 3. Facilitation is a skill that should be developed for leadership. 4. Reflection is a skill that should be developed for leadership. 5. Communication is a skill that should be developed for leadership.

The nurse is focusing on becoming a leader. What skills should the nurse continually develop? Select all that apply. 1. Empowerment 2. Participation 3. Facilitation 4. Reflection 5. Communication

Answer: 2, 4, 5 Explanation: 1. Caring is not a skill used to make the team nursing model of care effective. 2. Delegating is a skill used to make the team nursing model of care effective. 3. Advocating is not a skill used to make the team nursing model of care effective. 4. Communicating is a skill used to make the team nursing model of care effective. 5. Problem-solving is a skill used to make the team nursing model of care effective.

The nurse is starting a new position as a staff member on a busy medical-surgical unit. The unit uses the team nursing model of care. Which skills will be used to make this model effective? Select all that apply. 1. Caring 2. Delegating 3. Advocating 4. Communicating 5. Problem-solving

Answer: 3 Explanation: 1. The preference of medical records professionals is not the reason these records have had a slow adoption. 2. The cost of the records is not a primary reason they have had slow adoption. 3. The most overwhelming issue in using these records has been the profession's and public's concerns regarding privacy and confidentiality. 4. The transition time to EHRs is not the primary reason they have seen a slow adoption.

The nurse is trying to understand why it has taken so long for electronic health records (EHRs) to be used in healthcare. Which statement is a reason for this delay? 1. Medical records professionals do not like these records. 2. The use of these records is more expensive than the use of paper records. 3. There have been concerns about privacy and confidentiality. 4. The transition to EHRs is time consuming and tedious.

*Answer: reportable incident* *Explanation:* Reportable incidents include any unexpected or unplanned occurrences that affect or could potentially affect a client, family member, or staff.

The nurse manager receives a report that a medication was given to the wrong client. This is called a(n) ________ and will be reviewed with the physician and risk management committee member.

*Answer: 1* *Explanation:* 1. Critical thinking involves choosing the best alternative from among several, depending on the situation in which the problem occurred. This is the context of the problem. 2. Handling the problem the way it is usually handled may be easy but would not involve critical thinking. 3. Choosing the easiest or least expensive alternative may be easy but would not involve critical thinking. 4. The nursing process should be used in critical thinking, but the changing situation is the more defining and specific characteristic of critical thinking.

The nurse is using critical thinking skills to decide which of several options is the best. Which question is most important for the nurse to take into consideration? 1. Are there different situational effects or contexts to be considered? 2. How has the problem usually been handled? 3. What is the easiest and least expensive alternative? 4. Can the problem be solved using the nursing process?

*Answer: 2* *Explanation:* 1. This statement may be correct, but it is not likely to start a calm and focused conversation about the issue. 2. When offering criticism, one should always begin the conversation with a compliment. 3. "Wasting time" is a strong statement and is likely to inflame the situation. 4. The nurse may feel that continuing on the committee is impossible, but this is not the way to convey that information.

The nurse is working on a committee responsible for making policy decisions for the healthcare organization. During the work, the nurse has developed a strong belief that the focus of the committee is incorrect. Which statement by the nurse would be most appropriate? 1. "We are going about this all wrong." 2. "We are a good team, but we need to look at this problem from a different viewpoint." 3. "I have to intervene in our work. We are just wasting time." 4. "This is going nowhere. I am resigning."

Answer: 2, 3, 4 Explanation: 1. Completing the process is not the major focus of the work. 2. Those involved in change should be certain that sufficient data are present to make an informed decision. 3. Persons working on this committee should be aware of obstacles they may face. 4. It is important to consider the opinions of the organization's stakeholders. 5. Getting the change instituted quickly is not the focus of committee work.

The nurse is working on a committee tasked with making a major organizational change. Which comments by the nurse would help to advance the work of this committee? Select all that apply. 1. "I would like to focus on completing this process so we can move on." 2. "Have we looked at all available data in order to make an informed decision?" 3. "What are the obstacles to implementing this change within the organization?" 4. "Are we including the opinions of all stakeholders in this decision?" 5. "I think it does not really matter when we institute this change, as long as it is over quickly."

*Answer: 3* *Explanation:* 1. It is not appropriate to discuss errors with others. 2. Reporting the incident to the supervisor is appropriate only after the client's safety is protected. 3. The client's safety is always the priority. 4. Ignoring the mistake if no one saw it is not ethical and may be dangerous.

The nurse is working on a unit with a blame-free environment and makes an error that puts a client at risk. What should the nurse do first? 1. Discuss it with the other nurses on duty. 2. Immediately report the incident to the supervisor. 3. Ensure the client's safety as fully as possible. 4. Say nothing as no one saw the incident.

Answer: 2, 3, 4 Explanation: 1. Working alone is not an attribute of the practice partnership model of care. 2. Continuity of care is an attribute of the practice partnership model of care. 3. Less expensive for the organization is an attribute of the practice partnership model of care. 4. Accountability for client care is an attribute of the practice partnership model of care. 5. Coordinating implementation of care is not an attribute of the practice partnership model of care.

The nurse just left a healthcare agency that utilized the practice partnership model of care. When compared to team nursing, practice partnership offers which attributes? Select all that apply. 1. Working alone 2. Continuity of care 3. Less expensive for the organization 4. Accountability for client care 5. Coordinating implementation of care

*Answer: 3, 4* *Explanation:* 1. The leader is not a passive participant in visioning. 2. Top-down management is outdated and is not a part of shared visioning. 3. Shared visioning requires that all those involved in the organization have a say in its future. 4. Shared visioning is a strategy that encourages innovation. 5. The leader encouraging shared visioning would not use coercive power.

The nurse leader wishes to develop a culture of shared visioning for the healthcare organization. How should the nurse proceed with this plan? Select all that apply. 1. The leader should be a passive observer in meetings. 2. The leader should encourage a change to a more efficient top-down management system. 3. The leader should survey employees regarding what is important to them for the organization's future. 4. The leader should encourage innovative ideas. 5. The leader should use coercive primary power.

Answer: 2 Explanation: 1. A case study is an in-depth analysis used to translate evidence into other clinical situations. 2. Anecdotal evidence is derived from experience. 3. Nonexperimental design research includes gathering factors related to a clinical condition. 4. Statistical evidence is built from a scientific approach.

The nurse manager asks a staff nurse why a procedure is done in a certain manner. The nurse replies, "I don't know why I started doing it this way. I've never read any research on it, but this technique always works for me." The manager would place this technique into which category of evidence? 1. Case study 2. Anecdotal 3. Nonexperimental design research 4. Statistical

Answer: 1 Explanation: 1. Quantum leadership is based on the concepts of chaos theory, with the focus on outcomes. 2. Transactional leadership is based on the principles of social exchange theory. 3. Contingency theory suggests that managers adapt their leadership styles in relation to changing situations. 4. Transformational leadership emphasizes the importance of interpersonal relationships to inspire and motivate followers.

The nurse manager consistently refocuses the staff on achieving outcomes and directly involves the staff in decision making to achieve those outcomes. How would this style of leadership be described? 1. Quantum 2. Transactional 3. Contingency 4. Transformational

Answer: 2 Explanation: 1. It is not a good idea to indicate that a change is coming until further planning is completed. 2. Assessment is the first step of the change process, just as it is the first step of the nursing process. 3. Planting the seed of discontent with the status quo occurs after the problem has been assessed. 4. Operational indicators of success are developed when the planning phase is near completion.

The nurse manager feels that changing the unit's method of assigning break times would benefit the flow of client care. What should be the manager's first action associated with this idea? 1. Tell the staff that a change is coming, but that it is positive and they should not be worried. 2. Collect and analyze information about how the current system is working. 3. Mention in a staff meeting that the current system is causing a lot of trouble. 4. Identify how the manager would know if the change is benefiting the unit.

Answer: 2 Explanation: 1. Effective delegation is the process by which responsibility and authority for performing a task is transferred to another person. It is critical that the task is one that can be delegated. 2. Overdelegation occurs when the delegator loses control over a situation by providing the delegate with too much authority or responsibility. Discipline of an employee is a responsibility of the manager that cannot be delegated because of the confidentiality and controversy associated with it. 3. Reverse delegation occurs when a person with a lower rank (unit secretary) delegates to someone with authority (nurse manager). 4. Underdelegation occurs when full authority and responsibility are not transferred in a situation where delegation would otherwise be appropriate.

The nurse manager gave the unit secretary complete responsibility for the unit's staffing, including finding replacements for call-ins and disciplining nurses with excessive call-ins. This is an example of which type of delegation? 1. Effective delegation 2. Overdelegation 3. Reverse delegation 4. Underdelegation

*Answer: 3* *Explanation:* 1. The premise of the political decision-making model is that decisions align with the interests of powerful stakeholders such as hospital boards and regulatory bodies. 2. Experimentation involves the use of a pilot project to test the effectiveness of a solution. 3. The rational decision-making model is a series of steps that managers take to make logical, rational choices that maximize the achievement of successful outcomes. 4. The trial-and-error method is used by inexperienced managers and involves the application of one solution after another to improve a problem.

The nurse manager generally uses a stepwise method to arrive at decisions that are logical and that serve to maximize the achievement of the desired objective. Which decision-making model does this manager use? 1. Political decision-making model 2. Experimentation process 3. Rational decision-making model 4. Trial-and-error method

Answer: 1, 3 Explanation: 1. Negative assertion occurs when the speaker accepts some of the blame for the situation. 2. This is an example of negative inquiry. 3. Negative assertion is accepting some of the blame. 4. This is an example of fogging. 5. This is a confrontational statement and should be avoided.

The nurse manager has asked that another staff nurse position be funded for the unit. The supervisor denies the request. Which statements by the manager are examples of negative assertion? Select all that apply. 1. "I know I haven't been too careful in keeping personnel costs low, but we are really going to need another position." 2. "I don't see why another position cannot be funded. We have met our budget each year for the last 3 years." 3. "I realize that my staff is not always positive about organizational changes, but having this extra staff member might reduce some of their stress." 4. "I can understand what you said about budget being tight, but we still need the position." 5. "Do you not understand how hard my nurses are working?"

Answer: 2, 5 Explanation: 1. Deciding on the skill mix would be part of organizing the project. 2. Convincing or "selling" the new idea is part of the directing phase. 3. This comparison is part of the controlling phase. 4. In today's environment, the directing phase consists of guidance rather than telling the staff what to do. 5. Coaching and counseling are two major roles in the directing phase.

The nurse manager has been assigned the task of developing and implementing a new staffing system for the emergency department. The nurse has reached the "directing" phase of this project. On which activities would the nurse focus at this point? Select all that apply. 1. Deciding on the skill mix necessary for direct client care 2. Selling the new system to the current emergency department staff 3. Comparing the actual results of the new system to the projected results 4. Telling staff what to do 5. Coaching the staff through the implementation of a new schedule

*Answer: 4* *Explanation:* 1. Behavioral warnings and punishments should always be done in private. 2. Punishment for noncompliance should be fairly and consistently applied. 3. Infractions should be addressed promptly once the manager is certain of the facts. 4. The manager should always investigate to get facts and avoid jumping to conclusions.

The nurse manager has decided that the only way to deal with an issue is to use coercive power. What strategy is important for this nurse manager to employ? 1. Administer behavioral warnings in public to alert other staff to the seriousness of the issue. 2. Reduce punishments for noncompliance after the majority of staff members have complied. 3. Wait at least 72 hours prior to responding to infractions so that emotions are better controlled during the meeting. 4. Investigate to get the facts of potential infractions before responding to them.

Answer: 3 Explanation: 1. Assessing outcomes is the last step of the EBP process. 2. Evaluation of the evidence is step 3. 3. Identifying the clinical question is the first step in the EBP process. 4. Acquiring the evidence to answer the question is step 2.

The nurse manager has decided to use evidence-based practice (EBP) to solve an issue and has called staff nurses together for input. Which question, as posed by the manager, reflects the first step of the EBP process? 1. "What outcomes are we expecting from this work?" 2. "Is anyone prepared to evaluate the statistics we will find?" 3. "What is the exact clinical issue with which we are dealing?" 4. "Where can we look for information?"

*Answer: 1, 2* *Explanation:* 1. Current policy and procedures allow the manager to know what is already in place and if they need to be updated. 2. Current research determines that the policy and procedures should be guided by evidence-based research. 3. Length of stay is determined by specialized health problems and quality of practice. 4. Infection rates are determined by quality of practice. 5. Practice guidelines determine the care needed by a client with specialized health problems.

