Leadership Questions

Team dynamics can become dysfunctional over time. What are some factors that can contribute to team dysfunction (select all that apply)? Taking accountability Absence of trust Negotiating expectations Fear of conflict Lack of commitment

Absence of trust, fear of conflict, and Lack of commitment

A group of nurses is showing resistance to changes the manager is making with regards to staffing. Which of the following ways can the manager deal with the emotionality of the situation (select all that apply)? Use persuasion. Give the nurses adequate notice of change. Avoid discussion. Explain the rationale and patient impact. Inform staff that senior leadership made the decision.

Give the nurses adequate notice of the change Explain rationale and patient impact A factor in determining how change is accepted depends upon how it is managed. The way to deal with emotionality is to avoid persuasion and to allow people to express their feelings. Staff should be given as much notice as possible when making changes in staffing or scheduling, and discussion is encouraged. Staff should be informed about the rationale for the decision as well as patient impact. Effective managers possess self-confidence to explain the change without blaming. A factor in determining how change is accepted depends upon how it is managed. The way to deal with emotionality is to avoid persuasion and to allow people to express their feelings. Staff should be given as much notice as possible when making changes in staffing or scheduling, and discussion is encouraged. Staff should be informed about the rationale for the decision as well as patient impact. Effective managers possess self-confidence to explain the change without blaming.

The most difficult to change is: attitudes. group behavior. knowledge. individual behavior.

Group behavior Group behavior and performance changes are the most difficult to change and take the longest time.

The _____ is a tool which is useful in assessing the readiness for organizational change. Organizational Change-Readiness Scale (OCRS) five-dimensional scale Rapid Cycle Change plan-do-study-act model

Organizational Change-Readiness Scale (OCRS) The OCRS is a 76-item inventory that is used to analyze the ability of an organization to manage change effectively. There are five dimensions that are a part of this assessment tool.

There are two important elements associated with dealing with cultural diversity in the workplace. They are (select all that apply): increasing employee knowledge of other cultures. increasing employer pressure for nondiscriminating hiring practices. taking steps to eradicate ethnocentrism. taking steps to encourage egocentrism.

increasing employee knowledge of other cultures taking steps to eradicate ethnocentrism.

Group problem solving is known to be more effective over individual problem solving because of a larger knowledge and information base, increased acceptance of solutions, more approaches to a problem, lower economic costs, and the ability for: group development. individual expression. hierarchical bonding. organizational team building.

individual expression Individual expression is one of the major advantages of group problem solving (Veninga, 1982).

The critical care unit of a hospital utilizes team huddles at change of shift. This is an opportunity for the clinical supervisors to connect with team members and review the upcoming shift or any quick topics that need to be communicated. This is an example of a(n) _____ meeting. information-sharing opinion-seeking problem-solving strategy

information sharing An information-sharing meeting occurs when a group is gathered to disseminate information.

A disagreement or differences between the members of two or more groups over authority, territory, and resources is called _____ conflict. intragroup intergroup interpersonal intrapersonal

intergroup Intergroup conflict refers to disagreements or differences between the members of two or more groups or their representatives over authority, territory, and resources.

A nursing preceptor is giving feedback to a new nurse who currently is being oriented. Her preceptor suggests a better method of interacting with a family member by saying, "You might want to be cognizant of your nonverbal behaviors when talking with clients. Rather than continuing to chart when you are talking with an American family, stop charting, move closer to the family and client, look at them during the conversation, and take time to let them share their concerns." This preceptor is giving advice about: interpersonal communication. clarity. image. intention.

interpersonal communication If the verbal message is clear, but the nonverbal communication is not congruent, then listeners may misinterpret, distrust, or not even hear the intended message. In this situation, the nurse's nonverbal behavior may suggest that she is not interested in interacting with the family.

Care delivered to patients by caring and competent nurses is an example of which marketing mix component? A. Product B. Price C. Place D. Promotion

Correct answer: a Rationale: In the above scenario, the care delivered to patients is the product. Place refers to place for health care delivery. Price is the amount of money paid to obtain services. Promotion involves communication with target markets.

To establish legal liability on the grounds of malpractice, the injured party must prove which of the following (select all that apply)? A duty of care was owed to the injured party. An agreement was made to assume another party's liability. There was a breach of duty. Causation was present. Actual harm or damages were suffered by the plaintiff.

A duty of care was owed to the injured party There was a breach of duty Causation was present Actual harm or damages were suffered by the plantiff These four elements are required to establish legal liability on the grounds of malpractice.

Which of the following is an example of case management or would require the expertise of a case manager? A blood pressure screening clinic is started at the senior citizen center. A person with multiple chronic illnesses is admitted to the hospital. A program is started to address diabetes in the Native American population. An initiative is developed to promote fluoride treatments in schools.

A person with multiple chronic illnesses is admitted to the hospital. Case management involves an intensive focus on an individual patient in relation to one or more health conditions. It is an intervention strategy used by multiple health care providers and systems to advocate for clients, coordinate health care delivery, and facilitate outcomes of both cost and quality.

