leadership final

The staff nurse is caring for the client with total accountability and is in continual communication with the client, the family, the physicians, and other members of the health care team. This type of nursing delivery system is known as .

Answer: Total patient care Total patient care is the original model of nursing care delivery, in which one RN is responsible for all aspects of one or more patients' care.

In dealing with a conflict on a unit, the nurse manager decides to ask one of the staff nurses, who is not moving toward resolution, to transfer to another unit. What tactic has the manager implemented? a. Suppression b. Avoidance c. Competition d. Withdrawal

Answer: a. Suppression In suppression technique, one of the conflicting parties is eliminated through transfer or termination.

As a staff nurse you are asked to complete a task you feel you are not qualified to do. What is the best response? a. Thank the delegator for the offer and clearly explain why you must decline. b. Ask for other tasks for which you feel prepared. c. Try to do the task anyway. d. Inform the supervisor that you are being mistreated.

Answer: a. Thank the delegator for the offer and clearly explain why you must decline.

A nurse executive tells the nurse manager, "I have always admired your strengths in contingency planning." How should the manager interpret this remark? a. The manager is good at identifying and managing day-to-day problems. b. The manager has skills in operationalizing designed plans. c. The manager is good at seeing "the big picture." d. The manager can present a plan for the future in a persuasive manner.

Answer: a. The manager is good at identifying and managing day-to-day problems. Contingency planning refers to managing the day-to-day issues. The remaining options refer to strategic planning.

Which issue would be considered urgent and important? a. Preparing educational packets on self-administration of insulin for clients b. Replacing two staff who were injured while caring for a violent client c. Developing an educational program for the new heparin protocol, to be implemented in two months d. Implementing and evaluating the staff's response to a tornado drill

Answer: b. Replacing two staff who were injured while caring for a violent client

Which of the following is the correct definition of "chain of command"? a. The tendency for people to perform as expected. b. The hierarchy of authority and responsibility. c. Activity directed through linear authority. d. Relationship without authority.

Answer: b. The hierarchy of authority and responsibility.

Which of the following are essential components of strategic planning? (Select all that apply.) a. Reengineering b. Shared governance c. Vision statement d. Mission statement e. Values

D, C and E

The staff nurse would realize he is experiencing burnout when: (Select all that apply.) a. Staff questions the nurse's clinical judgment. b. The nurse is spending more time talking to staff on other units. c. The nurse spends days off socializing with family and friends. d. The nurse is sleeping longer hours, sometimes coming in late to work. e. The nurse is drinking alcohol more frequently to relax.

A, D and E

A nurse manager finds herself in opposition to her immediate superior. The nurse manager knows that an important strategy in a confrontation is to use: a. Absolutes. b. Negative assertion. c. "Why" questions. d. "I" language.

. Answer: d. "I" language. Using "I" language and a low voice is important in a confrontation. Negative assertion, absolutes, and "why" questions do not promote professional communication during conflict.

A nurse manager completes an interruption log and identifies two staff members who take up an excessive amount of time with drop-in issues that are not urgent. What are some methods to address this behavior and manage time more efficiently? (Select all that apply.) a. Designate scheduled drop-in time slots. b. Turn the desk chair so that it faces away from the hall. c. Discuss with staff using e-mail for nonurgent issues to facilitate better use of time. d. Turn the desk chair so that it faces the hallway. e. When the staff members drop in, stand and remain standing during the conversation.

A, B, C and E

A manager has been given a deadline to complete an assignment by the end of the day. It will take every minute left of the afternoon to complete. Which interventions illustrate assertiveness to minimize interruptions and meet the deadline? (Select all that apply.) a. Placing a "Do Not Disturb for the Afternoon" sign on the office door b. Checking voicemail every 20 minutes c. Turning off e-mail notification d. Allowing voicemail to answer all incoming calls e. Delegating a discharge planning issue for a client to one of the staff nurses

A, C, D and E

Which of the following can be a negative outcome of group decision making? a. Dissent b. Decisions that do not match the manager's c. Groupthink d. Risky shift

Answer: c. Groupthink Groupthink is a negative phenomenon occurring in highly cohesive, isolated groups in which group members come to think alike, which interferes with critical thinking. Risky shift is a phenomenon seen in groups in which riskier, more controversial decisions are made. Dissent can be a positive aspect of group decision making if the proposed action is not considered to be appropriate for the unit. There is a risk that the group will not come to the decision the manager prefers, but this can be a positive.

Politics is a means for influencing events and the decision of others. The nurse manager who consistently reminds the staff that "there is no I in team" and periodically brings treats for the staff is using: a. Expert power. b. Political skills. c. Reward power. d. Image enhancement.

Answer: b. Political skills. Politics involves interpersonal endeavors, collective activities, analysis and planning, and image. The manager is skillfully building the team morale. Occasional treats are not rewards, nor is the manager using expert knowledge with the staff.

A staff nurse has delegated the ambulating of a new post-op client to a new staff nurse. Which of the following situations exhibits the final stage in the process of delegation? a. Having the new nurse tell the physician the task has been completed. b. Documenting that the task has been completed. c. Supervising the performance of the new nurse. d. Telling the unit manager the task has been completed.

Answer: c. Supervising the performance of the new nurse.

The nurse manager is talking with the CNA about her time management. Which of the following is an example of a nurse manager as coach? a. "You never report AM blood sugar levels on time." b. "You must get the vital signs taken on time or you will be disciplined." c. "Your appearance is seldom professional." d. "Your timely response to clients' call lights is exemplary."

Answer: d. "Your timely response to clients' call lights is exemplary." Nurse managers must also be coaches, teachers, and facilitators.

Which of the following scenarios would be an example of shared governance on a nursing unit? a. Staff nurses delegate activities to CNAs. b. Procedure manuals are written by a committee of nurse managers. c. A unit manager seeks advice from her supervisor. d. Staff nurses and CNAs make their own schedules.

Answer: d. Staff nurses and CNAs make their own schedules. Shared governance is based on the philosophy that nursing practice is best determined by nurses.