The nurse manager reviews the policy and procedure for central line (flushes) maintenance. To determine potential changes, the manager considers which of the following areas? Select all that apply. 1. Current policy and procedures 2. Current research 3. Length of stay 4. Infection rates 5. Practice guidelines

Answer: 1, 3, 5 Explanation: 1. It is important to identify who is in control of the way things are being done currently. 2. Communication technology may be helpful in completing the change but is not assessed as part of the political climate surrounding the change. 3. Early knowledge of who will lose in the change is essential to preparation. 4. Costs and benefits of the change should be assessed but are not a part of the political climate. 5. Political climate involves power, benefits, and losses.

The nurse manager has determined that changes are necessary in the way holiday shifts are assigned. When assessing the political climate surrounding this potential change, the nurse manager would ask which questions? Select all that apply. 1. Who is in control of the way holiday shifts are being assigned? 2. What communication technology is available to distribute information about the change in holiday shift assignments? 3. Who will lose when holiday shift assignments are changed? 4. Will changing holiday shift assignments affect the budget? 5. Who is benefiting the most from the way holiday shifts are currently assigned?

Explanation: 1. The nurse manager should plan to meet with administration when there is sufficient time and the supervisor seems receptive. 2. Negative inquiry is used after a request has been denied. 3. Compromise occurs after a request has been denied. Persistence and repetition are used after a request has been denied. 4. Persistence and repetition are used after a request has been denied.

The nurse manager has determined that two staff nurses need to be hired. Which factor is most critical as the nurse manager prepares to submit the request to administration? 1. Timing of the request 2. Negative inquiry 3. Compromise 4. Persistence

Answer: 3 Explanation: 1. Span of control is the number of individuals a manager can effectively supervise. 2. Line authority is a linear hierarchy through which activity is directed. 3. The Hawthorne effect is the tendency of people to perform as expected because of special attention. 4. Adhocracy is a fluid structure in which management, staff, and experts work together on teams.

The nurse manager has established a program that recognizes a different staff member each month for contributions to client care. As a result, overall staff productivity and the number of client compliments have increased. This is an example of which concept of organizational theory? 1. Span of control 2. Line authority 3. Hawthorne effect 4. Adhocracy

Answer: 3, 4, 5 Explanation: 1. The four generations have different values, work ethics, and skills. Conflict is inevitable. 2. The manager should not stereotype the members of a generation. 3. Generation Y is technically savvy. 4. Traditionalists are typically loyal and respectful of authority. 5. Baby boomers typically value professional and personal growth.

The nurse manager has four different generations represented in the nursing staff on the unit. What statements indicate the manager is wise about how to deal with this generational mix? Select all that apply. 1. "I don't see why everyone can't just get along." 2. "Generation X nurses are just lazy." 3. "Our Generation Y nurses help keep us all up on new technology." 4. "The most loyal of all my nurses are the traditionalists." 5. "I expect that our next manager will come from my group of baby boomers."

*Answer: State Board of Nursing* *Explanation:* It is the nurses' duty to educate, examine and report another nurse's behavior to protect the health, safety, and welfare of the public.

The nurse manager has had two incidents happen on the unit in the last month. An LPN administered an intravenous push (IVP) medication to a client and a nurse noticed alcohol on another nurse's breath. The manager is aware that the ________ will take action after being notified of these incidents.

Answer: 3 Explanation: 1. Text messaging can make the problem worse because it implies the need to respond quickly. 2. Having everyone send a return email will set the nurse manager up for an onslaught of messages that really are not important. 3. Email communication is fraught with difficulties. The best of these options is to be certain that emails go only to the intended recipients. The use of "reply to all" or distribution lists is convenient, but it can result in sending the email to people that it does not affect. When this happens, people begin to ignore email. 4. Sending the message line "Important" with each email is much like crying wolf, and recipients will soon realize that the term Important is meaningless.

The nurse manager has instituted a policy of sending information to the staff in emails. Many misunderstandings have occurred since this policy was implemented. What technique should the manager use to reduce this miscommunication? 1. Use text messaging instead of email. 2. Require a return email from everyone reading the information. 3. Be certain that emails go only to the intended recipients. 4. Send all emails with a message line that says "Important."

*Answer: 4* *Explanation:* 1. Farsight is not part of this process. 2. Verification is evaluation of the solution's effectiveness. 3. Preparation is planning time. 4. The time lapsed before a decision is made is the "incubation" time.

The nurse manager has scheduled a series of meetings with employees to solve a unit problem. The manager purposefully created a two-week gap in the meetings to allow which portion of the creative process to occur? 1. Farsight 2. Verification 3. Preparation 4. Incubation

*Answer: 4* *Explanation:* 1. Probability is the likelihood, expressed as a percentage, that an event will or will not occur. 2. Probability analysis is a method of calculating expected risk; this is the method the nurse used to compare the two options. 3. Objective probability is the likelihood that an event will or will not occur, based on facts and reliable information. 4. Even though option A is more cost-effective, the manager believes option B to be in the best interest of the unit. Subjective probability is the likelihood that an event will or will not occur based on personal judgment and beliefs.

The nurse manager is calculating the cost of offering two bonus incentives to nursing staff for covering call-ins for sickness. After reviewing the statistics, the manager finds that option A is more cost-effective than option B but decides to implement option B because it seems safer. Which option best describes the basis of this decision? 1. Probability 2. Probability analysis 3. Objective probability 4. Subjective probability

*Answer: 1* *Explanation:* 1. Creativity is a part of the critical-thinking process that fosters the development and implementation of new approaches to different situations. 2. Problem solving implies there is a problem that needs a solution. 3. Brainstorming generates diverse ideas with many superficial solutions. 4. Decision making identifies one effective strategy that is not necessarily innovative.

The nurse manager is challenged to find an innovative way to adequately staff the unit and provide quality nursing care. Which ability would be most useful to the nurse in this situation? 1. Creativity 2. Problem solving 3. Brainstorming 4. Decision making

*Answer: 4* *Explanation:* 1. The purpose of a memo is to convey general information to a group; it has a low level of personal intimacy. 2. The purpose of email is to broadcast information to large groups; it has a low level of personal intimacy. 3. A telephone conversation is less intimate than face-to-face communication, and the individual's response cannot be seen. 4. More important or difficult issues should be communicated face-to-face to the nurse involved so that the individual's response can be seen and questions can be answered appropriately.

The nurse manager is concerned about a family member's complaint regarding the professional behavior of a nurse on the unit. Which is the most effective method to address this issue? 1. Post a memo to the nursing staff about expected professional behavior. 2. Send an email to the nursing staff about expected professional behavior. 3. Address the complaint with the individual nurse in a telephone conversation. 4. Discuss the complaint with the individual nurse face-to-face.

Answer: 2, 3, 4 Explanation: 1. Merely attending staff meetings is not a sign of good followership. 2. Active, positive participation shows good followership. 3. As long as the critique is private, this demonstrates that the nurse is engaged and thinking about the processes. 4. Taking the initiative to try out changes is considered good followership. 5. This is an example of dependent thinking, which is not good followership.

The nurse manager is conducting a nurse's annual performance review. Which events from the previous year would be evidence that this nurse is a successful follower? Select all that apply. 1. The nurse attended more than 80%of staff meetings but offered little input into discussion. 2. The nurse participated in testing a new charting system before it was installed on the unit. 3. In a private meeting with the nurse manager, the nurse critiqued the manager's decision to change the unit's method of client assignment. 4. After attending an in-service presentation on a new intravenous (IV) access catheter, the nurse used one of the devices the next time an IV was ordered. 5. When asked for an opinion on an issue dividing the unit, the nurse replies, "I don't know. What do you think?"

Answer: 2 Explanation: 1. Males tend to communicate clearly and concisely, especially in professional relationships. 2. There are many gender differences in communication. Males tend to take responsibility and feel the need to "fix" things. 3. Using phrases such as "sort of" is a more common trait of female conversation than of male conversation. 4. Women tend to personalize, whereas men are more focused on the issues.

The nurse manager is counseling a male nurse about several recent incidents in which female nurses complained that he was abrupt and condescending. What advice should the manager give this nurse? 1. "Make sure that anything you say is clear and concise." 2. "Don't feel as if you are responsible for fixing every problem." 3. "Avoid using phrases such as 'sort of' when talking to females." 4. "Don't personalize everything."

Answer: 1 Explanation: 1. Giving information is the most common method of changing individuals' perceptions, attitudes, and values. 2. Providing information and an opportunity to practice is called training. Training is not the most common method of changing perceptions, attitudes, and values. 3. While having a mentor may be a desirable method for the learner, it is not the most common method of changing perceptions, attitudes, and values. 4. Transferring or terminating those who resist change is a method of changing the perceptions, attitudes, and values of the remaining staff. It is not the most common method.

The nurse manager is facilitating change to a new documentation system in the unit. If the manager wants to use the most common method to overcome resistance to the change, which strategy would be chosen? 1. The manager distributes a handout explaining the new system and how to use it. 2. The manager creates a "quick tip" sheet about how to use the system and schedules practice sessions for each nurse. 3. The manager identifies a key supporter of the change and has that nurse act as mentor to the remaining staff. 4. The manager threatens to transfer anyone who resists the change.

Answer: 3 Explanation: 1. Resistance generally does not completely prevent change, but it may stall or delay it. 2. The late majority eventually does accept the change. 3. Client care is always the most important reason that nurses do what they do. If the change does not improve client care in some respect, is it worth the effort? If resisters interrupt the work of the unit or refuse to provide care as directed by the change, the quality of care may suffer. 4. Resistance is a normal part of change and does not mean that power has been diverted to the resisters.

The nurse manager is facing resistance to change from many staff nurses. Why should the manager work hard to address this resistance? 1. Resistance will keep the change from occurring at all. 2. Resistance from the late majority can keep others from accepting the change. 3. Resistance can negatively impact future client care. 4. Resistance allows others to take power from managers.

Answer: 1, 2, 3, 5 Explanation: 1. Staff nurses are responsible for prioritizing care for the clients for whom they provide care. 2. Staff nurses act as liaisons between clients and other healthcare professionals. 3. Staff nurses work to coordinate care provided by other healthcare professionals. 4. Staff nurses may have input into budget development but do not have direct responsibility for the process. 5. Staff nurses have the responsibility of delegating tasks to nonprofessional staff.

The nurse manager is listening to new nurses discussing nurses as managers and overhears one state, "I don't care how long I am a nurse; I will never be a manager." In which ways do nurses manage regardless of their official role Select all that apply. 1. Deciding on priorities 2. Being a liaison 3. Coordination of client care 4. Developing the unit budget 5. Delegation responsibilities

Answer: 2 Explanation: 1. Self-renewal and stabilization occur during the final stage and are most like Lewin's refreezing stage of change. 2. Choosing a solution and gaining acceptance are most like Lewin's moving stage. Previous to this stage in both models, the work is to convince participants that change is necessary and to secure resources for the change. After solutions are identified and implemented, the final stage begins. 3. The first three steps of Havelock's theory are building a relationship, diagnosing the problem, and acquiring resources. These three steps are most like Lewin's unfreezing stage. 4. The first step of Havelock's model is building relationships among participants. This is one of the steps that are equivalent to Lewin's unfreezing stage.

The nurse manager is planning to initiate new policies in the department and is reviewing several change theories. Which step of Havelock's model will the nurse find most closely resembles Lewin's moving stage? 1. Self-renewal occurs among all participants. 2. Solutions are identified to create change. 3. Resources are acquired to facilitate change. 4. Relationships are formed among all participants.

Answer: 1 Explanation: 1. The charge nurse is unique to the healthcare setting and assists with shift-by-shift coordination and promotion of quality client care as well as efficient use of resources. 2. The staff nurse is not formally a manager. This nurse is responsible for promotion of quality care for the shift worked. 3. The clinical nurse leader is not a manager but rather works as a resource to those providing direct care. This nurse may coordinate care at the bedside and works to integrate care. 4. The nurse executive is an upper-level manager and is responsible for quality care across the institution.

The nurse manager is working on a committee whose task is to review and revise job descriptions for nursing employees. In which job description would the committee most likely include the phrase "Management responsibilities include shift-by-shift coordination and promotion of quality client care"? 1. Charge nurse 2. Staff nurse 3. Clinical nurse leader 4. Nurse executive

Answer: 3 Explanation: 1. The nurse manager should always be honest when discussing the change. 2. The nurse manager should not "jump" the chain of command to speak to this person's supervisor. 3. The people just above and just below this person will be important to the way this key player reacts to the change. 4. This tactic would not be ethical.