This phenomenon occurs when clinicians know the ethical action to take but are prevented from doing so by either internal or external obstacles. A) Stress B) Time management C) Moral distress D) Relaxation response

Answer C

A physician is discussing treatment options with a patient. The doctor fails to present all of the treatment options because he feels a particular option is too risky. The doctor has violated which ethical principle? A) Autonomy B) Fidelity C) Confidentiality D) Privacy

Answer: A

A confused and combative patient is placed in soft wrist restraints to prevent him from pulling out his tracheostomy. The nurse caring for the patient failed to perform the required Q2 hour safety and comfort assessment because she was busy caring for another patient. She enters the room and finds the patient unrestrained, decannulated, and unresponsive. The patient is unable to be resuscitated. This is an example of: A) Breach of contract B) Malpractice C) Judicial risk D) A criminal act

Answer: B

The Humanizing Nursing Communication Theory: A) Is a theory that involves nurse-to-nurse communication. B) Describes the manner of communicating that acknowledges the unique characteristics of the holistic human being. C) Centers on conflict management. D) Is based on therapeutic communication only.

Answer: B

Which of the following statements regarding communication is not true? A) Communication is an essential skill for leaders. B) Effective communication can motivate and engage others. C) Poor communication affects care coordination. D) Emotion-laden terminology is appropriate to use when communicating changes.

Answer: D

Interpersonal communication and the ability to apply _____ are two critical skills every nurse needs to enhance professional practice. vision supervision delegation problem solving

Answer: Problem Solving Every nurse needs two critical skills to enhance professional practice. One is a skill at interpersonal relationships. This is fundamental to leadership and the work of nursing. The second skill is applying the problem-solving process. This involves critical thinking, problem identification, and the development of objectivity.

_____ has garnered considerable attention in health care because of its potential to save money, improve effectiveness, and increase quality of care. Disease management Development research groups Case management Diagnosis-related groups

Case management Case management has garnered considerable attention in health care. It has been suggested that the processes associated with case management have the potential to save money, improve effectiveness, and maintain or improve the quality of care.

Situational leadership focuses on three competencies deemed necessary for a leader's success. Which of the following are correct statements (select all that apply)? Communicating is a behavioral competency. Communicating is a process competency. Diagnosing is a behavioral competency. Diagnosing is a cognitive competency. Adapting is a behavioral competency.

Communicating is a process competency Diagnosing is a cognitive competency Adapting is a behavioral competency

A patient has arrived at the critical care unit with a head injury. On admission, the patient is talking and is a little drowsy but oriented. Two hours later, the nurse discovers that the patient is talking at a rapid pace and keeps repeating his words. Which of the following examples best depicts Benner's stages and appropriate critical-thinking processes in this situation? Advanced beginner—thinks that the patient is trying to be funny Competent—thinks that the patient is experiencing effects from cerebral edema Novice—thinks that the patient is stressed and has had a surge of adrenaline Proficient—thinks that the patient is waking up from a coma

Competent—thinks that the patient is experiencing effects from cerebral edema The competent nurse uses the information about head injury, change in mental status from talking and drowsy but oriented to talking at a rapid pace, and the potential for the patient to deteriorate to discern that the patient is experiencing cerebral edema or increased intracranial pressure.

All of the following are true in regards to a high-performance organization except: A. Leaders communicate a strong and clear mission and vision to employees. B. There is a commitment to ongoing identification of problems and a preoccupation with preventing potential failures. C. The environment is highly structured. D. The organization is resilient.

Correct answer: C Rationale: Characteristics of a high-performance organization include flexibility; leaders who communicate a strong and clear mission and vision to employees; strategic thinking that anticipates customer needs and market changes; resiliency; and creative and improvisational problem solving to address failures or "near misses."

All-hazards disaster preparedness refers to: A. A multifaceted internal and external disaster preparedness that establishes flexible and scalable action plans for every type of disaster. B. Preparing for local disasters. C. Preparing for hazardous waste spills on interstate highways. D. Preparing for small-scale natural disasters.

Correct answer: a Rationale: All-hazards disaster preparedness refers to multifaceted internal and external disaster preparedness that establishes flexible and scalable action plans for every type of disaster. All-hazards disasters include, but are not limited to, local disasters, hazardous waste spills on interstate highways, and small-scale natural disasters.

A hospital needs to upgrade its remote telemetry monitoring system. The new system will cost more than $100,000. The new system will be included in which of the following budgets? A. Capital B. Operating C. Personnel D. Unit

Correct answer: a Rationale: Purchase of major equipment or assets follows under the capital budget. The operating budget includes costs to keep a unit up and running and includes supplies, telephones, utilities, and housekeeping. A personnel budget includes only staff expenditures.

An executive leadership council makes practice decisions that affect nursing care delivery. Input from those affected by those decisions is rarely sought. This is an example of: A. Centralization B. Decentralization C. Selective decentralization D. Shared governance

Correct answer: b Rationale: Centralization means that decisions are made at the top levels. Decentralization means that decision making is diffused throughout the organization. Selective decentralization occurs when power for decision making is concentrated in the functional areas of staffing, purchasing, and operations, for example. Shared governance is an accountability-based system for professionals that empowers individuals within the decision-making system and increases nurses' authority and control over their practice.

Evidence shows that planned change is best carried out with the input of: A) Top leaders and managers only. B) Those affected by the change. C) Outside consultants. D) Anyone interested.

Correct answer: b Rationale: Evidence shows that change is best carried out with the input of those affected by change. Those who will be affected by the change likely have a different perspective on ramifications of and challenges related to the proposed change. Their input can be valuable in developing a plan for change. Top-down change is rarely successful as those in the top positions often view those affected by change as obstacles to that change. Although outside consultants can be valuable in the change process, consultants alone will likely not understand the affects of change on those involved. Again, "front-line" perspectives are needed. Those who do not have a vested interest in or are not affected by the change may add confusion to the change process, therefore input from anyone interested in the change is not an optimal strategy.