A nurse has been asked to serve in the capacity of charge nurse for the unit. What should the nurse expect from this role? (Select all that apply.) a. Accountability to the manager b. Trouble-shooting problems that occur during the shift c. Promotion of quality client care d. Responsibilities in planning and organizing the work of the unit e. 24-hour responsibility for the unit

A, B, C, D

A nurse manager has two out of six staff nurses call in sick for one shift. Because of reduced availability of staff, the manager decides to manage the unit with the three remaining nurses, which keeps the unit at minimal staffing standards What type of decision-making strategy would this be? a. Satisficing b. Routine c. Adaptive d. Rationalizing

Answer: a. Satisficing Satisficing is a decision-making strategy whereby the person chooses an alternative that is not ideal but good enough given the circumstances.

Influencing group processes on a unit toward the attainment of organizational objectives is the direct responsibility of which team member? a. The nurse manager b. All the group members c. An interested group member d. The informal group leader

Answer: a. The nurse manager

Advanced technology in health care, such as integrated health records, has allowed the nurse to do which of the following? a. Track clients' vital signs b. Skip the assessment step of the nursing process c. Take blood samples d. Prescribe medications

Answer: a. Track clients' vital signs

A staff nurse tells other staff nurses that the manager is ineffective in order to move into the manager position. Which of the following would describe the nurse's actions? a. Using a power play b. Using personal power c. Using information power d. Using punishment power

Answer: a. Using a power play A power play is an attempt to diminish an opponent. Punishment, or coercive, power is based on the penalties a manager might impose on an individual or a group. Personal power refers to one's credibility, reputation, expertise, experience, control of resources or information, and ability to build trust. Information power is based on access to valued data.

Health care systems primarily have functional structures. Which of the following would be an example of this? a. Open communication exists between Physical Therapy and Nursing. b. All nursing tasks fall under nursing service. c. Laboratory services have little authority. d. Medicine has authority over nursing.

Answer: b. All nursing tasks fall under nursing service. In functional structures, employees are grouped in departments by specialty, with similar tasks being performed by the same group.

The staff of a medical-surgical unit is in disagreement over holiday scheduling. The nurse manager knows that this is what type of conflict? a. Interpersonal conflict b. Intragroup conflict c. Intergroup conflict d. Intrapersonal conflict

Answer: b. Intragroup conflict Intragroup conflict occurs within one group. Intergroup conflict occurs between two or more groups. Interpersonal conflict occurs between two or more people. Intrapersonal conflict occurs within one individual.

The Hawthorne effect explains that the relationship between people and productivity is enhanced by which of the following? a. Creativity b. Special attention c. Organizations d. Groups

Answer: b. Special attention The Hawthorne effect explains that the relationship between people and productivity is enhanced by special attention.

A staff nurse describes the unit manager as "a born leader." The nurse ascribes to which theory of leadership? a. Behavioral theories b. Trait theories c. Democratic leadership theories d. Formal leadership theories

Answer: b. Trait theories Inborn characteristics are consistent with the trait theory of leadership. The behavioral theory believes people learn new behaviors through direct experience, or by observing other people performing the behaviors, which results in positive and negative outcomes. Leadership is formal when practiced by a nurse with legitimate authority conferred by the organization and described in a job description. A democratic leadership style assumes individuals are motivated by internal forces; the leader uses participation and majority rule to get work done.

One of the most important driving forces behind health care policy changes is which of the following? a. Emerging role of nurse practitioners b. New technology c. Ability to pay for health care d. Outsourcing of services

Answer: c. Ability to pay for health care One of the most important driving forces behind health care policy changes is the ability to pay for health care.

A multiple-car accident has occurred with multiple trauma clients being sent to an emergency department. The unit manager is preparing the staff for the arrival of the trauma victims. Which type of leadership would be most effective in this situation? a. Bureaucratic b. Permissive c. Authoritarian d. Participative

Answer: c. Authoritarian Different situations call for different types of managing style. An emergency is best handled with one person in control, delegating activities. Permissive leaders exert little control; therefore this would not be appropriate in an emergency. A participative leader seeks consensus and there is insufficient time in an emergency for this type of leadership. A leader who depends on bureaucratic rules and policies will be ineffective in an emergency situation.

When would a critical pathway need to be revised? a. When a member of the team retires. b. When it becomes too long. c. When the variances show a new trend. d. When the client leaves the hospital.

Answer: c. When the variances show a new trend. The length of the critical pathway is determined by the medical or surgical condition, interventions, and the length of stay. Critical pathways are revised when new trends are noted or a pattern of variances emerges. Staff are not part of a critical pathway. The critical pathway is designed for a medical or surgical condition, not an individual client.

Magnet certification requires a significant investment in time, money, and other resources. Why would a hospital seek this recognition? a. Physician groups want to work in Magnet hospitals. b. It helps nursing and ancillary services understand each other's role in caring for clients. c. It is a popular program to undertake. d. Client safety is improved when nurse staffing meets Magnet standards.

Answer: d. Client safety is improved when nurse staffing meets Magnet standards. Magnet certification results in an increase in client safety.

A team of nurses needs to move the clients and equipment to a new unit while remodeling is done. Each nurse has an assigned task within the group. This is an example of what type of group task? a. Conjunctive task b. Disjunctive task c. Informal task d. Divisible task

Answer: d. Divisible task With a divisible task, more people provide a greater opportunity for interdependency in performing tasks. For a disjunctive task (the group succeeds if one member succeeds), the greater the number of people, the higher the probability that one group member will solve the problem. With a conjunctive task (the group succeeds only if all members succeed), more people increase the likelihood that one person can slow up the group's performance (e.g., a jury trial).

A new nurse manager is attempting to solve a management issue by using one solution after another until she solves the problem. This would be known as what type of method? a. Experimentation b. Trial and error c. Decision making d. Analysis

Answer: b. Trial and error Trial and error is usually used by people with little management experience. Experimentation is a type of problem solving in which a theory is tested to enhance knowledge, understanding, or prediction.

The nurse manager can use several strategies to improve communication when giving directions. Asking the subordinate to repeat the instructions would be which strategy? a. Follow-up communication b. Verifying through feedback c. Knowing the context of the instruction d. Getting positive attention

Answer: b. Verifying through feedback

Productivity is influenced by groups. Which of the following work-group dynamics would positively affect productivity? a. Resources b. Individual relationships c. Cohesiveness and collaboration d. Leadership

Answer: c. Cohesiveness and collaboration

A staff nurse attends a continuing education class on advanced technology in health care. The nurse manager should interpret this as which of the following? a. Only important for nurse managers b. A waste of time c. Essential to nursing care d. Not important

Answer: c. Essential to nursing care Information technology will become increasingly integrated into systems of care.