The nurse manager knows that maximum power will be needed to achieve a desired change and has identified a key person on the organizational chart who will be affected by the change. What is important for the nurse manager to do? 1. Try to minimize the impact of the change when talking to this person. 2. Bypass this person and talk to the administrator who supervises him or her. 3. Pay attention to the people above and below this person on the organizational chart. 4. Try to find some information against this person to use as leverage.

Answer: 2 Explanation: 1. Initiative is the readiness to act and seize opportunities. 2. Transparency is displaying honesty and integrity. 3. Empathy is sensing others' emotions and understanding their perspective. 4. Conflict management is the ability to resolve disagreements.

The nurse manager makes an error that results in the unit being $20,000 short on operating budget for the fiscal year. When asked about the error, the nurse takes full responsibility This statement reflects which component of emotional intelligence? 1. Initiative 2. Transparency 3. Empathy 4. Conflict management

*Answer: 1, 4, 5* *Explanation:* 1. Seeking alternative is one of the steps in the decision-making process. 2. Making a decision is not one of the steps in the decision-making process. 3. Defining the problem is not one of the steps in the decision-making process. 4. Weighing the criteria is one of the steps in the decision-making process. 5. Troubleshooting is one of the steps in the decision-making process.

The nurse manager needs to cover vacation shifts and must decide whether to use agency nurses or the PRN nursing pool. The manager must decide between the two choices. Decision making includes which steps? Select all that apply. 1. Seek alternatives. 2. Make a decision. 3. Define the problem. 4. Weigh the criteria. 5. Troubleshoot.

Answer: 3 Explanation: 1. Because assuming a client assignment is included in the charge nurse's job description, this is assignment, not delegation. 2. Disciplining a nurse on the unit is the responsibility of the manager. Discipline should not be delegated. 3. Delegation is the mutual transfer of responsibility and authority that occurs on the basis of competence and trust. The nurse manager can delegate both the responsibility of leading this task force and the authority to make decisions regarding this role. Both must be delegated for the delegation to be successful. 4. The process of evaluation is the responsibility of the manager, and this authority cannot be transferred to a delegate.

The nurse manager needs to delegate specific tasks to the charge nurse of the unit. Which action is an appropriate use of delegation? 1. Instructing the charge nurse to assume a client team 2. Asking the charge nurse to discipline a nurse on the unit 3. Having the charge nurse lead a nursing quality assurance task force 4. Evaluating all unlicensed personnel assigned to the unit

*Answer: 2, 3, 4, 5* *Explanation:* 1. Boundaryless collaboration is one of the six themes of the Six Sigma quality management program. 2. Involving the total organization is a characteristic associated with TQM. 3. Focusing on the client is a characteristic associated with TQM. 4. Identifying key processes is a characteristic associated with TQM. 5. Using quality tools and statistics for measurement is a characteristic associated with TQM.

The nurse manager on the obstetrical unit is adopting Total Quality Management (TQM). Which characteristics are associated with TQM? Select all that apply. 1. Boundaryless collaboration 2. Involve the total organization 3. Focus on client 4. Identify key processes 5. Use quality tools and statistics for measurement

*Answer: 4* *Explanation:* 1. If the nurse is involved in at-risk or reckless behavior that results in an error, action will be taken. 2. Incident reports are not the first step after making a mistake. 3. Failure to report personal mistakes or the mistakes of others is an at-risk behavior and is not tolerated in a blame-free environment. 4. Mistakes should be reported and reflected upon so that the same mistakes will not be made again.

The nurse manager orienting newly hired nurses has explained the organization's blame-free environment. Which remark by one of the nurses indicates understanding of the policy? 1. "If I make a mistake and report it, I will not be reprimanded or punished." 2. "When I make a mistake, I should immediately fill out an incident report." 3. "It is left up to each employee to self-monitor so we do not report others' mistakes." 4. "When I make a mistake, I should report it and look for ways to prevent it from recurring."

Answer: 2 Explanation: 1. The average age of the registered nurse (RN) is 46 years, and while the number of RNs under age 30 is increasing, more RNs are retiring than are entering the profession. 2. The demand for nurses is increasing because of sicker clients both in the hospital and in outpatient settings. Job numbers for nurses are expected to continue to grow. 3. Nursing faculty members are also aging and moving into retirement. 4. Women continue to outnumber men in the nursing profession.

The nurse manager overhears staff discussing the shortage of nurses. Which statement by a staff member would the manager evaluate as misinformation? 1. "There are more nurses retiring than are entering the profession." 2. "The demand for nurses is declining because of fewer hospital admissions." 3. "There are insufficient numbers of nursing faculty to teach interested students." 4. "Women still outnumber men in nursing."

Answer: 2 Explanation: 1. The manager will probably pay close attention to the hospital administrator because of the position. 2. When there is a long-term relationship, the listener sometimes thinks they know what the other person is going to say. Careful listening is necessary in these situations. 3. The manager would be attuned to someone who is new to the organization and who might be hesitant to speak. This is not a common situation in which the manager would have preconceived beliefs. 4. The nurse manager will likely to listen very closely to this conversation without preconceived beliefs.

The nurse manager should be most careful not to hold preconceived beliefs when listening to which person? 1. The hospital administrator discussing next year's budget 2. A staff nurse the manager has worked with for 25 years 3. A newly licensed nurse who is hesitant to address the manager 4. A physician discussing prognosis with the client and family

Answer: 1 Explanation: 1. Functional nursing breaks down client care into tasks assigned to the appropriate professional or skilled caregivers. This may result in one nurse (the "med nurse") administering all the medications on the unit. 2. Total client care is given by one nurse assigned to a few clients. 3. Team or modular nursing uses a variety of skilled caregivers to provide care to an assigned group of clients. 4. Team or modular nursing uses a variety of skilled caregivers to provide care to an assigned group of clients.

The nurse manager tells a newly hired nurse that the unit practices functional nursing. What should the new nurse expect? 1. One nurse has responsibility for all the medications on the unit. 2. One nurse has responsibility for all the needs of three clients. 3. One charge nurse and one respiratory therapist have responsibility for all clients. 4. One nurse and one nursing assistant have responsibility for 10 clients.

Answer: 1, 4, 5 Explanation: 1. Body language is a strategy used to generate feeling of personal power. 2. Power play is not a strategy used to generate feeling of personal power. 3. Arguing is not a strategy used to generate feeling of personal power. 4. Word choice is a strategy used to generate feeling of personal power. 5. Listening is a strategy used to generate feeling of personal power.

The nurse manager works at a rural hospital and is in charge of a medical unit. Another nurse manager is in charge of the adjacent surgical unit. Equipment is shared between the two units. The surgical unit manager frequently confronts and intimidates the manager of the medical unit regarding the use of the equipment. Which strategies could the manager of the medical unit use to generate feelings of personal power? Select all that apply. 1. Body language 2. Power plays 3. Arguing 4. Word choices 5. Listening

Answer: 4 Explanation: 1. Intuition is not based in research and is not evidence based. 2. Clinical experience is useful when integrated with evidence-based practice but is not considered evidence based when used alone. 3. Knowledge from nursing school is very useful in client care but can become outdated if the nurse does not continually update that knowledge. 4. Current research is a good source of evidence-based practice strategies.

The nurse manager's expected outcome is to increase evidence-based practice on the nursing unit. To meet this outcome, the manager encourages nurses to base their practice on which technique? 1. Intuition 2. Personal clinical experience 3. Knowledge from nursing school 4. Current research

Answer: 2 Explanation: 1. The task was defined but is inappropriate. 2. The violation occurred at the step of deciding on a delegate. Nurse assistants cannot administer medications. 3. The task was determined but is inappropriate. 4. The nurse and nurse assistant reached agreement, but the delegation was inappropriate.

The nurse prepares the medication ordered for the client. The nurse asks the nurse assistant to give the medication when the client receives breakfast and to report on the task at its completion. The nurse assistant agrees. Which component of the steps of delegation was violated by this request? 1. Defining the task 2. Deciding on the delegate 3. Determining the task 4. Reaching agreement

Answer: 2 Explanation: 1. The goal of an integrated healthcare network is to keep clients healthy and out of the hospital. 2. Primary care is the focus of integrated healthcare networks. 3. The goal of an integrated healthcare network is to keep clients healthy, thereby minimizing the need for specialty care visits. 4. The goal of an integrated healthcare system is to keep clients healthy so that more expensive options, like home care, are not needed.

The nurse works in a school clinic that is part of an integrated healthcare network. How would this nurse explain to parents and teachers the focus of care provided in the clinic? 1. Hospital focused 2. Primary care focused 3. Specialty care focused 4. Home care focused

Answer: 3 Explanation: 1. Studies on the quality of care provided by these clinics have shown it to be comparable to care provided elsewhere. 2. Most retail clinics are less expensive than physician offices or emergency departments. 3. Care in these clinics is provided by nurse practitioners with physician backup. If the nurse practitioner believes additional studies or assessment should be done, referrals are made. 4. There is no indication that the clinic is not appropriate for children.

The nurse's friend says, "I've been thinking about going to that healthcare clinic in the grocery store so someone can look at my daughter's rash. What do you think?" Which response by the nurse is appropriate? 1. "Most of those retail clinics are not very good. I'd go somewhere else." 2. "That would be okay, but you have to pay extra for the convenience." 3. "If the nurse practitioner at the clinic thinks the rash is significant, you will be referred for additional care." 4. "I would use the clinic for myself, but not for my children."

*Answer: 3* *Explanation:* 1. Simulation mannequins are not essential for problem-based learning. 2. It is not essential to have a person who portrays a client in order to conduct problem-based learning. 3. Problem-based learning exists when students are exposed to "what comes next" in a case study. Additional information is revealed as the case study progresses. 4. Debates are a way to encourage innovation but are not essential for problem-based learning.

The nursing faculty would like to incorporate problem-based learning into the curriculum. Which action is essential? 1. Obtain funding for a simulation mannequin. 2. Write standardized scripts for volunteers who will portray clients. 3. Add more information to existing care plans as the study unfolds. 4. Assign client care debate topics to teams of three or four students.

*Answer: 3* *Explanation:* 1. Once the problem has been identified, the group would then look at solutions that have already been tried. 2. Brainstorming is used to develop solutions after information about the problem is analyzed. 3. Problem solving begins with collecting the facts, which provides clues to the scope and solution of the problem. 4. Information cannot be sorted into an orderly arrangement until it has been collected.

The nursing group has been charged with the task of solving a patient care problem on the unit. Which step should this group take first in this process? 1. Investigate what has already been tried to solve the issue. 2. Brainstorm about potential solutions. 3. Gather information to define the problem. 4. Categorize information in order of reliability.

Answer: 2 Explanation: 1. Evaluating the amount of change would occur before the final stage. 2. According to Lippitt's phases of change, the final stage is terminating the helping relationship. 3. Maintaining the change is the next to last of Lippitt's stages. 4. Looking for persons who may be sabotaging change efforts is not the last of Lippitt's stages.

The nursing supervisor identifies ineffective communication as a problem among the managers. According to Lippitt's phases of change, which action by the supervisor reflects the final stage of improving this issue? 1. The supervisor uses outcome data to evaluate the amount of change that has occurred. 2. The supervisor has gradually withdrawn from the role of change agent. 3. The supervisor has developed strategies to maintain the change. 4. The supervisor has determined if anyone in the group is sabotaging change efforts.

Answer: 2, 3, 4 Explanation: 1. There is nothing in this scenario to suggest that the nurse manager is inexperienced. 2. The unit clearly is having problems getting client responsibilities completed in a timely manner, resulting in stress and complaints. Reasons behind this might include distrust, poor communication, and a lack of delegation training. 3. When multiple client complaints are lodged against one unit, there is generally an overall problem with some aspect of the unit. 4. A lack of delegation training may result in chaos and client complaints. 5. There is no indication that the unit is short staffed.

The nursing supervisor is assessing a unit that has received several written complaints. The nurse manager seems overwhelmed and stressed trying to address many client situations. The charge nurse is trying to help everyone at once. Based on this assessment, what might this supervisor conclude? Select all that apply. 1. The nurse manager is inexperienced and needs time to adjust. 2. The unit culture may foster distrust and poor communication among staff. 3. Client complaints are usually an indicator of a larger unit problem. 4. Nurses on the unit are in need of additional training and skills. 5. The unit is short staffed.

