Management 3

Clinical incompetence is one of the more serious problems facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarah's peers are covering for her. Which of the following might Joyce include in her meeting with the nurses? SATA a. "It is a nurse's professional responsibility to maintain quality control." b. "All instances of clinical incompetence are to be reported." c. "It is not considered being disloyal when one nurse reports another for poor care." d. "Patient care is the number one concern. Meeting standards is mandatory and necessary."

a. "It is a nurse's professional responsibility to maintain quality control." b. "All instances of clinical incompetence are to be reported." c. "It is not considered being disloyal when one nurse reports another for poor care." d. "Patient care is the number one concern. Meeting standards is mandatory and necessary.

Sources of occupational stress in nursing include all except which of the following? a. Authoritarian leadership b. Concern about moral wrongdoing by colleagues c. Multiple changes in a short time d. Rotating shifts

a. Authoritarian leadership

Sarah determines, in partnership with her patient, that current medications are not enabling her patient, a married account executive with fibromyalgia, to continue with her employment and family responsibilities. After searching for additional information on fibromyalgia, Sarah finds nonpharmacologic interventions that are supported through credible evidence. Sarah suggests that the patient, her physician, and she meet to discuss the medications and possible options and a plan of care for the patient's discharge. This action exemplifies which of the four historical concepts? a. Authority b. Responsibility c. Communication of conflict d. Autonomy

a. Authority

In a job interview for a nursing position, Marley can be assured that which of the following will occur? a. Both eustress and distress b. Only eustress c. Only distress d. Neither eustress nor distress

a. Both eustress and distress

After a major flu vaccination campaign, an agency bills a private insurance company for allowable costs for administration of each vaccination according to the schedule established by the insurance company for reimbursement. This is an example of which major payment method? a. Cost-based reimbursement b. Charges c. Contractual allowance d. Prospective reimbursement

a. Cost-based reimbursement

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

a. Discuss the guidelines for the budget cuts with the staff, making the decisions with those who participate.

In reviewing the job description of a nurse manager, the staff becomes aware that a nurse manager's role is complex. Which of the following duties are required of a nurse manager? SATA a. Ensure unit productivity reports. b. Develop policy and legislation to protect nurses' well-being. c. Plan staffing of UNPs only. d. Prepare a unit budget that reflects unit staffing needs. e. Monitor nurse-sensitive indicators such as falls and incidence of infections.

a. Ensure unit productivity reports. d. Prepare a unit budget that reflects unit staffing needs. e. Monitor nurse-sensitive indicators such as falls and incidence of infections.

A busy neurologic ICU and step-down unit most likely would use which patient-classification system? a. Factor evaluation b. Prototype evaluation c. Hybrid system d. AHRQ system

a. Factor evaluation

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

a. Greeting patients, families, and colleagues with a handshake and a smile; listening carefully when problems arise

Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviors would most likely signal that Nathan is intending to resign from his position on the unit? a. Increased absenteeism over the past month b. Increased attempts to discuss his concerns with his colleagues c. Testing of workplace guidelines d. Frequent defensiveness

a. Increased absenteeism over the past month

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

a. Job satisfaction b. Absenteeism and turnover c. Nurses' health d. Client welfare

As a nurse manager in a hospital, you would expect what to be the major contributor to funding and revenues in your organization? a. The federal government b. Medicare c. Medicaid d. Blue Cross/Blue Shield

a. The federal government

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

a. The hospital is incurring a deficit related to a gap between the PPS and the DRGs and costs of care.

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

a. Training nurses on accurate documentation of supplies used for patient care

What has the literature on oppression in nursing demonstrated? a. Verified the presence of behaviors associated with oppression within nursing. b. Suggested that oppression leads to bullying but has little or no effect on patient outcomes. c. Failed to establish that oppression is present in nursing groups. d. Indicated that nurses use oppression negatively.

a. Verified the presence of behaviors associated with oppression within nursing.

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

a. a contractual allowance.

A facility that provides care for patients whose average length of stay is less than 30 days and to patients whose average length of stay is longer than 30 days, and who require inpatient and ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered: a. a healthcare network. b. a tertiary care institution. c. rehabilitative. d. long-term care.

a. a healthcare network.

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

a. advocacy for patients with regard to services required and services utilized.