In dealing with conflict, the nurse manager knows that feelings or perceptions about the situation will have an effect. According to Filley, what is this effect known as? a. Resolution aftermath b. Conflict suppression c. Felt conflict d. Antecedent conditions

Answer: c. Felt conflict Feelings or perceptions about the situation initiate behavior, known as felt conflict. Antecedent conditions are preexisting conditions. Resolution aftermath is the aftermath of the conflict. Conflict suppression is the next step, in which conflict is suppressed but not resolved.

Which of the following is true regarding health care systems today? a. They are all privately owned. b. Only HMOs are profitable. c. There are multiple types of organizations. d. They are all managed care organizations.

Answer: c. There are multiple types of organizations.

A nurse manager needs to resolve a conflict between the staff nurses and the physical therapy department. What type of power might the manager utilize? (Select all that apply.) a. Information power b. Coercive power c. Legitimate power d. Connection and referent power e. Reward and punishment power

A, C, D

The nurse is developing a critical pathway for congestive heart failure (CHF). Which components are essential to include? (Select all that apply.) a. Medical diagnosis b. Client outcomes c. Case management d. Expected length of stay e. Assigned staff nurse

A B D A critical pathway is developed with an expected length of stay and client outcomes that are appropriate for the medical diagnosis and treatment plan. The nurse is not indicated. Case management is not an essential element of a critical pathway.

A manager identifies that he is spending more time than desired on completing paperwork that is repetitive. Which of the following would not be an appropriate way to address this issue? a. Delegating staff evaluations to the staff nurse on the unit with the most experience b. Assigning the preliminary draft of the schedule to a subcommittee of staff nurses c. Combining data reports to reduce duplication d. Saying no to inappropriate paperwork assignments

Answer: a. Delegating staff evaluations to the staff nurse on the unit with the most experience

A nurse is considering employment at a long-term care facility that has a functional nursing delivery system. Knowing this, the nurse could expect that: a. One RN would pass meds for all clients on a unit. b. One RN, one LPN, and one unlicensed assistive personnel would share responsibility for a group of clients. c. Each RN would deliver total care to an assigned group of clients. d. Each RN would coordinate care for a group of clients.

Answer: a. One RN would pass meds for all clients on a unit. In functional nursing care is provided by assigning roles or functions to appropriate personnel In team nursing a team of personnel provides total care to a group of clients. Coordinating care for a group of clients is case management. Delivering total care to an assigned group of clients is primary care.

The changes brought forth by the state boards of nursing are an example of which type of change agent? a. Power-coercive b. Resistance c. Empirical-rational d. Normative-reeducative

Answer: a. Power-coercive Power-coercive strategies are based on the application of power by a legitimate authority. In the empirical-rational model of change strategies, the power ingredient is knowledge. The assumption is that people are rational, and will follow their rational self-interest if that self-interest is made clear to them. Normative-re-educative strategies of change rest on the assumption that people act in accordance with social norms and values. Resistance is opposing the change.

A new manager is implementing an initiative with the desired outcome to have the unit run more smoothly. What quality is the manager demonstrating? a. Being democratic b. Being a change agent c. Being unrealistic d. Being authoritarian

Answer: b. Being a change agent The nurse serves as a change agent when she acts to bring about change and ensure the effectiveness of the unit atmosphere.

A nurse who is planning to run for the local school board will find which source of power important? a. Reward b. Connection c. Expert d. Charisma

Answer: b. Connection Connection and information are two main sources of power important in political action. The nurse will want to use relationships to build coalitions and get information. The nurse does not have to be charismatic to use power effectively. The nurse is not an expert on education and as a candidate does not have rewards to grant.

The staff nurse in a long-term-care facility wants to delegate the passing of 9 AM medications. The additional staff consists of two UAPs. What type of barrier to delegation exists? a. Approval versus affiliation b. Lack of resources c. Poor communication d. Trust versus control

Answer: b. Lack of resources

While interviewing for a position at City Hospital, the nurse asks about the organizational structure of the institution. She is told that hospital is organized into departments based on specialty (e.g., nursing, dietary, pharmacy, etc.). Based on what you know about organizational structure, select the structure in this example. a. Parallel b. Service-integrated c. Functional d. Matrix

Answer: c. Functional In functional structures, employees are grouped in departments by specialty, with similar tasks being performed by the same group, similar groups operating out of the same department, and similar departments reporting to the same manager.

A supervisor is restricting the flow of communication between staff. This has resulted in the staff having two very opposite directions. The supervisor's actions are known as which type of force? a. Opposing force b. Driving force c. Restraining force d. Restrictive force

Answer: c. Restraining force Restraining forces impede change because they push participants in opposite directions.

The nurse manager talks with a new nurse once per week to determine how the nurse is adjusting to the new role. The manager asks if the nurse feels able to provide good care to clients and is becoming familiar with the electronic health record. This manager is demonstrating: a. An intrusive style. b. An attempt to intimidate. c. An authoritarian style. d. An effort to understand if the nurse is coping with the demands of the job.

Answer: d. An effort to understand if the nurse is coping with the demands of the job. Effective professionals benefit from self-awareness as well as feedback from mentors and preceptors who have experience and insight about professional growth and adjustment to stress.

"Organizations are made up of intertwined links and diversified choices that generate unanticipated consequences." This defines which of the following theories? a. Contingency theory b. Open system theory c. Closed system theory d. Chaos system theory

Answer: d. Chaos system theory The chaos theory is characterized by organizations that are made up of intertwined links and diversified choices that generate unanticipated consequences. The contingency theory best depicts the current health care delivery systems. Contingency theorists believe organizational performance can be enhanced by matching an organization's structure to its environment. Closed systems are self-contained, and usually can be found only in the physical sciences. An open system, in contrast, interacts both internally and with its environment.

Understanding the different modes of communication used by men and women is important for the nurse manager. Which of the following is a difference in communication in unpleasant situations? a. Women disagree more. b. Women talk longer and faster; men disclose more. c. Men tend to use tag questions. d. Men tend to talk more and women to withdraw.

Answer: d. Men tend to talk more and women to withdraw. In unpleasant situations, men tend to talk more, while women withdraw. Women tend to use tag questions and disclose more. Men tend to talk longer and disagree more.