Answer: 4 Explanation: 1. It is the responsibility of the supervisor to develop the staff. Failing to delegate is the time waster. 2. An effective manager's role is to develop staff in which such roles are delegated. 3. The fact that the nurse supervisor could do the job faster does not help to facilitate staff development. 4. Even though it may appear that these statements are straightforward and that the supervisor is just trying to save time, statements such as this often suggest a lack of trust and confidence in the abilities of the staff.

The nursing supervisor states, "I really don't have the time to delegate this task to a nurse manager. I can do it faster!" What is the most likely basis for this statement? 1. The nursing supervisor does not have time to delegate. 2. The nursing supervisor's job description needs to be redefined. 3. The nursing supervisor feels that he or she can do the job faster. 4. The nursing supervisor is concerned that staff is ill-prepared to assume additional responsibilities.

Answer: 4 Explanation: 1. The rule of thumb is to ask the lowest person in the hierarchy who has the requisite capabilities. 2. The rule of thumb is to ask the lowest person in the hierarchy who has the requisite capabilities. 3. The rule of thumb is to ask the lowest person in the hierarchy who has the requisite capabilities. 4. The rule of thumb is to ask the lowest person in the hierarchy who has the requisite capabilities.

The nursing supervisor would like to delegate an information-gathering task. All the people listed have the ability to perform the task. In general, whom should the supervisor ask to do this work? 1. A nurse manager 2. A staff nurse 3. A licensed practical nurse 4. An unlicensed nursing assistant

*Answer: 4* *Explanation:* 1. An indicator is a tool used to measure the performance of a structure, process, or outcome standard. 2. A structure standard is related to the physical environment and the organization as opposed to the delivery of nursing care. 3. Benchmarking is the process of comparing data with other reliable sources internally and externally in order to improve quality of care. 4. A process standard is a written statement that defines actual delivery of nursing care to a specific population.

The nursing task force is developing measurable goals for each client on the orthopedic unit. The statement "Each client will have a written assessment and plan of care document within eight hours of admission" is an example of which component of quality management? 1. Indicator 2. Structure standard 3. Benchmark 4. Process standard

Answer: 1, 5 Explanation: 1. Magnet status designates organizations that foster independence, autonomy, and creativity among the nursing staff. Nurses are involved in decision making in these institutions. 2. Money-saving ideas are not always good for staff or for clients. 3. Magnet-status organizations are flexible and encourage autonomy and independence. 4. Overtime is sometimes necessary, even in well-run facilities. 5. In Magnet organizations, staff members are encouraged to be involved in educational activities in the organization and the community.

The organization that awards Magnet status would look for environments where which practices are the norm? Select all that apply. 1. Nurses are involved in decision making. 2. Rewards are focused on ideas that save money. 3. Once a decision is made, it stands. 4. Nurses may be asked to work overtime. 5. Nurses are involved in educating the community about health.

Answer: 1 Explanation: 1. Men have been socialized to remain focused on the issue and avoid self-disclosure about personal experiences. 2. Men can tolerate disagreement within the group. 3. Men may be more apt to tolerate conflict than women are. 4. Women are more apt to ask questions to seek input.

The person who has just been promoted to nurse manager is male. If this nurse communicates in a way that is considered typical for men, what can the staff expect? 1. He will focus more on the issue than on personal experience. 2. He will strive to reach consensus within the group. 3. He will strive to avoid conflict within the group. 4. He will prefer to ask questions rather than make statements.

*Answer: 2, 3, 4* *Explanation:* 1. The CEO is not involved in the process of managing clients' pain and would not be part of this investigation. 2. Because the pharmacy is involved in providing the medication to control pain, this department would be represented at this meeting. 3. Because the orders for medications to control pain are generated by physicians, a representative from the medical staff would be invited to this meeting. 4. The staff nurse is on the front lines of controlling client pain and would be a valuable member of this group. 5. It would be rare for social services to be involved in the management of client pain, so this department would not be part of this group.

The procedures for managing client pain are being investigated as part of the hospital's total quality management program. Whom should the manager plan to invite to this meeting? Select all that apply. 1. The hospital CEO 2. A representative from the pharmacy 3. A representative from the medical staff 4. A staff nurse who works with clients in pain 5. A representative from social services

Answer: 1 Explanation: 1. Benchmarking uses an organization's outcome data and compares it with that of a similar organization to address strengths and challenges. 2. Because the hospitals with the organization are likely managed in a similar manner, this is not an example of benchmarking. 3. While establishing goals is a part of quality management, it is not benchmarking. 4. Setting up a quality monitor is a quality initiative, but it is not benchmarking.

The quality management director of a large healthcare conglomerate wishes to initiate benchmarking strategies to assess care. Which directive should this manager publish? 1. We will compare outcome indicators with other healthcare conglomerates of similar size and organization. 2. Outcome data of hospitals within the organization will be compared to assess quality. 3. Each client care unit in the organization will establish specific unit goals for quality. 4. Each unit in the organization will create a quality monitor to assess how well unit policies are followed.

Answer: 2, 3, 5 Explanation: 1. It is natural that the staff would discuss the change and its implications. 2. Adding the new work to the old work is a sign that the transition is not healthy. 3. This attitude is a sign that the transition is not healthy. 4. It is natural for the transition to a new process to take time. The nurse manager should be on the alert if this continues. 5. Making individual decisions about what parts of the old method to retain and what parts of the new method to adopt is a sign that the transition is not healthy.

The staff is transitioning to a major change in the provision of nursing care in a large hospital. Which behaviors should the nurse manager watch for that would indicate possible problems? Select all that apply. 1. Nurses are discussing the change at breaks and meals. 2. Nurses are doing both the old work and the new work. 3. A nurse says, "I guess everything we've done for years is wrong." 4. The provision of care with the new system takes longer than expected. 5. Nurses are doing parts of the old procedure and parts of the new procedure.

Answer: 1 Explanation: 1. This assignment reflects duties listed in the nurse's job description, so asking the nurse to attend a meeting is work assignment. 2. Overdelegation occurs when the delegator loses control over a situation by giving too much authority to the delegate. 3. Ineffective delegation occurs when authority and responsibility are given but the steps of effective delegation are not followed. 4. Assignments are a bureaucratic function and no transfer of authority occurs.

The staff nurse job description states that the nurse is responsible for attending hospital committee meetings as assigned. The nurse manager asking the staff member to attend a risk management meeting is an example of which concept? 1. Work assignment 2. Overdelegation 3. Ineffective delegation 4. Transfer of authority

Answer: 4 Explanation: 1. Although being more assertive in communication could help this nurse, this is not the most complete option. 2. Working to manage fear of conflict is not the most complete option. 3. Learning to delegate clearly would help the nurse learn to communicate better, but this is not the most effective strategy. 4. Attending training on communication would be the best plan for this nurse. The strategies described in the other options would likely be included in this training.

The staff nurse would like to improve personal communication with peers, patients, and the medical staff. Which strategy would be most effective for this nurse? 1. Plan to be more assertive in all communication. 2. Work to manage fear of conflict. 3. First learn to delegate clearly to others. 4. Attend the hospital-based communication training.

Answer: 1, 2, 3, 5 Explanation: 1. Few nurses have the training necessary to be managers. 2. Entry-level education programs are designed to produce generalists, and most content is focused on bedside nursing skills. 3. Many managers depend on their own experience with former supervisors. 4. Nurses work as managers of their own practice and can become very good managers when sufficient education and support are provided. 5. Nurses may manage as they were managed and perpetuate poor management techniques.

The vice-president for nursing services of a large teaching hospital has been aware that many of the problems in the nursing staff result from poor management at the unit level. What are reasons that nurse managers are sometimes ineffective in their role? Select all that apply. 1. There is little training available for nurse management positions. 2. Entry-level educational programs for nurses do not contain sufficient managerial content. 3. Management techniques are often learned "on the job." 4. Nurses are not good managers. 5. Nurses often experience poor supervision in their own careers.

*Answer: 4* *Explanation:* 1. Legitimate power is the authority to make a request of staff. 2. Expert power is based on a manager having unique skills or knowledge. 3. Referent power is based on the employees' respect for a manager. They comply with requests out of respect for the manager. 4. Reward power is based on the inducements a manager can offer a staff. In this case, the manager can offer increased benefits.

There is a shortage of nurses on weekends. The unit manager asks nurses to work every other weekend in return for an additional 8 hours of paid vacation per month. Which type of power is this manager using? 1. Legitimate power 2. Expert power 3. Referent power 4. Reward power

Answer: 2, 4, 5 Explanation: 1. The only trend that is consistent is the rapidly changing system. 2. Nurse managers must be aware of the responsibility of doing more with fewer resources. 3. Often the nurse manager is faced with staffing inadequate for the acuity of the clients requiring care. 4. Increasing numbers of retirees, both from nursing and as an aging population, have placed a strain on the healthcare system. 5. Complicated technology forces the nurse manager to keep up with the ever-present changes within the healthcare system.

To be effective in today's healthcare system, the nurse manager must be aware of which trends? Select all that apply. 1. An environment that does not change 2. Decreasing resources 3. Adequate staffing 4. Increasing numbers of retirees 5. Complicated technology

Answer: 4 Explanation: 1. Strategic planning is prioritizing long-term goals. 2. Organizing is related to planning to get the work done. 3. Directing is related to planning to get the work done. 4. Contingency planning is a proactive response to problems that may interfere with getting work done.

To address the problem of increasing costs of staffing agencies, a hospital has developed a plan for an internal float pool of nurses to be used when scheduled staff nurses call in sick. What type of planning has the administrative staff done? 1. Strategic 2. Organizational 3. Directive 4. Contingency

Answer: 80 Explanation: The IOM recommends increasing the level of education of all nurses. The goal is 80% at baccalaureate level or higher by 2020.

To meet the Institute of Medicine (IOM) recommendation, nursing should strive to have ________% of nurses prepared at the baccalaureate or higher level by 2020.

Answer: 3 Explanation: 1. The delegate has the option to negotiate for those aspects of a task the individual feels can be accomplished. 2. The delegator may have no intention of mentoring the delegate. 3. It is important for the delegate to make sure the time line and expectations are clearly defined, and he or she may opt to outline the specifications in writing. 4. Accepting delegation means accepting full responsibility for the outcomes and the benefits or liabilities associated with a task.

What action is necessary by a delegate accepting delegation? 1. Accept all aspects of the task delegated. 2. Assume the delegator will serve as a mentor. 3. Clarify the time line and expectations. 4. Realize the delegate and delegator share responsibility.

Answer: 1 Explanation: 1. Service-line structure is appropriate when environmental uncertainty is high and the organization requires frequent adaptation and innovation. 2. The medical staff is autonomous from the organization in parallel structure. This autonomy is reduced by service-line structure. 3. Parallel structure exists when there are two lines of authority in an organization. 4. Organizational structure is much clearer in a parallel structure.

What is occurring as the traditional parallel structure found in hospitals is being replaced by service-line structure? 1. Adaptation and innovation are encouraged. 2. The medical staff has become autonomous from the organization. 3. Two lines of authority have been created. 4. Organizational structure is becoming much clearer.

Answer: 2 Explanation: 1. Organizational climate is based on physical attributes and policy and procedure. Private rooms are an example of organizational climate. 2. Organizational culture is based on norms and traditions such as nurses wearing colorful attire. 3. Organizational climate is based on physical attributes and policy and procedure. The nurse-to-client ratio is an example of organizational climate. 4. Organizational climate is based on physical attributes and policy and procedure. Using primary nursing models is an example of organizational climate.

What is the best example of a pediatric unit's organizational culture? 1. All client rooms are private. 2. Nurses wear colorful scrubs. 3. The nurse-to-client ratio is 4 to 1. 4. The primary nursing model is used for care.

Answer: 3 Explanation: 1. Critical care experience is not necessary for effective leadership. 2. A leader may or may not have political knowledge but should have knowledge of and involvement in the community. 3. Regardless of the type of leader or the type of unit a nurse manages, communication skills are the key to effective leadership. 4. An effective leader may have formal power only.

What is the most common skill shared by effective nurse leaders in leadership theories or models? 1. Critical care experience 2. Political knowledge 3. Communication 4. Informal power

Answer: 2 Explanation: 1. Although nurses do communicate with all disciplines, the correct reason is broader. 2. Nursing activities occur in relationships, making communication skills essential. 3. Excellent communication skills can get the work done more quickly and effectively, but the correct reason is broader. 4. Excellent communication skills do not keep problems from occurring.