Sandra, an RN on the surgery unit, is assisting with a procedure in the patient examination room. The physician orders a medication to be given through IV. Sandra questions the order, based on her knowledge of the patient's history and of other medications that the patient has been given. The physician reiterates the order and Sandra refuses to give it. In this instance, Sandra is demonstrating: a. autonomy. b. accountability. c. authority. d. best practice.

a. autonomy.

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

a. both a positive stressor and a negative stressor.

Taylor Hospital has well-defined organizational units that provide maintenance, financial services, care for cardiac patients, care for surgical patients, and so on. The organizational chart indicates that surgical units report to a surgical manager and all nursing units report to a vice president of nursing; financial services to an accountant and then to a business executive; and so on. The primary disadvantage of this organizational structure is: a. breakdown in function and communication across specialties. b. lack of congruence in culture and organizational values. c. highly centralized decision making and authority. d. wide span of control.

a. breakdown in function and communication across specialties.

A Magnet® hospital surveys the staff about job satisfaction. This type of environment, in which nurses have authority and autonomy, is linked with: a. client satisfaction with the healthcare organization. b. organizations with a limited number of nurse managers. c. private, specialty organizations in urban areas. d. sophisticated academic health sciences universities.

a. client satisfaction with the healthcare organization.

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

a. coercive use of power.

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

a. commitment, control, and challenge.

You are hired as a new manager. When the offer of employment is made, you agree to at-will employment. Later, you become very concerned about the policies and practices of your organization and their impact on patient care. You speak with your supervisor several times about your concerns, but no action is taken. In considering your next steps, you: a. consider your increased vulnerability under the terms of your employment. b. recognize that your supervisor is more vulnerable than you are because of her more senior position. c. are more likely as a leader to take action because you are well protected from repercussions by federal and state regulations. d. contact your union to discuss your concerns and review your options.

a. consider your increased vulnerability under the terms of your employment.

A merger has occurred between a hospital and a local home health agency, creating new roles for the nursing staff in both agencies. The nurse managers of both systems begin to evaluate and revise patient care processes and systems. With the merger, the healthcare organization's changes are: a. creating more jobs in the community for registered nurses. b. resulting in an overall loss of jobs for registered nurses. c. controlled by the federal and state governments. d. controlled by the insurance agency.

a. creating more jobs in the community for registered nurses.

With revenue reductions and cost-saving measures, the number of managers has been reduced, this has increased the number of team leaders supervised by managers by as many as three. This change may result in: a. decreased patient satisfaction. b. increased efficiency in costs. c. a more positive perception of managers. d. little change to manager-staff relationships.

a. decreased patient satisfaction.

As a new nurse manager who has "inherited" a unit with high nurse turnover and complaints of patient dissatisfaction, your first course of action would be to: a. determine levels of nurse engagement on the unit. b. review the personnel files of nurses who have resigned. c. interview upper management about their vision for the unit. d. meet with your staff to clarify your vision for the unit.

a. determine levels of nurse engagement on the unit.

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

a. develops a centralized pool of float nurses.

During unit staff meetings, you observe that Marg rolls her eyes and snorts whenever Julia makes a comment. Your first response as a unit manager is to: a. discuss what you have observed with Marg. b. file immediate documentation in Marg's personnel file. c. ask Julie to monitor Marg's behavior during meetings. d. ignore the behavior, as Marg is one of your strongest nurses.

a. discuss what you have observed with Marg.

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

a. distancing oneself from work.

Nursing labor-management partnerships: a. engage nurses at all levels in problem solving for better patient care. b. require unions and management to negotiate in good faith regarding hours of work and wages. c. have been shown to have negligible effects on nurse turnover and patient outcomes. d. have typically resulted in increased polarization of nurses and management, leading to formation of collective bargaining units.

a. engage nurses at all levels in problem solving for better patient care.

All of the following are grounds for immediate dismissal except: a. failing to pursue further medical help for a patient; patient dies. b. selling narcotics obtained from the unit supply of narcotics. c. restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a staff member. d. grabbing the unit manager and threatening further physical harm after a poor performance appraisal.

a. failing to pursue further medical help for a patient; patient dies.

The hospital administration gives approval to the chief nursing officer to hire clinical nurse specialists in staff positions rather than in administrative positions. A clinical specialist who has staff authority but no line authority typically is able to: a. function through influence. b. take complete responsibility for the care of clients. c. interview and hire staff nurses for designated nursing units. d. be granted functional authority to determine standards of nursing care and enforce them.

a. function through influence.