A staff nurse wants to clarify his responsibilities regarding delegation. Which documents can the nurse refer to for assistance in decision making? a. The policy manual b. The job description c. The ANA standards of care d. The state nurse practice act

Answer: d. The state nurse practice act

A nurse manager wants to call a meeting with the staff. What is the first and most important step in the meeting process? a. Determine the place and time. b. Determine which members will contribute. c. Determine the members. d. Thoroughly prepare for the meeting.

Answer: d. Thoroughly prepare for the meeting.

Which techniques are effective when giving directions to subordinates? (Select all that apply.) a. Use lateral communication. b. Follow up as necessary. c. Verify feedback. d. Know the context of the instructions. e. Get positive attention.

B, C, D and E

What are the key elements essential to implementation of case management? (Select all that apply.) a. Synergy model of care b. Qualified nurse case manager c. Established critical pathways d. Quality management system e. Collaborative practice teams

B, C, D, E

When considering delegation of responsibility, the registered nurse should consider which "rights" of delegation? (Select all that apply.) a. Right supervision b. Right circumstance c. Right person d. Right implementation e. Right task

A, B C and E

Which of the following is the major difference between managers and leaders? a. Managers seldom are leaders. b. Leaders do not make good managers. c. Leaders usually have legitimate power. d. Managers always have legitimate power.

Answer: b. Managers always have legitimate power. Managers will always have legitimate power; leaders do not have to have it.

The complexities of the current health care delivery systems require a variety of leadership styles. Which of the following is one that has emerged in response to these changes? a. Emotional b. Quantum c. Servant d. Transactional

Answer: b. Quantum The quantum theory of leadership addresses complexity in organizations. Transactional leadership is based on social exchange theory, while emotional leadership involves personal competence. Servant leadership is based on the premise that in serving, one may be called to lead.

A staff nurse tells a client, "I am focused on your care" but then seldom comes into the room. What is the result of communicating this way? a. Metacommunication b. Upward communication c. Intrasender conflict d. Diagonal communication

Answer: c. Intrasender conflict When a verbal message is incongruent with the nonverbal message, it results in intrasender conflict. Metacommunications are behaviors that include head or facial agreement or disagreement. Upward communication is directed from staff to management or from lower management to middle or upper management. Diagonal communication involves individuals or departments at different hierarchical levels.

Which characteristic of a group contributes to cohesiveness? (Select all that apply.) a. Deriving satisfaction from involvement in the group b. Sharing similar values c. Preference for working alone rather than interacting with others d. Working far away from each other e. Being motivated by the same goals

A, B and E

A high-volume, noisy emergency room in an urban area with a high incidence of assault victims will affect staff in which ways? (Select all that apply.) a. A pessimistic sense about the world b. Phobias c. Inability to separate intense work situations from personal situations d. Fear of failure e. Feelings of extreme overload

A, B, C and E

A nurse manager would like to change a policy concerning staffing on holidays. How should the manager proceed? a. Practice patience during the effort b. Confront hospital administration with the unfairness of the current policy c. Remain fixed on the desired policy change d. Coerce other managers to join the movement to change the policy

Answer: a. Practice patience during the effort The manager should be patient as change can take time. Coercion should not be used. The manager should be open-minded to changes that might be suggested and should not confront administration with the unfairness of the current policy.

Which of the following is an important principle of delegation? a. Delegation is the same as work allocation. b. When delegating, you must transfer authority. c. No transfer of authority exists in delegation. d. Responsibility is not transferred with delegation.

Answer: b. When delegating, you must transfer authority.

When is the time to make people think about the routines that have been previously followed and to consider what might be a better plan of action? a. Analyzing data b. Identification c. Planning d. Collection of data

Answer: c. Planning Planning is the time to make people uncomfortable with the norm.

A staff nurse is working with a client who is on a critical pathway for education in preparation for home care. Which one of the following responsibilities would the nurse address first? a. Taking vital signs b. Evaluating client teaching c. Reviewing the information with the client and family d. Answering the client's questions

Answer: c. Reviewing the information with the client and family Assessment is the first phase of the nursing process, and history is part of client assessment that precedes all others. The nurse should review pertinent information with the client and family and establish goals for care.

In today's health care organization, who is most likely to fill the traditional "directing" role in management? a. The nurse manager b. The nurse executive c. The UAP d. The staff nurse

Answer: d. The staff nurse Today's health care organization is different in that the manager's role is much more as a facilitator or guide. The staff nurse directs the care of the UAP.

In our culturally diverse society, barriers to health care result from: a. Prejudice. b. Differences in language. c. Benchmarking. d. Telehealth. e. Different socioeconomic status.

Answer: a, e, b. Prejudice. The main factors that constitute barriers to health care are differences in language, different socioeconomic status, and prejudice. Telehealth is using telecommunications technology to provide medical and nursing services from afar. Benchmarking compares an organization's data with similar organizations.

Which of the following clients would most likely be selected for case management? a. An elderly client awaiting a hip replacement. b. A 41-year-old client admitted for outpatient tonsillectomy. c. A young adult with a fractured pelvis. d. An adolescent with a gunshot wound who is in the ER.

Answer: a. An elderly client awaiting a hip replacement. Hip replacement is a high volume surgery that would be appropriate for case management. Clients with uncommon problems who are not yet admitted to the hospital are not appropriate for case management. Outpatient procedures are not appropriate for case management.

After examining her client's abdomen and noting assessment of significant findings, even though the client says it doesn't hurt, the nurse says to a colleague, "I think something is going on here; I am going to investigate further." This nurse is using: a. Intuition. b. Trial and error. c. Deductive reasoning. d. Modified scientific method.

Answer: a. Intuition. Intuition is the "gut feeling" one has without the conscious use of reasoning.

A nurse manager has asked a group of nurses to submit a proposal regarding a policy change. The manager already knows what change he prefers and will support the administration. This is an example of which stumbling block? a. Preconceived ideas b. Rigidity c. Personality d. Fear of risk taking

Answer: a. Preconceived ideas The manager that already knows what will be proposed has preconceived ideas and may be asking the group for ideas to fulfill the concept of shared governance. Rigidity is an inflexible management style. Personality issues can affect decision making, but these are not overt in this situation. Fear of risk taking is a personality issue.