What is the most important reason that excellent communication skills are essential for nurses? 1. Nurses must communicate with all disciplines. 2. All nursing activities occur in relationships. 3. Interpersonal skills get the work done. 4. Good communication ensures no problems occur.

Answer: 1 Explanation: 1. The clinical microsystem method allows those who are involved in the smallest unit of care to make the decisions for that unit. 2. Clinical decisions should be made by professional healthcare providers, with client input. 3. Decision making "from the top" is not reflected in the clinical microsystem structure. 4. Clinical microsystems involve a core team of caregivers, not all the nurses working in a particular service area.

What is the primary belief behind the evolution of the clinical microsystem as a nursing care delivery system? 1. Those who deliver the nursing care make the most educated decisions for a particular unit. 2. Clinical decisions are best made by the clients who are served by a particular unit. 3. Clinical decisions are best made by nursing leaders for all units within that particular hospital. 4. Nurses working in a particular service area are best suited to make decisions for the clients in that area.

Answer: 1, 3, 4, 5 Explanation: 1. Optimizing the knowledge of the available nurses is an important component of deciding on a nursing care delivery system. 2. The system used by competing hospitals is not of great importance in choosing the system for a new hospital. 3. The provision of safe and effective nursing care is the most important of all considerations. 4. Optimizing nursing skills is an important consideration when choosing a nursing care delivery system. 5. The nurse executive must consider who is available to fill the nursing positions in the organization. Creating a system that requires employing numbers of nurses or nurses with particular specialties or education levels will not be effective if those nurses are not available to employ.

What should the nurse executive consider when planning the nursing care delivery system of a new hospital? Select all that apply. 1. How to optimize use of nursing knowledge 2. The system used by competing hospitals 3. How to ensure that clients receive optimal care 4. Skill sets likely to be present in the nurses who will be employed at the hospital 5. What groups of nurses are available for employment

Answer: 3 Explanation: 1. Laggards dislike change and are openly antagonistic. 2. Early adopters are not as eager to change as are innovators but are still receptive to change. 3. The early majority prefers the status quo but eventually accepts change. 4. Innovators love change and thrive on it.

When faced with the prospect of change, the nurse states, "We have always done it this way and never had any problems." A few weeks later, the same nurse remarks, "This new way seems to work better than the old way did." This statement is characteristic of which type of change response? 1. Laggards 2. Early adopters 3. Early majority 4. Innovators

Answer: 2 Explanation: 1. Telephoning an order leaves room for misinterpretation or inaccuracy in recording what was ordered. 2. To avoid misunderstanding what supplies are needed, a written request is the most appropriate choice. It avoids misunderstanding because the items can be checked off a list. 3. A verbal order in person may still result in double orders because there is no written record of what was ordered. 4. Voice mail may result in a mistake because there is no written record of what was ordered.

When the nurse manager orders supplies for the unit, which communication mode is best? 1. Telephone 2. Email 3. In person 4. Voice mail

*Answer: 3* *Explanation:* 1. Satisficing would not involve extra effort to honor requested days off. 2. If the nurse manager was satisficing, someone would be hired, even if the fit was not good. 3. This is an example of satisficing. An example of not satisficing would be the nurse manager not agreeing with the budget until funding for the beds was provided. 4. A nurse manager who is satisficing would provide continued counseling, work with the nurse, make excuses, and retain the nurse on staff.

Which action by the nurse manager is a demonstration of satisficing? 1. The nurse manager works with the staffing schedule until all requested days off are honored. 2. The nurse manager reposts a job opening because no applicants were a good fit for the current unit staff. 3. The nurse manager agrees with a proposed budget that does not provide badly needed new client beds. 4. The nurse manager insists on firing a nurse who is chronically late to work.

*Answer: 4* *Explanation:* 1. Reporting the accomplishments of the nursing staff is a way to support their importance and power. 2. Asking for and doing favors for one another is a form of collaboration. 3. The nurse manager should dress in the same manner as others in the meeting. 4. Talking more than listening can undermine credibility in the politics of the organization. The nurse should develop a reputation for listening and responding thoughtfully in discussions.

Which action is most likely to undermine the political power of a nursing department? 1. The nurse executive reports on the accomplishments of the nursing staff at each board meeting. 2. The nurses in the hospital often ask for and do favors for one another. 3. The nurse manager wears a business suit to meetings. 4. The nurse executive does more talking than listening in meetings.

Answer: 4 Explanation: 1. It is true that in some cases resisters are so disruptive that they must be disciplined. This is not the best method of assuring successful implementation of a change. 2. It is unlikely that everyone affected by the change will see it as positive. Attempts to ensure that everyone is happy with the change are generally a waste of energy and resources. 3. Rewards can be positive, but ignoring resisters is dangerous. 4. A supportive work environment for those experiencing the change is the strategy most likely to result in an easier transition.

Which action will have the greatest impact on the successful implementation of a planned change? 1. Disciplining individuals who continue to be resisters to the change 2. Ensuring there are no remaining pockets of disagreement when the change occurs 3. Continually rewarding those working toward the change and ignoring those who are not 4. Creating a supportive environment for those undergoing the change

*Answer: 3, 5* *Explanation:* 1. The nurse should build relationships with officials by keeping in touch. It is not savvy to make contact only when a need exists. 2. Email and Twitter are considered viable contact methods. 3. The nurse should focus the official's attention on one issue. 4. Handwritten letters get more attention than form letters. 5. Making an appointment is the best way to ensure that the official will be in the office, will have time to talk, and will be prepared to address the issue.

Which action would help the nurse work with public officials to influence policies? Select all that apply. 1. Contact officials only when necessary to avoid becoming a bother. 2. Avoid social media contact with officials. 3. Address only one issue in each correspondence. 4. Depend on form letters for correspondence. 5. Always make an appointment before visiting an elected official.

*Answer: 2, 3, 4, 5* *Explanation:* 1. Appearance can add to or detract from power. 2. The nurse should be professional in all encounters. Using endearing terms is not professional. 3. Power plays are attempts to diminish or demolish the opponent. The use of power plays is inappropriate. 4. The nurse should be assertive, not aggressive. 5. The nurse should not accept orders at face value. The nurse should never implement an intervention without knowing why the intervention is being done, that it is appropriate for the particular client, and what the outcome of the intervention should be.

Which actions diminish the image of power for nurses? Select all that apply. 1. Wearing a crisp, clean uniform 2. Addressing colleagues in endearing terms 3. Using power plays to achieve goals 4. Aggressively advocating for clients 5. Accepting orders without question

*Answer: 3* *Explanation:* 1. Lean Six Sigma is focused on improving process flow and eliminating waste. 2. Lean Six Sigma is focused on improving process flow and eliminating waste. 3. Lean Six Sigma focuses on eliminating waste, such as an increase in expensive overtime wages, and would focus on processes that may be allowing this to occur. 4. Lean Six Sigma focuses on improving process flow and eliminating waste.

Which data would be of most interest to an organization using Lean Six Sigma as a means of quality improvement? 1. Almost 85% of call lights are answered within 4 minutes. 2. Results of pain medication administration are documented 95% of the time. 3. Nursing overtime hours increased by 25% in the last quarter. 4. In the last 6 months, overall client satisfaction scores have increased by 15%.

Answer: 1, 2 Explanation: 1. Saying "Here are your directions" alerts the assistant that an important statement is going to be made. The instructions are clear and concise. 2. This is a clear and concise set of instructions. 3. This direction is not clear. Does the nurse want the clients whose rooms are on the south wing ambulated? Or does the nurse want all ambulation to occur on the south wing today? 4. This instruction is ambiguous. If the nurse would like for certain clients to have their hair shampooed today, the nurse should indicate that more clearly. 5. The nurse should be clear regarding what should be done before instruction is provided.

Which directions given by the nurse to the assistant are most likely to be understood and completed correctly? Select all that apply. 1. "Here are your directions for this morning. Please give the clients in rooms 2156, 2158, and 2159 total bed baths." 2. "Go to the diet kitchen and get a cup of apple juice for the client in room 2112." 3. "Ambulate the clients on the south wing." 4. "Do you think you'll have time to do shampoos today?" 5. "It might be a good idea to get the client in room 2110 up in the chair this morning. Or maybe it would be better to wait until this afternoon."

*Answer: 1* *Explanation:* 1. A just culture provides an environment in which employees can question policies and practices, express concerns, and admit mistakes without fear of retribution. 2. Making sure all nurses agree to report every mistake is being punitive prior to mistakes and is not blame free. 3. A self-reporting board is a form of punishment and placing blame. 4. The manager should not be keeping lists in a blame-free environment.

Which is the most effective method of creating a blame-free environment? 1. Work to develop a just culture within the organization. 2. Make sure all nurses agree to report every mistake. 3. Set up a self-reporting board so that all employees will know that everyone makes mistakes. 4. Ensure nurse managers keep a list of how often each employee makes a mistake.

*Answer: 2* *Explanation:* 1. The International Code of Ethics for Nurses is a guide for action based on social values and needs. 2. The Code of Ethics of the American Nurses Association makes explicit the professional values and standards of ethical conduct. 3. The American Association of Critical Care Nurses Ethics Work Group is a work group of critical care nurses who develop case studies and scenarios regarding ethical dilemmas. 4. Ethical Foundations for Critical Care Nursing Research design and carry out research studies prominent to the needs of critically ill clients and their families.

Which document serves to inform the nurse and the public of nursing expectations in ethical matters? 1. The International Code of Ethics for Nurses 2. The Code of Ethics of the American Nurses Association 3. The American Association of Critical Care Nurses Ethics Work Group 4. Ethical Foundations for Critical Care Nursing Research

*Answer: 1* *Explanation:* 1. Position power is determined by job description, assigned responsibilities, recognition, advancement, and authority. Being promoted to nurse manager increases position power. 2. Likability is associated with referent power, which is a personal power. 3. Advancing one's education is more likely to increase knowledge power, which is a personal power. 4. Connection power is based on an individual's links to influential people. Connection power is a personal power.

Which event would likely improve a nurse's position power within an organization? 1. The nurse is promoted to nurse manager. 2. The nurse is voted "most likable" as part of a Nursing Day celebration. 3. The nurse has just graduated from a master's program in nursing. 4. The nurse's wife has just been elected to the town council.

Answer: 4, 5 Explanation: 1. If the LPNs on the unit administer medications and complete dressing changes, and the RNs complete assessments and administer IV medications, then this scenario depicts functional structure. 2. If clinical services are organized around clients with colostomies and colostomy teaching, then this scenario depicts service-line structure. 3. If the nurse manager for the wound clinic reports to the vice-president of nursing and the vice-president of outpatient services, then this scenario depicts matrix structure. 4. If nursing councils address profession-wide issues linked to client care standards, then this scenario depicts shared governance. 5. If RNs are accountable to the latest standards and knowledge in the field, then this scenario depicts shared governance.

Which example of organizational structure depicts shared governance? Select all that apply. 1. All the LPNs on the unit administer medications and complete dressing changes; all the RNs complete assessments and administer IV medications. 2. Clinical services are organized around clients with colostomies and colostomy teaching. 3. The nurse manager for the wound clinic reports to the vice-president of nursing and the vice-president of outpatient services. 4. Nursing councils address profession-wide issues linked to client care standards. 5. RNs are accountable for the latest standards and knowledge in the field.

Answer: 3 Explanation: 1. This is a direct command or request and does not contain a qualifier. 2. This is a valid inquiry that does not include a qualifier. 3. Qualifiers are often used as "entry statements" into important discussions, but they can interfere with the message being communicated. This qualifier ("I hate to bother you") sets up the receiver of the message to feel bothered. Qualifiers also reveal a lack of confidence in the sender. 4. This is a valid inquiry and does not include a qualifier.

Which example represents a qualifier that may interfere with the message being communicated? 1. "Please notify me when this task is complete." 2. "Are you satisfied with the care you are receiving?" 3. "I hate to bother you with this, but we have a problem." 4. "How can I help you solve your issues with this physician?"

Answer: 4 Explanation: 1. An ineffective nurse manager is a restraining force that impedes change by discouraging participants from making specified changes. 2. An administration of long-term employees can be a restraining force that impedes change by discouraging participants from making specified changes. 3. A staff of long-term employees can be a restraining force that impedes change by discouraging participants from making specified changes. 4. A budget in the red necessitates change and pushes participants in the desired direction.