Empowerment and shared decision making are practices found in: A) Small organizations. B) Learning organizations. C) Innovative organizations. D) Stagnant organizations.

Correct answer: b Rationale: Learning organizations are organizations that learn to adapt to change. Porter-O'Grady and Malloch (2011) emphasized four practices that can be found in a learning organization: empowerment, shared decision making, self-direction, and shared governance. Any size organization can become a learning organization. Although an organization may espouse innovative practices and processes, staff may not be empowered or share in decision making. Stagnation implies a lack of movement or change. An organization such as this would likely not promote empowerment or shared decision making.

Nursing-sensitive indicators: A. Are used to make daily staffing decisions. B. Quantify nursing's contribution to quality and safety. C. Need to be developed to capture nursing's effect on care. D. Are only reported in the National Database for Nursing Quality Indicators.

Correct answer: b Rationale: Nursing-sensitive indicators are used to quantify nursing's contribution to quality and safety. Nursing-sensitive indicators are not used to make daily staffing decisions, although these data are used to support better nurse-to-patient ratios (e.g., evidence suggests poor staffing leads to poor outcomes). Several databases exist that have specific nursing indicators. These indicators are reported in these databases, like NDNQI, as well as organization-specific dashboards and scorecards.

Relationship management is a key leadership skill because: A) Being liked by staff makes it easier to get things done. B) Patient care requires a high degree of interdependence on other care providers. C) Transferring negative moods to staff can decrease productivity. D) Helping staff cope with change is important.

Correct answer: b Rationale: The definition of relationship management is the "use of effective communication with others to disarm conflict, and the ability to develop the emotional maturity of team members." Without effective communication, real or perceived conflict can take hold of a workgroup and disrupt the flow of communication between and among other staff and disciplines. This can seriously impact care coordination, quality, and safety. Relationship management is not related to being liked, transferring negative moods to staff (self-management), or helping staff cope with change (social awareness).

The development of the operating budget at the unit level for the upcoming fiscal year: A. Does not rely on historical trend data. B. Is based on projected volume of work. C. Does not include revenue projections. D. Is based solely on historical data

Correct answer: b Rationale: The development of the operating budget is based on historical trend data, projected volume of work, projected expenses, and projected revenue.

A nursing shortage is defined as: A. Understaffing of units. B. The discrepancy between supply and demand for RNs. C. A lack of graduating nursing students. D. A high turnover rate.

Correct answer: b Rationale: The hallmark of a nursing shortage is the discrepancy between the supply and demand for RNs. A nursing shortage is not just a matter of understaffing; in fact, understaffing can occur in conditions of shortage, equilibrium, or surplus, depending on local factors such as tight budgets or poor working conditions. A lack of graduating nursing students is one of the many causes that lead to a nursing shortage. A nursing shortage has been shown to have adverse effects, including decreased access to care, decreased job satisfaction, and increased turnover.

The aging of nursing faculty and inability of schools of nursing to meet education demands is an example of: A. A nursing shortage. B. A factor contributing to a nursing shortage. C. A recruitment strategy. D. Increased workload

Correct answer: b Rationale: The nursing shortage cycles over the past few decades have been primarily driven by six factors: Aging of current nurses in the workforce and their preparation for retirement; lower numbers of students entering nursing as a career and a shift in need for both BSN- and MSN/DNP-prepared nurses; aging of nursing faculty and inability of schools of nursing to meet education demands; aging of the American population and struggles to expand capacity to meet demand for care; and significant changes in health care delivery system as the nation moves into health care reform. The scenario in the question is not an example of a nursing shortage, a recruitment strategy, or increased workload.

Workplace violence: A. Is defined as a family member assaulting a staff member. B. Spans the continuum from psychological to physical harm. C. Only occurs in inner city hospitals. D. Is defined as a staff member verbally abusing another staff member.

Correct answer: b Rationale: Workplace violence is best as defined as a spectrum because people often manifest aggressive psychological behavior as a precursor to violent physical behavior. By using a broad definition of violence, workplace violence prevention policies can respond to the psychological precursors of violence in order to preempt physical violence. Sources of violence include, but are not limited to, family members, staff members, patients, former employees, and/or family of staff members. Workplace violence can occur in any setting regardless of its geographic location.

Which of the following statements is not true about performance appraisal? A. Informing the staff about the specific impressions of their work helps improve their performance. B. A verbal appraisal is an acceptable substitute for a written report when performing an informal evaluation. C. Patients are the best source of information regarding personnel appraisal. D. One goal of performance appraisal is to identify learning needs.

Correct answer: c Rationale: Although patients can be a source for appraisal data, they are not necessarily the best source. Data should be gathered from a number of sources, including, but not limited to, patients, peers, and physicians. Performance appraisals help to improve performance and identify learning needs. An informal appraisal can be given in a verbal format.

All of the following are true about strategic management except: A. It involves establishing goals and setting targets. B. It allows an organization to obtain and maintain a competitive advantage. C. It includes only financial goals. D. It requires implementation and evaluation.

Correct answer: c Rationale: Although the strategic plan can include financial goals, it does not exclusively contain these items. Strategic management (Coulter, 2009; Dess et al., 2011; Pearce & Robinson, 2012; Sare & Ogilvie, 2009) involves conducting an environmental scan, knowing the competition, establishing goals, setting targets, developing an action plan, implementing the plan, and evaluating success. Organizations require strategic management to obtain and maintain a competitive advantage. Strategic planning involves developing a strategic mission or vision; setting objectives; developing strategies to achieve the objectives; implementing the strategies; and evaluating the results.