A staff nurse delegates a task to a UAP and then does half of the task herself, telling the UAP that he is too slow. This violates which principle of delegation? a. Transferring authority empowers the delegate to complete the task. b. Poor communication is a barrier to delegation. c. To delegate effectively, the individual should be matched to the task. d. In work allocation, no transfer of authority exists.

Answer: a. Transferring authority empowers the delegate to complete the task. Transferring authority empowers the delegate to complete the task. Retaining authority cripples the delegate's abilities to accomplish the task.

When trying to facilitate change in the staff, it is necessary to build trust and recognize the need for change. This type of action is known as which of the following, according to Lewin's Force-Field Model? a. Unfreeze of the system b. Moving the system to a new level c. Refreeze of the system d. Institutionalization

Answer: a. Unfreeze of the system Unfreezing the existing equilibrium is the stage that motivates the participants and builds trust/recognition. Refreezing reinforces the new patterns of behavior.

A new nurse on a pediatric unit works nights and has minimal time to spend with her children. A colleague observes that the nurse speaks abruptly with parents and is easily annoyed when clients cry or are demanding. The nurse realizes she is becoming increasingly distressed. Which action should the nurse take? a. Communicate minimally with clients and parents so as not to offend them. b. Ask the nurse manager for a schedule with an equal number of day and night shifts. c. Call off sick as frequently as possible without violating policies so more time can be spent with the children. d. Express negative comments to colleagues about annoying clients and parents.

Answer: b. Ask the nurse manager for a schedule with an equal number of day and night shifts. Self-care and self-awareness are key elements in professional nursing. Being aware of reactions to situations, emotional triggers, and feelings of being overwhelmed or burned out can protect an individual from becoming physically or psychologically exhausted.

Quality management and benchmarking are two approaches used to improve the quality of care. The major difference between these two approaches is which of the following? a. Benchmarking looks only at outcomes specific to nursing. b. Benchmarking compares outcomes in a variety of settings and disciplines. c. Quality management is used only in the primary care setting. d. Quality management is not useful in the outpatient setting.

Answer: b. Benchmarking compares outcomes in a variety of settings and disciplines. The major difference between quality management and benchmarking is that benchmarking compares outcomes in a variety of settings.

In determining a way to make shift change more effective for the nurse and the client, a hospital implemented a course of action. After a week of implementation, the decision was deemed inappropriate. What step of Roger's diffusion of innovations is this? a. Knowledge b. Confirmation c. Implementation d. Persuasion

Answer: b. Confirmation The stage of confirmation seeks reinforcement of the action taken. In the implementation stage, the innovation is put to use, and reinvention or alterations may occur. In persuasion stage, a favorable (or unfavorable) attitude toward the innovation forms. In the knowledge stage, the decision-making unit is introduced to the innovation and begins to understand it.

How does decision making differ from problem solving? a. Problem solving always involves selecting one of several alternatives. b. Decision making always involves selecting from a set of alternatives. c. Problem solving never involves decision making. d. Decision making always involves solving a problem.

Answer: b. Decision making always involves selecting from a set of alternatives. Decision making always involves selecting one of several alternatives; problem solving always involves diagnosing a problem. Both problem solving and decision making can involve aspects of the other.

Which of the following conditions would be well suited to use of a nursing critical pathway? a. Foreign object in ear b. Hip replacement surgery c. Fever of unknown origin d. Bacterial infection acquired in a foreign country

Answer: b. Hip replacement surgery A critical pathway tracks the client's progress through assessment, interventions, treatments, and outcomes for conditions across a time line. Hip replacement surgery would have a specified time line, with specific interventions and treatments to get the client back to optimal functioning. Episodic, undiagnosed, and unusual problems are not suited for critical pathways.

Behaviors such as not calling in sick on Fridays, accommodating requests for trading shifts, and returning from breaks in a timely manner are examples of what group characteristic? a. Roles b. Norms c. Group communication d. Status

Answer: b. Norms Norms are the informal rules of behavior shared and enforced by group members. Norms emerge whenever humans interact. Groups develop norms that members believe must be adhered to for fruitful, stable group functioning. Nursing groups often establish norms related to how members deal with absences that affect the workload of colleagues. Roles are a set of expected behaviors that fit together into a unified whole and are characteristic of persons in a given context. Status is the social ranking of individuals relative to others in a group, based on the position they occupy.

Scientific methods for problem solving are useful when time is not an issue. For problems requiring immediate action, nurses can use an organized method that involves seven specific steps. What is this method? a. Brainstorming b. Problem-solving process c. Trial-and-error d. Experimentation

Answer: b. Problem-solving process The problem-solving method is an organized seven-step process useful for problems that require immediate action.

A committee of nurses tries to determine who should be charged with the different workloads of the committee. In what stage of group development is this committee? a. Performing b. Storming c. Forming d. Norming

Answer: b. Storming In the storming stage, the members wrestle with roles and relationships. In the forming stage, individuals assemble into a well-defined cluster. In the norming stage, the group defines its goals and rules of behavior. In the performing stage, members agree on basic purposes and activities and carry out the work.

A group of nurses selected by their colleagues plan an orientation program for new staff. What type of group is this? a. Command group b. Task group c. Informal group d. Formal group

Answer: b. Task group A task group is composed of several persons who work together and are charged with accomplishing specific time-limited assignments. Informal groups evolve naturally from social interactions. Groups are informal in the sense that they are not defined by an organizational structure. Real (command) groups accomplish tasks in organizations and are recognized as a legitimate organizational entity. Formal groups are clusters of individuals designated temporarily or permanently by an organization to perform specified organizational tasks.

Which of the following leaders would be considered a transformational leader? a. A unit manager who reminds a CNA to work on time management skills b. The advanced practice nurse who encourages a staff nurse to pursue additional education for career advancement c. The supervisor of a unit who requests staff to work overtime d. The unit secretary who encourages staff to use the proper forms

Answer: b. The advanced practice nurse who encourages a staff nurse to pursue additional education for career advancement Transformational leaders focus on effecting change through a commitment to the organization's vision and seek to elevate followers. A focus on tasks like using proper forms, time management, or making requests is not representative behavior of transformational leaders.

Cultural diversity presents an important challenge to nurse managers due to which of the following? a. 80% of nursing staff comes from one or more minority groups. b. The increase in cultural diversity is seen both in the client population and the nursing staff. c. Staff nurses are not trained to be culturally sensitive. d. A nursing shortage exists.