Which factor best represents a driving force in the process of change? 1. An ineffective nurse manager 2. An administration composed of long-term employees 3. A staff composed of long-term employees 4. A financial deficit of millions of dollars

Answer: 2, 3, 4 Explanation: 1. The philosophy of quality management is focus on the needs of the client. If there is no reason for the visitors to leave other than it is after visiting hours, this is not focused on client need. 2. Even though 2:00 p.m. is after "lunchtime," this nurse is focused on the client's needs. This is an example of quality management. 3. Quality management empowers the employee to evaluate quality. 4. This nurse has seen a need and is working to improve the quality of service. This is quality management. 5. Salary increases can be tied to quality improvement initiatives, but just asking for an increase is not quality management.

Which healthcare situations reflect the philosophy of quality management as designed by Deming? Select all that apply. 1. A nurse asks visitors to leave because it is after visiting hours. 2. At 2:00 p.m. the nurse orders a lunch tray for a client who has just been removed from nothing by mouth (NPO) status. 3. A nurse tells the manager that a housekeeper's work is not up to standards. 4. A nurse volunteers to take a Spanish language class to be able to communicate with clients. 5. A nurse who has not made a medication error in two years asks for a salary increase.

Answer: 1 Explanation: 1. While all four options are important, client need takes precedence over the others because nursing provides a service to the client. 2. Efficiency can be improved by choosing the correct nursing care delivery system, but this is not the most important consideration. 3. Costs can be contained by choosing the correct nursing care delivery system, but this is not the most important consideration. 4. Timeliness of care can be improved by choosing the correct nursing care delivery system, but this is not the most important consideration.

Which is the most important consideration in choosing a structure for nursing care? 1. Client need 2. Efficiency 3. Cost 4. Timeliness

Answer: 3 Explanation: 1. Higher job satisfaction occurs when delegation skills are improved, but this is not the most important outcome. 2. Effective delegation may result in greater confidence in skills, but this is not the most important outcome. 3. When effective delegation takes place in an organization, everyone benefits. This leads to higher client satisfaction, which is the ultimate goal of nursing care and nursing management. 4. If delegation skills improve, the delegator should have increased time for other endeavors. This is not the most important outcome of increasing delegation skills.

Which is the most important reason that practicing and mastering effective delegation skills is essential for nurses? 1. Higher job satisfaction 2. Greater confidence in skills 3. Higher client satisfaction 4. Increased time for other tasks

Answer: 3, 4 Explanation: 1. In quantum leadership, the outcome is more important than how it was achieved. 2. This social emphasis is more likely to occur with a leader who is transactional. 3. Change is expected by the quantum leader. 4. Informational power is shared by the quantum leader. 5. Focus on vision is an attribute of a transformational leader.

Which leadership activities exemplify a quantum leadership style?Select all that apply. 1. The leader reports how outcomes were achieved. 2. The leader brings cookies and coffee to every early morning meeting. 3. The leader is accepting of change. 4. The leader encourages staff nurses to help clients access internet sites about their disease process. 5. The leader often talks about the "vision" of the organization.

Answer: 1 Explanation: 1. The most important work of the manager is to stay physically and mentally healthy. 2. Innovation is important, but not as important as other factors. 3. Commitment is important, but not as important as other factors. 4. Enthusiasm is important, but not as important as other factors.

Which manager statement reflects concern about the most important requirement for today's nurse manager? 1. "I am taking a day off tomorrow for my annual physical." 2. "I think this class will help me learn to be innovative." 3. "I am committed to being a good manager." 4. "I feel enthusiastic about our new plans for the units."

Answer: 2, 3 Explanation: 1. Staff nurses are not seen as having legitimate leadership authority. Staff nursing is not a management or leadership role. 2. Nurse managers have legitimate authority conferred by the organization and described in job descriptions. 3. Case managers have legitimate authority conferred by the organization and described in job descriptions. 4. The leadership of the quality improvement coordinator is informal and stems from the nurse's knowledge. 5. The leadership of the education specialist is informal and stems from the nurse's knowledge.

Which nurse has legitimate leadership authority in the organization? Select all that apply. 1. Staff nurse 2. Nurse manager 3. Case manager 4. Quality improvement coordinator 5. Education specialist

Answer: 3 Explanation: 1. The free clinic likely does not have the support staff, equipment, and facilitative environment necessary for a clinical microsystem. 2. A walk-in clinic in a retail outlet does not have a tightly defined population to receive care and is not likely to function as a clinical microsystem. 3. The burn unit likely has a core team of caregivers, a defined population to receive care, informational systems in place, support staff, equipment, and an environment that facilitates provision of care. 4. A general medical-surgical unit is less likely to have the components necessary to support a clinical microsystem.

Which nursing care delivery situation best reflects the concept of a clinical microsystem? 1. A rural free clinic housed in a church gymnasium that is staffed by volunteer nurses and physicians 2. A walk-in clinic in a local discount store that is staffed by a nurse practitioner 3. An inpatient burn unit 4. A general medical-surgical unit in a mid-sized hospital

Answer: 2, 3, 4, 5 Explanation: 1. The chronic care model manages how care is delivered, not a specific disease. 2. Self-management is one of the six components of the chronic care model. 3. Decision support is one of the six components of the chronic care model. 4. Use of clinical information systems is essential to the chronic care model. 5. Use of community resources is one of the six components of the chronic care model.

Which nursing interventions would be in line with the chronic care model? Select all that apply. 1. Blood sugar is measured frequently in an attempt to achieve tight glycemic control. 2. The nurse provides the client with the Uniform Resource Locator (URL) for a new website dedicated to self-management of a chronic respiratory disease. 3. The nurse advocates for the client who has decided to forego further dialysis. 4. Client information is entered into an electronic medical record. 5. Information about the operating hours of a community recreation center is provided to the client with coronary artery disease.

*Answer: 1, 4, 5* *Explanation:* 1. Statutory laws are laws that protect the public from incompetent practitioners. Other statutory laws affecting nursing practice are guardianship codes, statutes of limitation, informed consent, living will legislation, and protective and reporting laws. 2. Marriage by mutual agreement is a common law marriage. Common law is a type of law that establishes a custom or tradition by which other similar cases are judged. Awareness of this law assists nurses to function within the boundaries of their role and to advocate for nursing practice when necessary. 3. Disability benefits are governed by administrative laws. This allows the legislature to delegate the authority to create rules and regulations governing a specific administration to an administrative agency of experts in the field. 4. Statutory laws are laws that protect the public from incompetent practitioners. Other statutory laws affecting nursing practice are guardianship codes, statutes of limitation, informed consent, living will legislation, and protective and reporting laws. 5. Statutory laws are laws that protect the public from incompetent practitioners. Other statutory laws affecting nursing practice are guardianship codes, statutes of limitation, informed consent, living will legislation, and protective and reporting laws.

Which of the following are examples of statutory laws? Select all that apply. 1. Informed consent 2. Marriage by mutual agreement 3. Disability benefits 4. Licensing laws 5. Elder abuse

*Answer: 3, 4* *Explanation:* 1. Vicarious liability: the law ascribes negligence to certain parties who may not be negligent themselves but whose negligence is assumed because of association with the negligent person; this is not an element that falls under unintentional tort. 2. Respondent superior: this doctrine allows the courts to hold the employer responsible for the actions of the employee when the employee is performing services for the organization; this is not an element that falls under unintentional tort. 3. Negligence is defined as the failure of an individual not to perform an act (omission) or to perform an act (commission) that a reasonable, prudent person would or would not perform in a similar set of circumstances; this is an element that falls under unintentional tort. 4. Malpractice is professional negligence and it is under the premise that all individuals are responsible for the consequences of their actions or inactions and refers to any misconduct or lack of skill in carrying out professional responsibilities; this is an element that falls under unintentional tort. 5. Intentional torts is defined as the intent to harm is present. Assault, battery, false imprisonment, invasion of privacy, inappropriate disclosure of private information, libel, slander, and defamation of character are all examples of intentional torts; this is not an element that falls under unintentional tort.

Which of the following elements fall under unintentional torts Select all that apply. 1. Vicarious liability 2. Respondent superior 3. Negligence 4. Malpractice 5. Intentional torts

*Answer: 2, 3, 4* *Explanation:* 1. Privacy is not one of the basic requirements for informed consent. 2. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 3. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 4. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 5. Coercion is not one of the basic requirements for informed consent.

Which of the following requirements are necessary for informed consent? Select all that apply. 1. Privacy 2. Voluntariness 3. Capacity 4. Information 5. Coercion

Answer: 2, 3, 4 Explanation: 1. Privacy is not one of the basic requirements for informed consent. 2. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 3. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 4. The basic requirements necessary for informed consent are capacity, voluntariness, and information. 5. Coercion is not one of the basic requirements for informed consent.

Which of the following requirements are necessary for informed consent? Select all that apply. 1. Privacy 2. Voluntariness 3. Capacity 4. Information 5. Coercion

Answer: 1 Explanation: 1. The Magnet Recognition Program, developed by the American Nurses Credentialing Center, designates healthcare organizations that provide nursing excellence. 2. The American National Magnet Commission is fictitious. 3. The Joint Commission accredits healthcare organizations, but does not award Magnet status. 4. The AMA does not award Magnet status. Magnet status is focused on nursing excellence.

Which organization would the hospital management team contact to pursue certification as a Magnet hospital? 1. Magnet Recognition Program 2. American National Magnet Commission 3. The Joint Commission 4. American Medical Association (AMA)

*Answer: 3* *Explanation:* 1. Most quality improvement programs are client focused. 2. Data drive most quality improvement programs. 3. One of the Six Sigma themes is aiming for perfection but tolerating failure. 4. Proactive management is common in most quality improvement initiatives.

Which part of Six Sigma is vastly different from other quality management programs? 1. Six Sigma has a client focus. 2. Data drive the program. 3. Failure is tolerated. 4. Management is proactive.

*Answer: 1, 3, 5* *Explanation:* 1. No waste is an IHI goal. 2. Increasing the educational preparation of nurses is not an IHI goal. 3. No unwanted waiting is an IHI goal. 4. Employee attendance is not an IHI goal. 5. No needless pain or suffering is an IHI goal.

Which quality improvement initiatives would help the healthcare organization meet Institute of Healthcare Improvement (IHI) goals? Select all that apply. 1. The amount of material opened and wasted for surgical procedures will drop by 25% this fiscal year. 2. The number of nurses who hold a bachelor's degree will increase by 10% this year. 3. Wait times in the emergency department will decrease by 15% this year. 4. Employee absences will drop by 10% this year. 5. Fewer than 5% of clients will report inadequate pain control while hospitalized.

Answer: 2 Explanation: 1. The charge nurse can delegate the responsibility of preparing rooms to the unlicensed assistant. 2. Unless the office nurse is an advanced practice nurse, the office nurse cannot call in orders not signed off by a physician or nurse practitioner. This opens the organization up to problems with liability. 3. The physical therapy assistant is part of the rehabilitation nurse's team and can legally accept direction from that nurse. 4. A home health nurse might be delayed at a visit and need another nurse to visit the next client. It would be inappropriate for the nurse to ask an unlicensed assistant to make the visit.

Which situation indicates that the nurse needs additional training on effective delegation? 1. The charge nurse tells the unlicensed assistant to help prepare rooms for new clients. 2. The office nurse calls in orders for admission on a client following a surgical complication. 3. A rehabilitation nurse asks a physical therapy assistant to assist a client with ambulation around the facility. 4. A home health nurse calls the office and asks another nurse to make the visit to her next client.

Answer: 1 Explanation: 1. Duplication of resources is a major weakness of service-integrated structures. 2. Coordination across functions and the ability to coordinate, collaborate, and compromise are strengths of service-integrated structure. 3. One of the strengths of a service-integrated structure is that the same activities can occur in several units and can be unit specific. 4. When there are two lines of authority, as in the parallel structure, conflicts may occur at the department or unit level.

Which situation is an example of a major weakness of service-integrated structure? 1. Two different units have purchased a demonstration model that could be used by both units. 2. The pharmacy has been asked to compromise on the times that medications are delivered to the units. 3. Nurse managers in several units are interviewing new graduates for staff positions. 4. The nurse manager of a unit is involved in a conflict between hospital management and the medical staff.