Which of the following statements about nursing informatics is false? A. Nursing informatics provides information and evidence-based knowledge to support clinical decisions. B. Nursing informatics involves analyzing, designing, and implementing information and communication systems. C. Nursing informatics deals exclusively with the development of electronic medical record systems. D. Nursing informatics reengineers clinical and administrative workflow.

Correct answer: c Rationale: The field of nursing informatics encompasses a broad set of functions, including development of electronic medical record systems; providing information and evidence-based knowledge to support clinical decisions; analyzing, designing, and implementing information and communication systems; and reengineering clinical and administrative workflow.

The statement "As a member of a progressive health care system, we deliver high-quality comprehensive services to the local and extended community with excellence, compassion and competence" is an example of which part of a strategic plan document: A. Executive summary B. Background C. Mission D. Goals and strategies

Correct answer: c Rationale: The mission, vision, and values statement should describe the philosophy of the organization. The executive summary is a two- to three-page encapsulation of the essence of the plan, written in language understandable by all potential readers, since many will not venture beyond the first few pages of the document. The background is a description of the institution, its history, and current state, including its accomplishments, as well as the situation that prompted the strategic planning process. Goals and strategies describe the target objectives and the strategies identified to ensure achievement of the objectives.

The staffing management plan: A. Is mandated by law. B. Does not include the use of hours per patient day. C. Is used to determine staffing through a forecasted workload and recommended care standard. D. Measures and predicts the demand for an institution's products and services.

Correct answer: c Rationale: The staffing management plan provides the structured processes to identify patient needs and then to deliver the staff resources as efficiently and effectively as possible. An effective plan first focuses on stabilizing the unit core staffing. A staffing pattern, or core coverage, is determined through a forecasted workload and a recommended care standard. Although over 25 states have various regulations related to staffing management, no legislation dictates every aspect of the staffing management plan. One care standard that can be used in determining staffing is hours per patient day. Demand management as a discipline focuses on (1) measuring, predicting, and understanding demand for an institution's products and services; and (2) deploying resources and management to ensure that demand is met in the way the consumer's wants and needs are satisfied.

Evidence-based practice: A. Encompasses critique of research studies, synthesis of findings, a determination of the applicability of findings, implementation of scientific findings in practice, an evaluation of the practice change, and dissemination of results to expand scientific knowledge. B. Is a statement designed to assist providers and clients in making decisions about appropriate health care for specific clinical circumstances. C. Includes testing the effect of interventions aimed at promoting the rate and extent of adoption of evidence-based practices by health care providers. D. Is a process of shared decision making in a partnership between patients and providers that involves the integration of research and other best evidence with clinical expertise and patient values and preferences in making health care decisions.

Correct answer: d Rationale: Evidence-based practice is a process of shared decision making in a partnership between patients and providers that involves the integration of research and other best evidence with clinical expertise and patient values and preferences in making health care decisions. Research utilization encompasses critique of research studies, synthesis of findings, a determination of the applicability of findings, review for application with implementation of scientific findings in practice, an evaluation of the practice change, and dissemination of results to expand scientific knowledge. The shift from research utilization to evidence-based practice reflects the realization that not all clinical questions have been answered through research; thus other forms of evidence may be required to guide practice. A clinical practice guideline is a statement designed to assist providers and clients in making decisions about appropriate health care for specific clinical circumstances. Translational research includes testing the effect of interventions aimed at promoting the rate and extent of adoption of evidence-based practices by nurses, physicians, and other health care providers and describing organizational, unit, and individual variables that affect the use of evidence in clinical and operational decision making.

Which statement regarding leadership and management is false? A) Leadership focuses on people while management focuses on systems and structures. B) Both leadership and management processes seek to accomplish goals. C) Strategies used to accomplish goals may be different in leadership and management. D) Leadership and management have discrete skill sets.

Correct answer: d Rationale: Leadership and management have several areas of overlap in regards to skill set. For example, both require excellent communication skills. Differences between leadership and management can be seen in regards to focus (people versus systems/structures) and strategies used to accomplish goals.

What is the definition of the process of making choices that will provide maximum benefit? Critical thinking Problem solving Decision making Leading

Decision making Decision making is the process of making choices that will provide maximum benefits.

Utilizing the DECIDE acronym for the process of decision making, what are the first and final steps in the process (select two that apply)? Develop and implement an action plan for problem solution. Establish criteria for what you want to accomplish. Define the problem and determine why anything should be done about it. Evaluate the decision through monitoring, troubleshooting, and feedback. Determine the best choice or alternative.

Define the problem and determine why anything should be done about it. Evaluate the decision through mentoring, troubleshooting, and feedback. The first step in the decision-making process using DECIDE is to define the problem and determine why anything should be done about it and explore what could be happening. The final step in the process is to evaluate the decision through monitoring, troubleshooting, and feedback.

Methods to overcome procrastination include (select all that apply): delegating sections or portions of the task. determining personal benefit from completing the task. reassessing the purpose and goals of the task. waiting until motivated to begin the task.

Delegating sections or portions of the task Determining personal benefit from completing the task At its core, time management is self-management. One of the most effective methods of managing stress is to manage time. Suggestions to overcome procrastination include examining motivation and personal benefit, confronting your fears, positively reframing the task, gathering information to complete the task, or delegating it.