Answer: b. The increase in cultural diversity is seen both in the client population and the nursing staff. Cultural diversity presents an important challenge to nurse managers due to the increase in cultural diversity seen both in the client population and the nursing staff.

In a staff meeting, a nurse manager asks the staff to suggest ways to change a policy. The list is written on the whiteboard as the suggestions are made. What type of decision-making technique did the nurse manager use? a. Trial-and-error b. Democratic c. Brainstorming d. Experimentation

Answer: c. Brainstorming Brainstorming is a decision-making method in which group members meet and generate diverse ideas about the nature, cause, definition, and/or solution to a problem. Trial-and-error is applying one solution after another until the problem is solved or appears to be improving. Experimentation involves pilot programs or limited trial of possible solutions. It is more rigorous than trial-and-error. Democratic decision making would be by majority vote.

A staff nurse wants to become instrumental in changing a policy regarding scheduling. Which of the following might be helpful in this situation? a. Talking to the Director of Nursing b. Demonstrating positional power c. Compiling data that would support the policy change d. Using image power

Answer: c. Compiling data that would support the policy change Using facts and figures to demonstrate the effectiveness of a policy change is an effective tool. Image refers to presentation of oneself in a given situation. The staff nurse does not have positional power sufficient to effect change. It would be inappropriate for the staff nurse to communicate with the Director of Nursing without prior communication with the unit manager.

A nurse manager is interested in solving a serious conflict among the nursing staff. He uses a strategy that involves allowing the group to explore a variety of options and come to a consensus on a solution. What strategy for conflict resolution has the manager used? a. Win-win b. Confrontation c. Integrative decision-making d. Competing

Answer: c. Integrative decision-making Allowing the group to explore a number of solutions and come to a consensus on a solution is an integrative decision-making method.

A staff nurse develops an innovative documentation system for postoperative clients. The nurse manager grants the nurse paid leave to develop one for medical clients. What type of power is the nurse manager using? a. Legitimate power b. Information power c. Reward power d. Expert power

Answer: c. Reward power Reward power is based on inducements in exchange for contributions towards the manager's objectives. Legitimate power stems from the manager's right to make a request because of the authority associated with job and rank in an organizational hierarchy. Expert power is based on possession of unique skills, knowledge, and competence. Information power is based on access to valued data.

A babysitter calls the staff nurse to let him know that she will not be able to take care of his children on the day the nurse is scheduled to work. The nurse is presenting important material at a committee meeting that day. What type of conflict is the staff nurse experiencing? a. Intergroup conflict b. Perceived conflict c. Role conflict d. Structural conflict

Answer: c. Role conflict Role conflict exists when one has responsibilities that are overlapping. Intergroup conflict occurs between two or more groups. Structured relationships (superior to subordinate, peer to peer) provoke conflict because of poor communication, competition for resources, opposing interests, or a lack of shared perceptions or attitudes. Perceived conflict refers to each party's perception of the other's position.

After discussing alternatives to dressing change procedures to minimize discomfort, the nursing staff accepted a new procedure as part of the daily routine. This is an example of which stage of Havelock's model of change? a. Acquiring resources b. Building a relationship c. Stabilization and self-renewal d. Choosing the solution

Answer: c. Stabilization and self-renewal Havelock's model starts with building a relationship. Acquiring resources and choosing the solution are middle steps. The final step, that of accepting the new procedure and moving on is stabilization and self-renewal.

A nurse manager describes a newly hired nurse executive as an "edge runner." How should the staff nurses interpret this statement? a. The executive is rigid in management style. b. The executive is unpredictable. c. The executive is very innovative. d. The executive has preconceived ideas.

Answer: c. The executive is very innovative. An "edge runner" is a nurse who creates innovation solutions for the health care system.

A high-volume maternity unit uses differentiated practice as its staffing model. As a new graduate employed on this unit, the nurse can expect that: a. Client teaching is the responsibility of the team leader. b. Seniority is the main determination of client assignments. c. The initial level of practice responsibility will be limited. d. Evidence-based practice guides risk management principles.

Answer: c. The initial level of practice responsibility will be limited. Client teaching is the responsibility of the registered nurse who provides the client's care. In differentiated practice, client assignments are made based on the level of education, competence, and experience of the nurse relative to client needs. Risk management has many facets, but the staffing model does not affect them. The scope of nursing practice and responsibility are defined for each level of practice. A new graduate will have limited experience so the level of practice will be limited.

A nurse manager says, "One of our nurses was injured in a car accident. I know you will want to help by picking up one or more of her shifts as she recovers." This nurse is using which leadership style? a. Transactional b. Quantum c. Transformational d. Servant

Answer: c. Transformational Transformational leaders appeal to the individual's better selves. A transactional leader would emphasize the reward associated with picking up the shift. The quantum leader would ask for input into how to cover the shifts. The servant leader would assume the staff nurses would volunteer to cover the shifts.

The staff nurse delegates AM care for two clients to the UAP. What principle of delegation is the nurse following? a. Delegation requires a situation with clearly defined superiors. b. Delegation is a tool used only by nurses. c. You can delegate only those tasks for which you are responsible. d. Delegation can only exist with a subordinate.

Answer: c. You can delegate only those tasks for which you are responsible.

Even though this is not easy, facilitating ____________ is a mandatory skill for all nurse managers and is crucial in the success of the manager.

Answer: change Successful change agents demonstrate certain characteristics that can be cultivated and mastered with practice. Making change is a mandatory skill for managers.

Which of the following would a nurse suggest are significant benefits to an organization that is considering adoption of a practice partnership model? (Select all that apply.) a. Leadership is well accepted. b. Clients express greater satisfaction. c. It is less expensive to implement than other models. d. Continuity of care is facilitated. e. It takes less planning to implement.

Answer: d, c. Continuity of care is facilitated. It is less expensive to implement than other models. Evidence has shown that practice partnerships are the most cost effective of the nursing care delivery systems. Leadership is independent of the care delivery system; effective leadership is necessary for successful implementation of any care delivery system. Client satisfaction can occur with any type of nursing care delivery system. Continuity of care is enhanced when all members of the health care team work together to plan and implement care. Adoption of a new model takes considerable planning, time, and commitment prior to implementation.