In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should: a. include a plan to correct them and to prevent future occurrences. b. state a detailed history of past problems that are related to the current one. c. be written at the convenience of the manager. d. not be discussed until the formal performance evaluation.

a. include a plan to correct them and to prevent future occurrences.

As a nurse manager in a for-profit hospital, you are interested in promoting teaching programs for physicians, because evidence suggests that hospitals with teaching programs tend to promote better care for patients. Your administration indicates that it cannot support your ideas or proposal because of: SATA a. increased salary costs. b. duplication of tests and procedures. c. graduate medical education. d. potential damage to reputation through learner error.

a. increased salary costs. b. duplication of tests and procedures. c. graduate medical education.

With the help of a federal grant, the local school nurse has established a spreadsheet that contains relevant nursing data so that she can analyze children's health. School health programs are: a. increasingly seen as primary care sites for children. b. providing only health education programs for children and their parents. c. capable only of providing referrals for health problems to primary care providers. d. funded exclusively by local authorities.

a. increasingly seen as primary care sites for children.

Senior executives at Hospital A determine that the hospital will engage in a strategic planning process after changes in healthcare funding and concerns expressed in the community about care that is being delivered at the hospital. The senior executives decide on a participatory process in which staff are widely consulted regarding input about the organization and the external environment and are actively invited to be part of decisions related to the mission statement, goals, and objectives. For true shared governance to be seen as part of this approach: a. it must be evident in the outcomes of the process that staff and senior executives have partnered on the decisions. b. stakeholders must be assured of the value of their input even though final decisions rest with senior executives. c. publications must clearly outline how staff input was solicited and obtained. d. staff must be reassured that significant concerns will be kept in mind even if they have not been addressed in planning documents.

a. it must be evident in the outcomes of the process that staff and senior executives have partnered on the decisions.

A nurse manager in a for-profit environment finds it difficult to recruit staff. This difficulty may be most related to aggressive profit goals and: a. lower salary compensation for staff. b. rising expectations of impoverished and indigent individuals for services. c. poor orientation and retention practices for staff. d. an overwhelming emphasis on accepting learners from health disciplines.

a. lower salary compensation for staff.

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

a. maintaining unit morale.

Organizational culture includes: SATA a. norms. b. traditions. c. behaviors. d. values.

a. norms. b. traditions. c. behaviors. d. values.

Susan, a new graduate, is upset that so many staff have been absent lately from the unit. She declares to you that all absenteeism could be eliminated with proper management. Your response is based on understanding that: a. not all absenteeism is voluntary. b. high personal control contributes to absenteeism. c. direct discussions with employees who have high levels of absenteeism are not recommended. d. all absenteeism is related to personal issues and needs.

a. not all absenteeism is voluntary.

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

a. offering nurse practitioner-led clinics that educate parents about non-pharmacologic strategies for managing ear infections.

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

a. organizational staffing policies.

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

a. plan a social event and include the agency and traveling nurse staff members.

Martin, the unit manager, receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care. Martin checks the patient teaching sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has been done. Potential outcomes of Martin's actions include: SATA a. poor morale on the unit. b. disruption in community relationships. c. corruption of patient-staff relationships. d. patient outcomes for quality care are met.

a. poor morale on the unit. b. disruption in community relationships. c. corruption of patient-staff relationships.

The Emergency Department staff decides to use a collective bargaining model for negotiation rather than a traditional trade union model. A traditional trade union model is characterized by: a. positional conflict. b. management support of labor's initiatives. c. a spirit of trust between management and labor. d. an ability to resolve complaints.

a. positional conflict.

The work group on Nursing Unit 23 is marked by apathy toward the ward's patients, high absenteeism, open conflict among team members, and high turnover of personnel, including managers. The underlying behavior in this situation may be characterized as: a. powerlessness. b. anger. c. apathy. d. oppression.

a. powerlessness.

As a nurse manager, you have been offered a position at a Veterans Administration hospital. In accepting the position, it is important for you to understand that Veterans hospitals provide: a. primary care and are privately funded. b. a range of services and are responsible to government and taxpayers. c. secondary care only and are publicly administered and funded. d. services to Veterans under an HMO.

a. primary care and are privately funded.