Transferring the authority to perform a selected nursing task in a selected situation to a competent individual is: authorization. delegation. empowerment. supervision.

Delegation The National Council of State Boards of Nursing (1995) defines delegation as transferring the authority to perform a selected nursing task in a selected situation to a competent individual.

A manager should never delegate: disciplining. hiring. interviewing. scheduling.

Disciplining Discipline, praise, recognition, and morale issues are aspects of the managerial role that should not be delegated.

A nurse believes that she should provide optimal care to all clients, regardless of their cultural background. She is struggling with her emotions when caring for a client with a violent criminal background. What would be the best course of action for this nurse? Avoiding the client as much as possible but providing care Identifying her biases but providing care Requesting another patient assignment Taking sick days while the patient is hospitalized

Identifying her biases but providing care Identifying her biases but yet still providing care to the client is a step in providing culturally competent care.

How is the refreezing stage of change similar to the nursing process? Refreezing is similar to the assessment phase of the nursing process. Refreezing is similar to the problem identification phase of the nursing process. Refreezing is like the planning and implementation phase of the nursing process. Refreezing is like evaluation in the nursing process.

Refreezing is like evaluation in the nursing process.

Which of the following behaviors build trust between leaders and employees in an organization (select all that apply)? Sharing relevant information Encouraging competition via winners and losers Reducing controls Meeting expectations Avoiding discussion of sensitive issues

Sharing relevant information reducing controls meeting expectations Leadership is founded on trust. Behaviors that build trust include sharing relevant information, reducing controls, and meeting expectations. Trust-destroying behaviors include being insensitive to beliefs and values, avoiding discussion of sensitive issues, and encouraging competition. Leadership is founded on trust. Behaviors that build trust include sharing relevant information, reducing controls, and meeting expectations. Trust-destroying behaviors include being insensitive to beliefs and values, avoiding discussion of sensitive issues, and encouraging competition.

Good leaders need to be able to demonstrate an intuitive skill of empathy and expressiveness when dealing with others in the workplace. This requires sensitivity and awareness of the emotions and moods of others and is known as: social awareness. self-awareness. self-management. relationship management.

Social Awareness Social awareness is an intuitive skill of empathy and expressiveness in being sensitive and aware of the emotions and moods of others.

The five rights of delegation are right task, right circumstance, right person, right direction and communication, and right: interaction. outcome. supervision. time.

Supervision Right supervision is the fifth right of delegation as outlined by the National Council of State Boards of Nursing (1995).

The provision of guidance or direction, evaluation, and follow-up by the licensed nurse for accomplishment of a nursing task delegated to unlicensed assistive personnel (UAP) is: authorization. delegation. observation. supervision.

Supervision Supervision is the provision of guidance or direction, evaluation, and follow-up by the licensed nurse for accomplishment of a nursing task delegated to UAP (National Council of State Boards of Nursing, 1995).

The five rights of delegation include all of the following except: A) Right task B) Right circumstance C) Right person D) Right time

answer: d Rationale: The five rights of delegation include right task (element of care), right circumstance, right person, right direction/communication, and right supervision and evaluation. The right time is not included in the five rights of delegation.

An external factor that affects violence in hospitals is the: availability of handguns. growing acceptance of drug use by health professionals. inability of facilities to screen employees properly. increasing number of patients with mental illness.

availability of handguns

An experienced critical care nurse left a CCU staff nurse position to finish a master's degree. Periodically, he would return to work as a per diem nurse in the CCU. The staff was impressed with the nurse's performance; however, one staff member complained that he was unfamiliar with the new telemetry monitors when he first returned to work several months ago. This comment showed up in his evaluation, resulting in a poorer overall evaluation from the nurse manager compared with previous evaluations. This is an example of: a halo effect. a horn effect. recent behavior bias. similar-to-me effect.

a horn effect -- A horn effect occurs when a manager perceives one negative aspect about an employee or that employee's performance and generalizes it into an overall poor appraisal rating.

Cultural diversity refers to the: acknowledgment of variation in thoughts, communication, values, and beliefs. belief that one's own culture is similar to another's culture. realization that all people in a particular culture have the same beliefs. view that individuals living in a country should speak the native language.

acknowledgment of variation in thoughts, communication, values, and beliefs. Cultural diversity refers to variations with respect to the thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.

A hospital would like to implement the SBAR communication technique. Before the change is implemented throughout the hospital, one unit will implement SBAR use. This is an example of what type of decision-making strategy? A) Trial and error B) Pilot project C) Brainstorming D) Decision tree

answer: B

The following is true regarding informal power: A) Informal power comes from relationships and alliances with people in the organization. B) Informal power is derived from work that is relevant to pressing organizational issues and that provides opportunities to perform extraordinary and highly visible activities. C) Executive leaders do not have informal power. D) Informal power is a type of empowerment

answer: a Rationale: Informal power comes from relationships and alliances with people in the organization. Formal power is derived from work that is relevant to pressing organizational issues and that provides opportunities to perform extraordinary and highly visible activities. Executive leaders can have both formal and informal power. Empowerment can be derived from informal power but is not a type of informal power.