Answer: 4 Explanation: 1. As this is a system-wide condition initiated by the administrator, it is an example of organizational environment. 2. These are set rules published for everyone, including visitors, and make up part of the organizational environment. 3. This is a system-wide "rule" established by administration and is part of the organizational environment. 4. The nurses have created this system of coverage informally as part of their daily work. This is an example of organizational culture and may vary from unit to unit.

Which situation is an example of organizational culture? 1. Every Friday the administrator allows everyone to wear crazy hats while on the units. 2. The cafeteria opens at 7:00 a.m. for breakfast, 11:00 a.m. for lunch, and 5:00 p.m. for dinner. 3. The administration has set the time clock to count staff late if clocking in 7 minutes after the shift starts. 4. ICU nurses know to take turns covering each other's clients to facilitate eating breakfast and lunch on the day shift.

Answer: 3 Explanation: 1. It is appropriate for a person with more authority (nurse manager) to delegate a task to someone with a lower rank (staff nurse). 2. It is appropriate for a person with more authority (nursing supervisor) to delegate a task to someone with a lower rank (nurse manager). 3. Reverse delegation occurs when someone with a lower rank (licensed practical nurse) delegates a task to someone with more authority (nurse manager). 4. It is appropriate for a person with more authority (staff nurse) to delegate a task to someone with a lower rank (licensed practical nurse).

Which situation is an example of reverse delegation? 1. The nurse manager asks the staff nurse to attend an in-service on a new product. 2. The nursing supervisor asks the nurse manager to attend a meeting with the physicians. 3. The licensed practical nurse asks the nurse manager to administer insulin to a client. 4. The staff nurse asks the licensed practical nurse to record intake and output in his client's charts.

*Answer: 4* *Explanation:* 1. The focus of quality management is on ways to prevent problems and improve quality of care. Identification of failed standards is reactive, not proactive. 2. The focus of quality management is on ways to prevent problems and improve quality of care. Assessment of problems within the organization was the focus of quality management in the past. 3. The focus of quality management is on ways to prevent problems and improve quality of care. Identifying inefficient employees is reactive, not proactive. 4. The focus of quality management is on ways to prevent problems and improve quality of care. This nurse may have prevented a fall.

Which situation is an example of the overall goal of quality management in today's healthcare activities? 1. The nurse manager realizes a policy was ineffective in reducing incidents. 2. The administrator walks around making a list of potential problems. 3. The human resources department fires nonproductive employees. 4. The nurse wipes up a spilled drink before clients are allowed to enter a room.

Answer: 2 Explanation: 1. Physical therapy is an important aspect of home healthcare but is not the major service provided. 2. Nursing care is the primary service provided by home health agencies. 3. Provision of durable medical equipment is an important aspect of home healthcare but is not the primary service provided. 4. Provision of medical supplies is an important aspect of home healthcare but is not the primary service provided.

Which situation reflects the primary service provided by home healthcare? 1. The physical therapy assistant performs range-of-motion exercises three times each week. 2. The nurse changes the client's abdominal dressing daily. 3. Oxygen is provided in the home and managed by a durable medical equipment company. 4. Diabetic testing supplies are delivered to the client's home each month.

*Answer: 1, 4* *Explanation:* 1. Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors. Changing nursing notes is illegal unless specific protocols are followed, which would be unlikely on a routine basis. 2. Human errors are handled by the just culture of the blame-free environment. Overlooking an order is a human error. 3. Human errors are handled by the just culture of the blame-free environment. Client accidents are considered human errors. 4. Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors. 5. Human errors are handled by the just culture of the blame-free environment. Miscounting errors are considered human errors.

Which situation represents an exception to the blame-free environment? Select all that apply. 1. A nurse routinely changes nursing notes after a client is discharged. 2. A physician order is overlooked on a newly admitted client. 3. An unlicensed assistant drops a client. 4. A nurse does not complete an incident report after a medication error. 5. A nurse miscounts narcotics.

Answer: 3 Explanation: 1. A staff that includes many competent nurses enables the nurse manager to delegate and still have other nurses to rely on to deliver quality nursing care. 2. Democratic leadership styles facilitate delegation and provide good role models. 3. Resources such as qualified nurses, finances, and educational resources may be limited, which are obstacles to delegation. 4. Environmental factors such as a norm of crisis management as a result of poor job descriptions and unclear chains of command are unsupportive to delegation.

Which situation represents an obstacle to delegation? 1. Most of the nursing staff deliver highly skilled care. 2. The entire organization has a team-centered culture. 3. There is a budget shortfall for the current fiscal year. 4. Each employee knows and executes job responsibilities.

*Answer: 1* *Explanation:* 1. Adaptive decisions must be made when the situation is unusual and there is no clear-cut policy for decision making. 2. Making a medication error is not an unusual situation, and a policy exists for handling this issue. 3. A policy exists for handling procedure errors. 4. A policy exists for handling staffing errors.

Which situation requires an adaptive decision? 1. The nurse manager discovers that two clients require the use of a new piece of equipment and that the one the hospital has is the only one in the state. 2. The nurse has made a medication error on an experimental medication. 3. The nursing student makes an error when changing a client dressing. 4. The nurse manager scheduled too many nurses for the client census on the night shift, and all of the nurses scheduled have already been asked to take a low-census unpaid day off this month.

*Answer: 2, 3, 4, 5* *Explanation:* 1. Increased wait times are not included as a client safety goal. 2. Improving staff communication is one of The Joint Commission's national client safety goals. 3. Using medications safely is one of The Joint Commission's national client safety goals. 4. Preventing infection is one of The Joint Commission's national client safety goals. 5. Preventing mistakes in surgery is one of The Joint Commission's national client safety goals.

Which situation would be included in reporting for Joint Commission mandatory national client safety goals? Select all that apply. 1. The average wait time in the emergency department has increased by 5 minutes over last year's average. 2. A client is left waiting in the hallway because the transport person did not make contact with the client's nurse. 3. A nurse gives a medication by the wrong route. 4. A client developed sepsis after insertion of a urinary catheter. 5. Surgery is done on a client's right eye instead of the left eye.

Answer: 2, 3, 4 Explanation: 1. This is delegation. 2. This situation is a crisis, so this is direction. 3. This is a crisis situation, so this is direction. 4. This is a crisis situation, so this is direction. 5. Because this crisis is not occurring, this is delegation.

Which situations are examples of the nurse directing rather than delegating? Select all that apply. 1. A nurse manager asks a staff nurse to participate in a standing hospital committee. 2. A staff nurse asks the assistant to sit with the roommate of a client who has just died. 3. During a code blue situation, a nurse tells another nurse to start an IV. 4. A nurse tells an assistant to move a client into the hallway during severe weather. 5. A nurse reminds assistants of standard protocol for evacuation in case of fire.

Answer: 1, 2, 3, 5 Explanation: 1. Transactional leadership uses personal reward as a method of maintaining the status quo. 2. Transactional leaders value policy and procedure. 3. Interpersonal dependence is valued by transactional leaders. 4. An emphasis on empathy, awareness, and persuasion is more characteristic of servant leadership. 5. Transactional leaders value standardization.

Which topic would likely appear on the agenda for a staff meeting chaired by a nurse manager who follows transactional leadership theory? Select all that apply. 1. Progress on request to increase personal day benefits 2. Review of policy and procedure for unit evacuation 3. The value of teamwork 4. Being empathetic with clients 5. Standardized first of shift assessments

Answer: 1, 2, 4 Explanation: 1. The LPN cannot usually work with central lines and cannot legally change the dressing for the RN. 2. Confidential information cannot be shared with individuals not directly involved in the client's care. Under normal circumstances, the nursing supervisor would not need information about a client's history. 3. It is acceptable for a nursing assistant to ask the nurse to check on a client. 4. Requesting that a nurse be given a difficult assignment is leaving the organization open to liability issues. 5. It is common and acceptable for nurses to ask other nurses for consultation on client care.

Which situations would cause concern about liability with regard to delegation? Select all that apply. 1. The nurse asks the LPN to change a central line dressing. 2. The nursing supervisor asks the nurse for details about a client's history. 3. The nursing assistant asks a nurse to check the status of a client on the team. 4. The supervisor asks the charge nurse to give a nurse a difficult assignment. 5. The charge nurse asks a staff nurse's opinion on the client's surgical incision.

Answer: 1, 2, 5 Explanation: 1. Structure is necessary to ensure that care is coordinated. 2. Structure is necessary to ensure that all care responsibilities are covered. 3. While structure may make nursing care more efficient, it does not ensure that no overtime will be necessary. 4. The objective of structuring nursing care is not to ensure physician efficiency. 5. Structuring nursing care helps to assign nurses with certain skills to clients whose care requires those skills.

Which statement by a newly licensed nurse indicates an understanding of why it is necessary to structure nursing care. Select all that apply. 1. "It helps to coordinate care to a group of clients." 2. "It organizes care responsibilities." 3. "It ensures that the staff doesn't get overtime." 4. "It improves physician efficiency." 5. "It provides skilled care by skilled staff."

*Answer: 3, 4, 5* *Explanation:* 1. Basing decisions on placating staff indicates the leader is insecure and does not energize staff or promote creativity. 2. The leader who does not value input from staff will not promote creativity. 3. The leader who recognizes the staff's efforts and sacrifices is more likely to energize the staff. 4. Optimism is crucial to energizing staff and promoting creativity. 5. Humor is a good method to help energize staff and promote creativity.

Which statement by the formal leader of a nursing unit reflects the personality required to energize the staff and promote creativity? Select all that apply. 1. "I would like to change the format we use for shift report, but I'm afraid it would upset staff members who have been here a long time." 2. "This is the decision I have made, and there is no room for discussion." 3. "I would like to thank everyone for your hard work and dedication while we have been short staffed." 4. "I am certain that our new assignment system is going to make the workload more equitable." 5. "I know this week has been rough. I feel a little like sandpaper myself."

*Answer: 1, 3, 4, 5* *Explanation:* 1. Decisions made by groups are often better than those made by individuals because there is more input into the process. 2. There is no evidence to support that a decision made by an individual results in greater commitment. 3. Decisions made by groups are often better than those made by individuals because there is more input into the process. 4. The peer pressure of a group can create a greater commitment or feeling of obligation to achieve results. 5. Routine decisions are often made by individuals, with no group input necessary.

Which statement describes the primary difference between group and individual decision making, besides the number of individuals involved? Select all that apply. 1. A decision made by a group is often better than a decision made by one person. 2. A decision made by an individual results in greater commitment. 3. Groups can provide more input into the process. 4. A decision made by a group can create a greater obligation to achieve results. 5. Routine decisions are more often made by individuals.

*Answer: 2, 3, 4, 5* *Explanation:* 1. Getting credit for one's own ideas indicates political savvy. 2. Being "in the loop" is a sign of political savvy. 3. Knowing how to deal with a difficult colleague is a sign of political savvy. 4. A politically savvy nurse's ideas get a fair hearing. 5. Knowing when and how to present ideas is being politically savvy.

Which statement indicates that a nurse has the skills to be politically involved? Select all that apply. 1. The nurse does not take credit for his or her own ideas but attributes them to others. 2. The nurse knows a lot about what is going on in the organization. 3. People often say that the nurse has a way of dealing with difficult people and situations. 4. Staff members seek out this nurse's ideas on how unit problems should be solved. 5. The nurse has a "sixth sense" about when to present new ideas.

*Answer: 2* *Explanation:* 1. Depending on a group is not likely to help the nurse improve personal decision-making skills. 2. Practicing making decisions will increase the nurse's experience, comfort, and overall skill. 3. Including a "we" in this process is not as likely to improve the nurse's personal decision-making skills as making an individual decision. Asking for input to make certain the choice was correct indicates lack of certainty. 4. Decision-making skills can be learned regardless of one's perceived personal strength.

Which statement indicates understanding how a nurse could improve personal decision-making skills? 1. "We should gather a group together to make important unit decisions to ensure fairness." 2. "I should practice making decisions by developing potential solutions and then choosing one." 3. "We can make a decision and then ask for input from others to make sure it was the right choice." 4. "I know I will never be able to improve my decision-making skills because I am not a strong person."

Answer: 3 Explanation: 1. Choosing the person to delegate to can only be accomplished after the task to be delegated is identified and defined. 2. Information regarding the task, such as when it will be evaluated, is given to the delegate as part of the delegation process. This cannot be done until the task is defined and the delegate is chosen. 3. The first step of the process is to identify and define the task that will be delegated. 4. Additional information can only be offered when the delegate has been chosen, and the delegate can be chosen only after the task has been identified.