Nurses in an Emergency Department, in an inner-city neighborhood characterized by high levels of violence, are concerned with low levels of security presence in their department. Security levels have recently been decreased and the nurses question why this has occurred. An appropriate action would be to: a. provide nurses with information about rationale for recent changes in security staffing. b. refer the matter to the head of security and let her deal with it. c. provide mentors who can help nurses diffuse aggressiveness. d. accept the security levels as a consequence of funding realities.

a. provide nurses with information about rationale for recent changes in security staffing.

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

a. puts the right person in the right position.

In opening a new dialysis unit, the nurse manager has to develop a philosophy for the unit. This philosophy needs to: a. reflect the culture of the unit and its values. b. be developed by the nursing manager on the unit. c. identify the clients that will be served on the unit. d. replicate the organization's philosophy.

a. reflect the culture of the unit and its values.

To maintain patient safety, studies suggest that scheduling should avoid: a. rotating shifts. b. weekends. c. 8-hour shifts. d. mandatory overtime.

a. rotating shifts.

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

a. start taking yoga lessons.

The chief nursing officer is given the task of reviewing and proposing revision of the organization's mission, philosophy, and technology. In reviewing them, the chief nursing officer understands that they should be reflected in: a. the organizational structure. b. line and staff responsibilities. c. the policies and procedures. d. government regulations.

a. the organizational structure.

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

a. using power.

"Georgia Hospital will provide care that is a national example of consumer service" is a: a. vision statement. b. statement of philosophy. c. mission statement. d. rationale for care.

a. vision statement.

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

b. 0.7

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

b. 85%.

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

b. Average non-productive hours

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

b. Cost comparisons; how much and how often infusion pumps are used; condition of existing pumps

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

b. Determine who is most likely to send useful or important information or requests.

The unit manager on 4E is concerned about the performance of Jean, a staff nurse. She is not involved directly with Jean, so she has not been able to determine whether the problem is one of motivation, ability, or both. If Jean lacks ability, which of the following strategies might the head nurse use? a. Dismiss or transfer Jean. b. Document all problem areas and then discuss them with Jean. c. Develop appropriate solutions and make recommendations to human resources. d. Smooth over the problems if they are minor in nature.

b. Document all problem areas and then discuss them with Jean.

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

b. Expert power

A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems? a. Use of the performance appraisal on an annual basis b. Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up c. A tally sheet of medication errors and other specific problems that will be used at annual review d. Copies of reports, placed in his or her file, of all unusual occurrences involving the employee

b. Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up

The unit manager discusses absenteeism with the unit clerk. She indicates that it is a serious problem on the unit. Which of the following points would they have likely discussed? a. Employee morale is at a high level. b. Patient care will be jeopardized and possibility below standards. c. Existing staff have experienced little effect from the absenteeism. d. Cost for the unit remains the same when new staff are hired.

b. Patient care will be jeopardized and possibility below standards.

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

b. Speaking positively about one's work c. Dressing and grooming in a clean and neat manner d. Using titles (e.g., Mr., Mrs., Ms.) and last names f. Developing a code of conduct for the ED staff.

Nurse Stacey is a self-admitted drug addict and has been a heavy abuser of codeine. Stacey and the unit manager decide that changes have to occur. Stacey enrolls in an addiction program, and the manager has her transferred to a drug-free area. What other strategies might be appropriate? a. The manager could refer Stacey to the human resources department. b. The manager could assist in monitoring Stacey's progress. c. The manager could counsel Stacey if Stacey has formed a trusting relationship with her. d. Stacey needs to be asked not to involve her family in the recovery program because this is a work-related situation.

b. The manager could assist in monitoring Stacey's progress.

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

b. The two men may or may not feel the same amount of stress.

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

b. Trends in acuity on the unit

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

b. a coalition.

Government and third-party payers announce reduction of compensation for the delivery of patient services. Hospital STV has a flat organizational structure. After the funding announcements, senior officials at the hospital meet and make decisions regarding cost containment of new revenue streams. This action is consistent with: a. the practice of leaving financial decisions with senior officials who understand the total context of funding. b. a tendency to concentrate decision making during economic downturns at the top administrative level. c. a need to make expedient decisions that are likely to be poorly received by staff. d. ensuring that decisions with regard to cost are made equitably across all departments.

b. a tendency to concentrate decision making during economic downturns at the top administrative level.