Workplace diversity: A) Is an interaction between patient/family, organization, co-worker, and clinician's own culture. B) Has a specific definition. C) Is likely to decrease with changes in health care. D) Is dependent on race

answer: a Rationale: Workplace diversity occurs as a result of the interaction between patient/family, organization, co-worker, and clinician's own culture. Many different definitions of workplace diversity exist. The key in any definition is to realize how various aspects of culture affect diversity. Workplace diversity is likely to increase as more patients from previously underserved and minority populations begin to seek care under the Affordable Care Act. Workplace diversity depends on many aspects of culture, which includes but is not limited to race

The nursing supervisor informs the staff that if they refuse to stay on the nursing unit and work an additional 8-hour shift, they will be reported to the state for patient abandonment. This type of power is known as: coercive. expert. legitimate. reward.

coercive French and Raven's five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When coercive power is used, an individual reacts to the fear of the negative consequences that might occur for failure to comply.

The executive leadership team's recommendation of increasing the nurse-to-patient ratio spurred the nursing staff to develop creative staffing strategies. These strategies included utilizing an acuity tool to make patient assignments. This is an example of what type of conflict? A) Competitive conflict B) Constructive conflict C) Disruptive conflict D) Intrapersonal conflict

answer: b Rationale: Constructive, or functional, conflict stimulates creativity and innovation. In this scenario, the decision to increase the nurse-to-patient ratio lead the staff to develop a creative solution that would not only cut costs but preserve patient care and safety. Competitive conflict involves following rules to win or beat an opponent. Disruptive conflict is designed to attack, defeat, or eliminate an opponent. Intrapersonal conflict involves conflict from within an individual.

A hospital's executive leadership team wants to increase nurse-to-patient ratios in an effort to decrease costs. The staff nurses are against the change because they feel they already have difficulty completing care for their patients. Adding more patients to their assignment will decrease quality, safety, and patient satisfaction. This is a type of what kind of conflict? A) Intrapersonal conflict B) Intergroup conflict C) Intragroup conflict D) Relationship conflict

answer: b Rationale: Intergroup conflict occurs between two groups. In this scenario, the executive leadership team and the staff nurses are the two groups involved in conflict over the nurse-to-patient ratios. Intrapersonal conflict is conflict that arises from within an individual (e.g., competing home and work obligations). Intragroup conflict is conflict within a group (e.g., the executive leadership team disagrees about increasing the nurse-to-patient ratio). Relationship conflict occurs when there is an awareness of interpersonal incompatibilities.

Which of the following statements regarding organizational culture is true? A) Staff are unaffected by organizational climate. B) Staff retention, workplace safety, and patient outcomes are directly affected by the organizational climate. C) Organizational leadership does not affect organizational culture. D) Working in an organizational culture that values continuous learning has been found to decrease nurses' job satisfaction.

answer: b Rationale: Research has shown that, among nurses, culture affects job satisfaction (Hart & Moore, 1989), intent to turnover (Hemingway & Smith, 1999), needlestick injuries and near misses, surgical outcomes, and patient mortality. Clearly staff are affected either positively or negatively by organizational culture. Organizational leadership typically defines the mission, vision, and values of an institution. Because of this, it is very likely the tone set in these statements will affect the culture of the organization. Organizational cultures that value continuous learning have been found to increase job satisfaction.

All of the following influence the shape of the organization except: A) Formal reporting relationship B) Span of control of managers C) Informal and formal power structures D) Number of management layers

answer: c Rationale: The shape of an organization structure can be described as relatively tall or flat. Several structural factors influence the shape of an organization. The formal reporting relationships among positions, which ensure the assignment of responsibility, authority, and accountability, result in hierarchical levels. The span of control of managers, which is the number of employees reporting directly to a management position, also influences organizational shape (Meyer, 2008). For instance, when managers on average have fewer direct-report staff, the organizational shape is relatively taller. Another structural factor involves decisions about the number of management layers in the hierarchy (i.e., scalar principle). Increased layers of management help the organization cope with increasing work complexity and extended time lines (Jaques, 1990). A tall organization structure assumes a pyramidal shape with multiple management layers (Figure 13-5). In contrast, a flat organization structure has minimal management layers.

In an effort to improve glycemic control of hospitalized patients, a hospital puts together a team of doctors, nurse managers, nurses, and pharmacists. The goal of the group is to implement a standardized glycemic management protocol to be used throughout the hospital. This type of a team is an example of a: A) Primary work team B) Leadership team C) Ad hoc team D) Dysfunctional team

answer: c Rationale: An ad hoc team is formed to solve a specific problem. When the problem has been solved, the team dissolves. In this scenario, a team was formed to improve glycemic management by implementing a standardized glycemic management protocol. A primary work team includes all types of patient care teams (e.g., IV team) while a leadership team consists of leaders at the executive or unit levels. A dysfunctional team is not one of the types of teams.

The nurse manager calls a meeting of unit staff members to discuss ways to improve the timeliness of patient discharge. The nurse manager and group decide that the use of an admit/discharge nurse would help improve patient flow. This is an example of what kind of decision procedure? A) Autocratic B) Consultative C) Joint D) Delegated

answer: c Rationale: Since the manager and staff decided on a course of action together, this scenario is an example of a joint decision procedure. An autocratic decision procedure in which the leader makes all of the decisions. A consultative decision procedure occurs when decisions involve employee participation but the leader still makes the final decision alone. A delegated decision procedure occurs when the committee chair or leader allows participants to make the final decision.

A case manager develops a document that outlines the care and expected outcomes that must occur during recovery from coronary artery bypass graft surgery. This is an example of: A) Case management B) Disease management C) Care coordination D) Clinical pathway

answer: d Rational: A clinical pathway is a written plan that identifies key critical or predictable incidents that must occur at set times to achieve client outcomes within an appropriate time frame. As a pathway, they are a tracking system for the timing of treatments and interventions, health outcomes, complications, activity, and teaching/learning. Case management and disease management are models to manage patients. Care coordination is component of all case management models.