Which statement made by the nurse manager is an example of the first step of delegation? 1. "I must choose a person with good time management skills to be the delegate for this task." 2. "I plan to evaluate the outcomes of your work in 6 months." 3. "I am going to delegate the responsibility for creating the vacation schedule." 4. "I have some additional information that will help you in this task."

*Answer: 2* *Explanation:* 1. All the staff members in the organization are expected to provide quality service, but not all staff members are included in quality management activities. 2. Quality management is not designed for the purpose of placing blame on an individual. 3. Quality management systems do not provide clinical information; they use the data from clinical information systems to determine a focus on quality improvement. 4. The focus of quality management is on more than cost containment; it also focuses on improving services to clients and fixing processes that are causing errors or compromising quality.

Which statement reflects a characteristic common to all methods of quality management? 1. Each method uses all staff members in the organization. 2. None of the methods are designed to place blame on an individual. 3. All methods provide clinical information. 4. Most methods focus on cost containment.

*Answer: 2* *Explanation:* 1. Using power to evaluate staff is not its most important use. 2. The most important use of power is to affect the quality of client care. 3. The nurse can use power in relationships with unlicensed personnel, but this is not the most important use of power. 4. Using power to assist newly licensed nurses is not the most important way it is used.

Which statement reflects the most important use of power in nursing? 1. The nurse manager uses power when evaluating staff. 2. The nurse can use power to impact and improve client care. 3. The nurse uses power in relationships with unlicensed personnel. 4. The nurse manager can use power to assist newly licensed nurses.

*Answer: 2* *Explanation:* 1. There is not enough research to prove a strong linkage. 2. There is not enough research on using EMR and the quality of care provided to determine the impact. 3. Not enough research has been done to make this statement. 4. Research does exist, but it is insufficient to measure correlation.

Which statement regarding the use of electronic medical records (EMR) is accurate as associated with quality improvement? 1. EMR has strong linkage to improving quality. 2. Much more research must be done before the impact of EMR on quality can be determined. 3. EMR does not affect the quality of care provided. 4. Although no research into the impact on quality exists, EMR must continue as it is federally mandated.

Answer: 1 Explanation: 1. The RN is the only caregiver legally responsible for assessing clients. Thus, the RN cannot delegate this to the LPN, and this is an example of overdelegation. 2. It is within the LPN's scope of practice to administer oral medications. 3. The LPN can delegate tasks to the unlicensed assistant. Reporting vital sign changes to the RN is within the scope of an unlicensed assistant. 4. The nurse manager can delegate to the RN. An RN is a logical substitute for the charge nurse in this situation.

Which statement represents a situation is which delegation is ineffective or inappropriate? 1. The RN asks the LPN to assist with admissions by assessing the clients as they get to their rooms. 2. The RN delegates administration of oral medications for a group of clients to the LPN. 3. The LPN directs the unlicensed assistant to report vital sign changes on a postoperative client to the RN. 4. The nurse manager asks the RN to act as chairperson for today's unit council meeting because the charge nurse went home sick.

*Answer: 3* *Explanation:* 1. Collecting data can take time, especially as staff members are acclimating to new processes. This is not the most dangerous result given. 2. The work of CQI should be balanced out by the improvements to care and reduction in waste. 3. When innovation is sacrificed because of the work involved in CQI or because variance is discouraged, stagnation occurs. This is the biggest danger of using standardization. 4. Boredom is not the biggest danger of using measured standards.

Which statement reveals the most dangerous result of using measured standards as part of the CQI process? 1. A nurse complains, "Collecting this data takes so much time." 2. A radiology technician says, "CQI is lots of work." 3. A nurse manager says, "I'm not going to change this process, because I'd have to change the CQI monitors." 4. The laboratory technician says, "Writing these CQI reports is boring."

Answer: 1, 2, 3 Explanation: 1. Power-coercive strategies are based on the application of power by a legitimate authority-in this case, the federal government. 2. Power-coercive strategies are based on the application of power by a legitimate authority-in this case, Medicare. 3. Power-coercive strategies are based on the application of power by a legitimate authority-in this case, the accrediting body. 4. The empirical-rational model of change focuses on logical actions. 5. Normative-reeducative strategies rest on the assumption that people act in accordance with social norms and values.

Which statements by a hospital executive reflect power-coercive strategies to implement change? Select all that apply. 1. "We must follow the federal guidelines in the way we bill for our services." 2. "If we don't reduce our nosocomial infection rate, Medicare won't reimburse us." 3. "Administration has to make this change or our accreditation status will be at risk." 4. "This change is the only logical action we can take." 5. "All our sister institutions in the association have already made this change."

*Answer: 1, 2, 3* *Explanation:* 1. Suppression of dissent and new ideas occurs with groupthink. 2. Stereotyping outsiders is a symptom of groupthink. 3. There is a strong tendency in groupthink to seek concurrence. 4. Considering the opinion of others is not a symptom of groupthink. 5. Leadership controls the discussion and numbers of topics to be discussed in groupthink.

Which statements by a nurse in the emergency department are examples of groupthink? Select all that apply. 1. "We've already talked about this enough. We need to present a united front on this issue." 2. "The medical unit nurses won't like this decision because it is too much work." 3. "Let's all vote yes on this so we can get back to work." 4. "We need to consider the workload of the intensive care unit nurses." 5. "Does anyone else have any ideas to discuss?"

Answer: 2 Explanation: 1. Hybrid structure is typical of a growing institution and consists of both self-contained units and functional units. Top administrators still make many of the decisions for the organization. 2. Shared governance is a form of participative decision making. Nurses gain control over practice, are more accountable, and feel empowered. 3. Matrix structure combines functional structure and product structure into one overlapping structure. The dual authority created can be frustrating and confusing. Managers and administrators make many of the organizational decisions. 4. Functional structure is a traditional structure in which employees are grouped in departments by specialty. Most decisions are made by senior managers.

Which structure is reflected by the statement, "Nursing practice is best determined by nurses"? 1. Hybrid 2. Shared governance 3. Matrix 4. Functional

Answer: 4, 5 Explanation: 1. This statement suggests that the manager is not completely behind the projected change. This lack of decisiveness may confuse supporters of the change and encourage resisters to keep resisting. 2. This statement suggests that the manager may not be completely in favor of the change. In some cases, the staunchest resister is the manager. 3. If the nurse manager waits until everyone agrees to be a participant in change, change will never occur. 4. All changes and actions that occur within an organization should flow from the mission and values. 5. It is important to acknowledge that change is difficult. Full support of the administration makes change easier.

Which statements by the nurse manager would demonstrate effective change management? Select all that apply. 1. "If this approach doesn't work, at least we can say we've tried." 2. "Let's wait until the administration has completed their reorganization before we implement change." 3. "In order for this plan to work, everyone must agree to participate." 4. "We cannot lose sight of the mission and values of our institution as we begin to integrate these changes." 5. "Although this task is going to be difficult, we have the full support of our hospital administration."

*Answer: 1, 3, 5* *Explanation:* 1. Curiosity and a willingness to examine underlying assumptions are characteristic of a critical thinker. 2. A critical thinker is not in a hurry to make a decision but waits until all the facts are known and can be considered. 3. The critical thinker considers the possible alternative perspectives. 4. The critical thinker does not discount the concerns of others who have knowledge of the issue. 5. The critical thinker collects and analyzes the facts before considering any decision.

Which statements exemplify the attributes of critical thinking essential to nurses? Select all that apply. 1. "I am always curious about why we do things the way we do." 2. "I think we need to hurry up and make a decision." 3. "Can you help me understand your perspective a little better?" 4. "I don't think that your concern is necessarily pertinent to this issue." 5. "I don't think I can make that decision until I have more information."

*Answer: 2, 3, 4* *Explanation:* 1. Real power does not come from fear. 2. Respect is one of the principles of principle-centered or real power. 3. Honor is one of the principles of principle-centered or real power. 4. Loyalty is one of the principles of principle-centered or real power. 5. Using power for one's own purposes is not part of principle-centered or real power.

Which statements reveal that the nurse being described has real power? Select all that apply. 1. "She is so powerful. I have to admit that I'm a little afraid of her." 2. "I have such respect for her and the work she does." 3. "It is an honor to work with her." 4. "She had an opportunity to go to another hospital, but she chose to stay here and help us through accreditation." 5. "She knows how to use her power to get what she wants."

Answer: 1, 3 Explanation: 1. Key behaviors in delegating tasks are describing the task and providing the delegate with the benefit gained for the task. 2. Delegating should be done for the right reasons and not to dump tasks for purely personal reasons. 3. Key behaviors in delegating tasks are describing the task as well as the benefits to be gained. 4. The delegate should be assigned because the task meets the delegate's abilities. 5. The delegator should make the delegate aware of the reason for and the benefits gained from the delegation.

Which statements would be important for the charge nurse to make when delegating a responsibility? Select all that apply. 1. "I think it would be important to our organization if you represent the unit on the policy and procedure committee." 2. "I have assigned you to be the unit's representative because I don't have enough time to go." 3. "I think your attendance at the task force meeting will be a good reflection on our unit." 4. "I chose you to attend the meeting because it seems as though you have the lightest assignment." 5. "I would like you to be the unit's representative on the client education task force committee."

*Answer: 1, 3, 4, 5* *Explanation:* 1. Nursing is a knowledge profession, and the nurse must maintain expertise in order to retain power. 2. Nurses must affect this image personally, not through their clients or other disciplines. 3. Today's healthcare environment requires collaboration across disciplines. The nurse who can effectively work with others toward organizational goals is powerful. 4. Working with and knowing people of influence helps to increase the nurse's power. 5. Asking questions serves a twofold purpose: the nurse is increasing his or her personal knowledge base, and the nurse is seen as being an interested and active participant in the work of the organization.

Which strategy could be used by nurses to promote nursing's power image? Select all that apply. 1. Maintaining expertise by attending continuing education events 2. Encouraging clients to write letters of praise for a job well done 3. Encouraging all disciplines to work toward organizational goals 4. Attending local events with influential people 5. Asking questions about reasons behind processes and policies

*Answer: 1* *Explanation:* 1. To become powerful in the organization, the newly licensed nurse should develop an image of power. This includes building a "can do" reputation. 2. The nurse who wants to be powerful should not develop a reputation as a complainer. 3. Dressing for success is important. 4. Commitment to the organization is demonstrated by referring to the staff as "we."

Which strategy is best for the newly licensed nurse who wishes to develop power in the organization? 1. Develop a "can do" attitude and reputation. 2. Develop rapport with other staff members by joining in on complaint sessions. 3. Choose uniforms that do not look better than the ones other nurses wear. 4. Refer to the staff as "they" when discussing the unit.

Answer: 4 Explanation: 1. Ensuring adequate training by itself is not enough. 2. Asking for opinions will do little to encourage the use of evidence-based practice. 3. Recognition for those willing to use evidence-based practice is an insufficient motivator. 4. There must be training, easy access, and recognition for using evidence-based practice in nursing.

Which strategy is most likely to increase participation in the use of evidence-based practice in nursing? 1. Ensure adequate training and encourage its use by the nursing staff. 2. Elicit employee opinions of its use at least four times per year. 3. Give those nurses willing to use it extra recognition. 4. Ensure adequate training, recognition, and easy access to the internet.

*Answer: 2* *Explanation:* 1. Although becoming politically active is important, it is not the most effective way to promote a powerful image. 2. A powerful image would best be created by nurses acting and speaking in a professional manner. 3. Motivating others to become nurses is a result of power, but it is not the most effective way to promote a powerful image. 4. Having clients speak positively about nursing encounters is certainly a good thing, but nurses must improve their own image.

Which would be the most effective way for nursing to improve the power of its image? 1. All nurses becoming politically active 2. Dressing, speaking, and acting in a professional manner 3. Motivating others to become nurses 4. Encouraging clients to speak positively about their encounters with nurses

*Answer: 1* *Explanation:* 1. If leaders and followers share in a vision for the future, it is easier for changes to be made. 2. It is not necessarily true that shared visioning allows changes to be implemented more quickly. 3. Diluting the responsibility for error is not a reason to implement shared visioning. 4. The leader does not have reduced responsibility in shared visioning.

Why would the strategic planning committee choose shared visioning as a strategy for change? 1. Shared visioning makes change easier. 2. Shared visioning facilitates the more rapid implementation of changes. 3. Shared visioning means responsibility for error is shared. 4. Shared visioning means the leader has less responsibility for getting things done.