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

b. balance value-added services against costs and revenues.

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

b. concern related to the validity of classification systems.

The Emergency Department staff members are concerned that working long hours without rest puts patient safety at risk. One staff member decides that she will risk her job and become a whistleblower. Whistle-blowing is an appropriate recourse when management: a. disregards due process when disciplining a nurse. b. delays responding to repeated efforts to provide safe care. c. hires nurses who are not a part of the union during a strike. d. refuses to bargain in good faith with the elected bargaining agent.

b. delays responding to repeated efforts to provide safe care.

Nurses on the dialysis unit notice that changes in labeling of fluids have meant several alarming near miss in terms of wrong administration of fluids. They take this concern to the unit manager. As an advocate of nurse autonomy, the most appropriate response in this situation would be to: a. ensure that the nurses are aware of the reasons for the change and how the decision was made about the new labels. b. discuss concerns about the labels and develop potential solutions that take into account changes that can be made at the local level and those that need system intervention. c. suggest that the staff wait until they have become more familiar with the labels before taking further action. d. tell the staff that you will notify the pharmacy about these concerns and leave it up to the pharmacy to decide what should be done.

b. discuss concerns about the labels and develop potential solutions that take into account changes that can be made at the local level and those that need system intervention.

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

b. do not understand how their failure to exercise power can limit the power of the whole profession.

The chief nursing officer utilizes the hospital's workplace advocacy to help the overwhelmed Emergency Department staff. Workplace Advocacy is designed to assist nurses by: a. creating professional practice climates in their institutions. b. equipping them to practice in a rapidly changing environment. c. negotiating employment contracts. d. representing them in labor-management disputes.

b. equipping them to practice in a rapidly changing environment.

The local health department nurse manager has developed and implemented a disaster readiness plan as part of a community service. Community services: a. care for the specific needs of individual families in the community. b. focus on the treatment of community-wide problems rather than on individual health problems. c. do not include services provided by public health departments. d. provide personal health follow-up for all acute care hospitalizations.

b. focus on the treatment of community-wide problems rather than on individual health problems.

Before terminating an employee, a nurse manager must: a. be an expert in all legal aspects of termination and discipline practices. b. follow the organization's specific policies for addressing disciplinary problems and termination. c. function as a counselor for problem employees. d. do everything to assist and protect the employee by adjusting standards and policies.

b. follow the organization's specific policies for addressing disciplinary problems and termination.

A statement such as "We believe in the right of patients to make choices and to have care that is sensitive to their preferences and needs" is a _____ statement. a. mission b. goal c. vision d. philosophy

b. goal

A local hospital has formed a corporate partnership with a reputable HMO (health maintenance organization). The nurse manager has had to educate staff and personnel about the financial implications of this partnership. An HMO: a. provides more expensive care than other types of insurance plans. b. has a centralized administration that directs and compensates physician services. c. pays physicians on a fee-for-service basis. d. does not pay as much for acute care as other practice plans.

b. has a centralized administration that directs and compensates physician services.

In matrix organizational structures, a nurse manager understands that this type of structure: a. is a simplified organizational structure. b. has both a functional manager and a service or product-line manager. c. arranges departments strictly according to function. d. promotes harmony in organizational decision making.

b. has both a functional manager and a service or product-line manager.

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

b. helping people realize that negative thinking causes emotional distress.

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

b. higher than expected client acuity.

Martin, the unit manager, receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care. Martin checks the patient teaching sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has been done. Martin's follow-up to complaints from the community is: a. appropriate and indicates that he has assumed accountability for the actions of his staff. b. indicative that he does not clearly understand the concept of accountability. c. indicative of strong support for his staff and their autonomy. d. important in clarifying the difference between his accountability and that of the community in patient care.

b. indicative that he does not clearly understand the concept of accountability.

On Unit 62, the nurses and the unit manager have been involved in shared decision making related to the model of nursing care delivery that the unit will adopt. All individuals have participated and been involved in decision making and implementation of changes. When issues arise during implementation, it is expected that: a. accountability resides entirely with the unit manager. b. individual expertise will be utilized to provide solutions, but that responsibility for the change is shared. c. no one really has any accountability or responsibility for the changes. d. this will contribute to widespread skepticism among the staff about the probability of success.

b. individual expertise will be utilized to provide solutions, but that responsibility for the change is shared.