Which of the following statements is false with regard to care coordination? A) Care coordination is a part of every nursing role. B) Care coordination is a component of all case management models. C) Care coordination involves advocating for the necessary and appropriate care for patients. D) Care coordination is only a function of case managers

answer: d Rationale: Care coordination is a function of all nursing roles, including nurse managers, staff nurses, and case managers. Care coordination is a component of all case management models and involves advocating and obtaining necessary and appropriate care for patients.

A staff nurse is facing a dilemma between upholding personal care standards and meeting organizational goals. The nurse manager understands that the best way to assist staff members in resolving ethical dilemmas effectively is to: avoid applying any pressure to compromise personal values. change their work assignment until the dilemma is resolved. continually remind staff of consequences related to ignoring organizational goals. refer indecisive staff members for additional training.

avoid applying any pressure to compromise personal values. An important way in which those in health care facilities and their managers can assist nursing professionals in resolving ethical dilemmas effectively is by neither explicitly nor implicitly pressuring them to go against their own ethical values (Cooper et al., 2003).

A hospital administrator is involved in contract negotiations with the nursing union leaders. To resolve issues: nurses should be assertive to make certain that their view predominates. both sides should strive to meet the interests of both parties. the negotiator should use independent problem-solving skills. the budget should dictate the conditions of the negotiation.

both sides should strive to meet the interests of both parties. Both sides should strive to maintain the poise of the other party in a win-win situation, also known as interest-based bargaining. Each party should gain something, and the solution should be acceptable to both sides. Problem solving, consensus building, and integrative decision making are techniques used to achieve this goal.

The manager of a rural, thriving, nurse-managed clinic is considering purchasing equipment to furnish two additional examination rooms. The resource he must consider is the _____ budget. capital expense operating product line

capital

A nursing manager recognizes that the changes that she is expected by administration to implement will be met with staff resistance. She is committed to determining the root of the resistance and communicating positively with her staff. The nurse manager's actions characterize her as a(n): change agent. implementation expert. restructuring motivator. supervisory threat.

change agent The change agent needs to anticipate resistance, determine why it is occurring, and try to determine what the person who is resisting is trying to protect.

Disease management is the monitoring of: chronic illness across the health care continuum. mental illness in the outpatient setting. surgical illness across the health care continuum. terminal illness in the hospice setting.

chronic illness across the health care continuum. Disease management programs contain a series of clinical processes and services across the health care continuum that rely on informatics to identify and manage a medical or chronic condition in at-risk populations to improve care, promote wellness, and manage or reduce costs.

The informal performance appraisal process includes: coaching. mentoring. preceptoring. teaching.

coaching

The art of being able to structure and transmit a message in a way that another can understand easily and accept is: articulation. communication. evaluation. pronunciation.

communication Communication is the art of being able to structure and transmit a message in a way that another can understand easily and accept.

Case management is an interventional strategy used by health care providers to: advocate for nurses. coordinate health care delivery. facilitate cost accounting. investigate medical errors.

coordinate health care delivery. Case management is an intervention strategy used by health care providers and systems to advocate for clients, coordinate health care delivery, and facilitate outcomes of cost and quality.

The process of identifying the specific costs related to the delivery of nursing care to each client so that nurses have data to identify the actual amount of services received is: personnel budget development. evaluating budget expenditures. costing out nursing services. strategic financial planning.

costing out nursing services

Ben has reported to work late four times in the last three months. His manager brings this to his attention and asks him to meet her in her office tomorrow at 10 AM to discuss the issue. At their meeting, Ben is given an opportunity to explain his tardiness. Together they come up with an action plan to reduce Ben's tardiness. This type of management of consequences is called: coaching. mentoring. precepting. counseling.

counseling

A staff registered nurse (RN) has been struggling with the delivery system from central supply. He documents a delay of 1 to 3 hours from the time that the order is sent to central supply to the time that the requested equipment is sent to the floor. The RN asks, "Why does a central supply unit need to service the entire hospital? Why not consider a decentralized central supply established for each floor?" This is an example of what type of thinking? Amiable thinker Critical thinker Traditional thinker Unrealistic thinker

critical thinker A critical thinker challenges and questions the norm.

Cultural affiliation, health and care beliefs and practices, illness beliefs and customs, and spiritual practices best describe components of a: cultural assessment. data collection. health evaluation. medical history.

cultural assessment A cultural assessment consists of cultural affiliation, health and care beliefs and practices, illness beliefs and customs, interpersonal relations, spiritual practices, world view, and other social structure features.

The nurse manager within a small department has requested that the staff decide department coverage over the holidays. The department is not associated with patient care and serves as a supportive role to the organization. The staff is to present the manager with the coverage plan during the month of December. This is an example of which type of decision? Autocratic decision procedure Consultative decision procedure Joint decision making Delegated decision procedure

delegated decision procedure A delegated decision procedure occurs when the leader allows participants to make the final decision. An autocratic decision procedure occurs when the leader makes all of the decisions. A consultative decision procedure occurs when decisions involve employee participation but the leader still makes the decision. Joint decision making occurs when the entire group decides by vote or consensus.