According to Homans's framework, there are three essential elements of group systems. Which of the following exhibits attitudes? a. An LPN enrolls in an IV certification class. b. Staff nurses perform their jobs satisfactorily. c. Two nurses share their understanding of the role of the CNA. d. An individual nurse feels that the nurse manager is ineffective.

Answer: d. An individual nurse feels that the nurse manager is ineffective.

The nurse manager has had a lot of turnover on the unit recently and decides that team building is needed. An effective technique would be to: a. Allow the team to progress through the normal group developmental process until cohesiveness occurs. b. Identify individuals who are not team players and recognize their poor attitude in a team meeting. c. Pull staff members aside individually to identify who is undermining the team. d. Clarify team goals, roles, responsibilities, and boundaries.

Answer: d. Clarify team goals, roles, responsibilities, and boundaries.

Which factor is least likely to affect successful communication? a. Cultural background b. Method of communication c. Organizational structure d. Educational achievements

Answer: d. Educational achievements The factors that may affect successful communication are gender, method of communication, cultural background, and organizational structure. Educational achievements are less likely to influence successful communication.

The hospital administration plans to introduce a new system of client transport within the hospital. The nurse managers, when communicating with the staff about the change, should use which source of power to make certain the transition goes smoothly? a. Connection power b. Expert power c. Reward power d. Information power

Answer: d. Information power The nurse managers have access to the information, planning, and rationale for the change. It is important to communicate information in a positive way that reinforces the benefits to the staff and clients. Connection power refers to the manager using relationships to achieve results. Reward power suggests that the manager can offer some inducement for the staff to accept the change. The manager is not an expert on transportation issues in the hospital.

Which of the following is a specific benefit to an organization when delegation is carried out effectively? a. The clients feel that more of their needs are met. b. Managers devote more time to tasks that cannot be delegated. c. Delegates gain new skills facilitating upward mobility. d. The organization benefits by achieving its goals more efficiently.

Answer: d. The organization benefits by achieving its goals more efficiently.

A client who is in pain refuses to be repositioned. In making a decision about what to do, what should the nurse consider first? a. When a decision is needed b. What the alternatives are c. Who actually gets to make the decision d. Why a decision is needed

Answer: d. Why a decision is needed Decision making requires the nurse to select the best action to meet a desired goal. When a decision is needed comes after determining why a decision is needed. Who actually makes the decision is important, but not the first thing to consider. What the alternatives are comes after determining why a decision is needed, who makes the decision, and when a decision is needed.

A nurse who is determined to be a better follower should focus on building which characteristics? (Select all that apply.) a. Displaying commitment to the goals of the leader b. Being more self-directed c. Acting quickly d. Being more proactive e. Supporting the leader's decisions

A, B and E

Effective strategies to become more resilient include: (Select all that apply.) a. Becoming more self-aware. b. Managing time effectively. c. Deciding that one's career is not one's highest priority. d. Requesting as much overtime as possible. e. Exercising and avoiding high-fat foods.

A, B and E

In what ways can nurses use communication in a more gender-neutral manner? a. Eliminating words such as "sort of" and "truly" b. Hinting at what they want c. Not crying d. Stating the message clearly e. Focusing on the person rather than the issue

A, C and D

Which of the following skills is essential for nurses in today's health care environment? (Select all that apply.) a. Management b. Practice partnerships c. Supervision d. Delegation e. Communication

Answer: a, d, e, c. Management, supervision, delegation, and communication are all skills essential for nurses in today's health care environment. Practice partnerships are integrated models of care, not nursing skills.

A manager is prioritizing several issues. Which issue should be considered urgent and important? a. A staff nurse reports a pattern of malfunctioning IV pumps on the unit during the current shift, resulting in overdosing of medications. b. The manager of physical therapy calls and complains about inappropriate behavior of one of the staff nurses with one of the therapists. c. One of the staff nurses, who would have been an extra nurse for the next shift, calls in sick. d. A small group of staff nurses requests a meeting to discuss initiating a scheduling committee.

Answer: a. A staff nurse reports a pattern of malfunctioning IV pumps on the unit during the current shift, resulting in overdosing of medications.

A group of physicians are in conflict with the nursing staff of a unit over when AM vital signs are recorded. To resolve the conflict, what type of technique might be used that respects the professionalism of both parties? a. Collaboration b. Avoiding c. Competing d. Accommodating

Answer: a. Collaboration Collaboration implies mutual attention to the problem, as the talents of all parties are used.

Selye's stress theory explains that a person stressed for long periods will: a. Face exhaustion and be more susceptible to illness. b. Ignore personal safety needs. c. Become more assertive. d. Become fatigued but also stronger.

Answer: a. Face exhaustion and be more susceptible to illness. Individuals who have frequent, intense, hostile experiences will have a physical response to these stressors. As result, an individual is more likely to become physically and/or psychologically depleted, and may be more susceptible to health problems.

A manager decides that setting goals will assist her in better utilizing her time. Which of the following are true regarding goal setting in the manager role? a. Goals need to be measurable, realistic, and achievable to be effective. b. Goals should be vague, so they are more likely to be met. c. Setting goals is a time waster in the manager role. d. Writing goals will increase the stress level of the manager.

Answer: a. Goals need to be measurable, realistic, and achievable to be effective. Goals decrease stress by providing direction and saving time. They need to be measurable, realistic, and achievable in order to be effective.

A manager has a budget request deadline today at 3:00. He stops his work to answer the phone, check e-mails as they arrive, and speak with staff who stop by his office. As a result, he misses the deadline. What best describes the cause of missing the deadline? a. Time wasters b. Assertiveness c. Goal setting d. Organization

Answer: a. Time wasters

Which statement by a newly promoted nurse manager would the supervisor interpret as indicating a need for further education regarding stress? a. "I have asked the staff to modulate their speaking voices while in the halls and nursing station." b. "I am working to eliminate stress from this unit." c. "I have asked maintenance to repair the noisy elevator doors at the end of the hallway." d. "I have engaged the nurses in planning a way to reorganize the nurses' station to make it more user-friendly."

Answer: b. "I am working to eliminate stress from this unit." Some stress is necessary to sustain life, and moderate amounts serve as stimuli to perform.