Some of the major disadvantages to group decision making are premature decisions, individual domination, and: autonomous conclusion. disruptive conflicts. group synergy. inaccurate data interpretation.

disruptive conflicts Group decision making can be derailed at a number of points in the process. The main disadvantages commonly noted about group decision making are the potential for premature decisions, individual domination, and disruptive conflicts (Veninga, 1982).

The transferring of authority, responsibility, and freedom to act and the inspiring of self-confidence is known as: actualization. authorization. empowerment. ratification.

empowerment Empowerment is the transfer of actual power and inspiring self-confidence (Kramer & Schmalenberg, 1990).

The chief operations officer of a local hospital has issued a memorandum indicating that the modular waiting room furnishings will be replaced with stationary units. This is an example of which type of strategy for preventing workplace violence? Administrative controls Behavior modification Environmental design Fixture adaptation

environmental design

An organizational chart with one line of management and one line of staff reflects which of the following types of organizational structures? Authoritarian structure Flat structure Power structure Vertical structure

flat structure A flat or horizontal structure has few administrative layers between management and employees. Employees have more decision-making power in this type of hierarchy.

Staff nurses' involvement in budgeting is essential because they: have the final authority on the annual budget. have the ability to contain costs at the unit level. have a unique perspective on the budgetary process. are the largest user of the budgeted funds for the unit.

have the ability to contain costs at the unit level

Which organizational theory emphasized the informal aspects of organization social structure and was influenced by the Hawthorne experiments? Bureaucratic theory Scientific management school Classical management theory Human relations school

human relations school Theorists in the human relations school emphasized the informal, rather than formal, aspects of organization social structure. Hawthorne experiments were influential in this school of thought.

A group of tenured nursing faculty at a major university votes on whether a faculty member should receive tenured status. This type of decision making is referred to as: autocratic decision procedure. consultative decision procedure. delegated decision procedure. joint decision making.

joint decision making Joint decision making occurs when the entire group makes the decision by two-thirds vote, a simple majority, consensus, or some other process. In this process, the group members have as much power as the leader.

A staff nurse has a concern about a co-worker who may be diverting medications. The staff nurse would like to report the concern to a supervisor, but she is fearful of retaliation from her colleagues. The staff nurse knows that the ethical thing to do is report the concern for the sake of patient safety. This nurse is experiencing: stress. procrastination. moral distress. burnout.

moral distress Moral distress occurs when clinicians know what is the ethical action to take, yet are prevented by either external or internal obstacles. Moral distress will contribute to stress and eventual burnout if the staff nurse does not take action.

The major responsibility for upholding patient care standards belongs to the: chief executive officer of the facility. nurse manager. on-call physician. staff nurse providing patient care.

nurse manager Nurse managers carry the major responsibility for developing and upholding the standards of care for staff nurses.

The nursing chief executive officer (CEO) works in a major rehabilitation and subacute facility network. Her span of control refers to the number of: miles in which the network resides. ancillary staff accountable to her. nurses and non-nurses reporting to her. inpatients that the facilities service.

nurses and non-nurses reporting to her. Span of control refers to the number of nurses and non-nurses reporting to a manager.

A human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading is known as: advisement. consultation. persuasion. suggestion.

persuasion Persuasion is a human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading.

Performance management includes the processes of human resources management. The purpose of this system as related to the employee includes job productivity, compensation, job performance recognition, and: compensation administration. job analysis. planning for professional development. structuring educational programs for staff.

planning for professional development

A group of people who believe they are a team but fall short of the definition of a true team is known as a: club. group. meeting. pseudoteam.

pseudoteam A pseudoteam is a group of people who believe they are already a team, although clearly they fall short of the definition of a true team.

Individuals join groups because of: monetary rewards. mandatory obligations. physical needs. psychological drives.

psychological drives The reasons individuals join groups vary but may include psychological drives and primary needs.

The division of work by occupation or function is a form of: specialization. interdependence. uncertainty. technology.

specialization The division (or differentiation) of work by occupation or by function is a form of specialization. Specialization is the extent to which work is divided and assigned to positions and divisions.

Referring to a patient as Hispanic or Mexican can contribute to: stereotypes. cultural competency. spiritual competency. diversity.

stereotypes In patient care of a Mexican versus Hispanic person, the failure to identify differences not only perpetuates stereotypes evaluations but also can cause the clinician to fail in accurately assessing potential conflicts with the cultural values of the patient or important communication barriers.

A small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable and whose membership should be consistent is known as a: committee. group. team. unit.

team A team is a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable and whose membership should be consistent (Katzenbach & Smith, 1993; Manion et al., 1996).

Nurses who are successful at time management: display an ability to set measurable goals and objectives. frequently volunteer for new and creative projects. hesitate to delegate because of perfectionist characteristics. tend to accomplish specific activities within a time frame.

tend to accomplish specific activities within a time frame. Time management is accomplishing specific activities during the time available. It is a process of managing the things an individual does with his or her available time.

Group as well as individual accountability exists within a: work group. true team. pseudoteam. committee.

true team A true team occurs when there is a collective entity in which leadership rotates and is shared by various members of the team. There is group as well as individual accountability.

On admission, the patient was found to have a blood glucose level of 218. The RN knows that except in emergency situations, it is hospital policy to obtain physician's orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. Because of the nurse's actions, the admitting hospital may be found to be: vicariously liable a judicial risk. an ostensible authority. indemnified.

vicariously liable If a nurse negligently injured a client during the course of and within the scope of employment, not only would the nurse be directly liable for damages, but also the health care organization would be vicariously liable.