The staff nurse says, "I can't take working in the emergency department anymore. I am so sick of seeing people hurt and dying." How would the nurse manager best interpret this statement? a. As posttraumatic stress disorder b. As compassion fatigue c. As prolonged anxiety d. As burnout

Answer: b. As compassion fatigue Compassion fatigue is secondary traumatic stress experienced by caregivers. Symptoms are similar to those of burnout but can be more severe.

What is a positive benefit of conflict within an organization? a. Conflict always leads to a win-win resolution. b. Conflict helps people recognize differences and motivates them toward improved performance. c. Conflict leads to compromise in values and beliefs. d. Conflict leads to intergroup competition.

Answer: b. Conflict helps people recognize differences and motivates them toward improved performance. Conflict helps people recognize legitimate differences within the organization and serves as a powerful motivator to improve performance.

A nurse manager has left the facility, and one of the remaining managers is given that assignment in addition to his current load. He is told that the open position will not be filled. This is an example of which of the following? a. Proactive Management b. Job enlargement c. Time log d. Prioritizing

Answer: b. Job enlargement Job enlargement occurs when positions are combined, and managers have more employees to supervise.

A staff nurse submits a 6-week notice of resignation. The nurse manager prepares a request to immediately post the position and begin interviews. This action is best described as which of the following? a. Delegation b. Proactive management c. A time waster d. Reactive management

Answer: b. Proactive management Proactive management attempts to resolve problems over which you have control. This manager is attempting to prevent short staffing. Reactive management wastes time on problems over which you have no control. Nothing is delegated or considered a time waster in this example.

A nurse has been promoted to charge nurse. This role has changed his relationship with coworker friends, and now he feels tense and isolated. He decides to delegate more time-consuming tasks to non-friend staff, who then complain to the manager about perceived unfairness. What should the charge nurse do? a. Talk about staff who are annoying him with staff on other units b. Talk with his friends individually to let them know he will be assigning tasks to all staff in a more equitable manner c. Ignore his feelings of uncertainty, hoping they will diminish d. Not express his angry feelings

Answer: b. Talk with his friends individually to let them know he will be assigning tasks to all staff in a more equitable manner An individual's managerial style, interpersonal relationships, and sense of fairness influence a team's functioning and ultimately affect client care.

The nurse manager has two employees engaged in a longstanding conflict that is affecting the group's productivity and cohesiveness. She decides to meet with the employees in private, discuss the conflict openly, and attempt to resolve it using knowledge and reasoning. Which conflict management strategy is she employing? a. Suppression b. Collaboration c. Confrontation d. Intervention

Answer: c. Confrontation Confrontation is the most effective means of resolving conflict. The conflict is brought out in the open and attempts are made to resolve it through knowledge and reason.

A resident on night call refuses to answer pages from the staff nurse on the night shift and complains that she calls too often with minor problems. The nurse feels offended and reacts with frequent, middle-of-the-night phone calls to "get back" at him. The behavior displayed by the resident and the nurse is an example of what kind of conflict? a. Perceived conflict b. Felt conflict c. Disruptive conflict d. Competitive conflict

Answer: c. Disruptive conflict In disruptive conflict, the parties involved are engaged in activities to reduce, defeat, or eliminate the opponent. Filley (1975) defines competitive conflict as a victory for one side at a loss for the other. Felt conflict refers to the feelings of opposition within the relationship of two or more parties. Perceived conflict refers to each party's perception of the other's position.

Which behavior would be an early warning sign that the nurse is not handling job stress in a healthy way? a. The nurse feels it is necessary to spend more time with staff. b. The nurse has determined that the focus should be on client outcomes. c. The nurse has developed strategies to juggle work, studies, and family. d. When the nurse awakens in the morning, he does not feel rested.

Answer: d. When the nurse awakens in the morning, he does not feel rested. To manage stress effectively and keep stress at levels that enhance one's performance rather than deplete energy, the key is to develop resiliency.

Change is a mandatory skill for managers. Successful change agents display certain characteristics. Some of these characteristics are: (Select all that apply.) a. Envisioning skills. b. Empowerment. c. Energy. d. Confidence. e. Trustworthiness.

C, D and E

Which of the following are effective ways to apply power and politics in nursing? (Select all that apply.) a. Joining professional organizations b. Challenging authority c. Writing letters to legislators d. Picketing the employer e. Networking with other professionals

A, C and E

Integrated health care systems function in a variety of models. Which is a common characteristic of all systems? a. Provide care only in the primary care setting b. Deliver selective care only c. Treat clients only in the hospital d. Deliver a whole continuum of care

Answer: d. Deliver a whole continuum of care

The staff on a medical-surgical unit is in conflict with the occupational therapy department. What type of communication will be used to discuss the problem? a. Lateral communication b. Downward communication c. Upward communication d. Distorted communication

Answer: a. Lateral communication Lateral communication occurs between individuals or departments of the same hierarchical level. Upward communication occurs from staff to management or from lower management to middle or upper management. Downward communication is communication, generally directive, given from an authority figure or manager to staff.

Which of the following is an important emerging challenge to changes in health care? a. Bioterrorism b. Decrease in immigration c. Nursing staff shortages d. Increased surgical procedures

Answer: a. Bioterrorism

Nurse managers often need to attend to the complaints of their clients. In communicating with the client who has a complaint, what principle is important to keep in mind? a. Clients and families should be treated with respect; communication should be open and honest. b. Avoid discussing complaints. c. Supervisors should always be involved. d. The client's physician is often the cause of the problem.

Answer: a. Clients and families should be treated with respect; communication should be open and honest.

Which of the following theories best depicts current health care delivery systems? a. Contingency theory b. Chaos theory c. Open system theory d. Closed system theory

Answer: a. Contingency theory The contingency theory best depicts the current health care delivery systems. Contingency theorists believe organizational performance can be enhanced by matching an organization's structure to its environment. Closed systems are self-contained and usually can be found only in the physical sciences. An open system, in contrast, interacts both internally and with its environment.

Lippitt's phases of change are important factors in the change process. The phase that involves key people in data collection is known as: a. Diagnose the problem. b. Maintain the change. c. Choose a change agent. d. Assess the motivation.

Answer: a. Diagnose the problem. There are seven steps in Lippitt's phases of change. The first is the diagnosis of the problem, and it involves the key people in data collection and problem solving. The second step is assessing the motivation. Choosing a change agent is the fifth step. Maintaining the change is the sixth step.