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

b. listening to each nurse speak to the other without interruption and asking clarifying questions to help them resolve the issue themselves.

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

b. minimize costs.

"At Thoroughcare, we provide health care for women and children in transition" is an example of a: a. vision statement. b. mission statement. c. goal statement. d. statement of philosophy.

b. mission statement.

Tracy is an RN case manager who interfaces between the Centers for Medicare & Medicaid. Tracy's responsibilities most likely would include: a. managing physician-led research. b. monitoring physician documentation of the need for medical care. c. determining which services are designated fee-for-service. d. identifying errors in physician diagnoses.

b. monitoring physician documentation of the need for medical care.

The chief nursing officer and the dean of the School of Nursing create a partnership based on belief that by establishing rules and regulations and controlling the environment, this partnership will: a. promote professional medical authority, autonomy, and responsibility. b. need a degree of flexibility to engender success. c. be essential for self-governance. d. provide for the establishment of medical committees.

b. need a degree of flexibility to engender success.

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

b. occupation.

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

b. participate in databases that compare the outcomes and staffing levels versus those of similar institutions.

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

b. participation of nurses in projecting staffing needs.

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

b. perfectionism.

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

b. reviewing vacation requests.

The education consultant for the hospital is presenting a workshop titled "Documentation: A Manager's Responsibility." Which of the following points would she not include in her PowerPoint presentation? Documentation: a. cannot be left to memory. A notation must be placed in the personnel file. b. should avoid discussion of the problem. c. should include what was done about the problem when it occurred. d. needs to include date, time, and place.

b. should avoid discussion of the problem.

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

b. staffing.

At Hospital XYZ, staff members on Y3 Unit have dealt with the third charge nurse in 3 years. Donna, the current charge nurse, lacks confidence in patient-nurse relationships, and scheduling and other processes are routinely left to the last minute. Staff members approached Donna first and then administration with their concerns about Donna's effectiveness as a leader. The staff was told that the problem is likely staff related, that it is simply an unhappy group, and that there is nothing that will be done further about their concerns. The philosophy of the organization indicates that "open, transparent communication between staff and management is desired and supported," and that "innovation and creative thinking are the foundation of the organization's progress." In assessing this situation as a newly hired senior executive, you anticipate that: a. staff members will resolve the conflict on their own. b. the situation will lead to ongoing disgruntlement and attrition. c. no further discussion or concerns will come out of the situation. d. the head nurse will be able to resolve the conflict on her own.

b. the situation will lead to ongoing disgruntlement and attrition.

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

b. two part-time staff members are hired to work in a unit, but the job expectations for them are not clear, and the head nurse expresses disappointment in their performance.

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

b. understand the budget timetable and level of involvement expected of individual managers in budget preparation.

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

b. using fewer services per client.

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

b. women lacked legal, social, and political power because of legal and cultural barriers.

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

c. "Is there a strategy in place to reduce the number of overtime hours on the unit?"

In preparing a budget, the nurse manager needs to anticipate the cost of benefits (e.g., health, life insurance, pension, and retirement plans). Based on the usual cost of benefits, how much should a nurse manager include for a total full-time salary cost of $312,000? a. $78,000 to $93,600 b. $62,400 to $78,000 c. $46,800 to −$93,600 d. $31,200 to $46,800

c. $46,800 to −$93,600

In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year. The nurse manager determines that RN 1 has 5 weeks of vacation and 3 days of education and has averaged 3 sick days a year. RN 2 has 6 weeks of vacation, has asked to attend a 3-day conference and a 2-day workshop, and has no history of sick time. RN 3 is new, and you anticipate 3 weeks of orientation, as well as 4 weeks of vacation. RN 4 has 6 weeks of vacation and has an ongoing health condition, so you anticipate 2 weeks of sick time, as well as 3 days for education. RN 5 has 5 weeks of vacation, has no education planned, and averages 5 sick days per year. RN 6 has 6 weeks of vacation, has no educational opportunities planned, and has been off ill for 4 weeks. How many hours of productive paid time can be anticipated for the budget? a. 12,480 b. 11,200 c. 10,848 d. 10,688

c. 10,848

In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year. Based on a 40-hour week, this means that the nurse manager has determined that the budget will provide for _____ hours. a. 12,480 productive b. 10,820 productive c. 12,480 paid d. 10,800 patient care

c. 12,480 paid

As a unit manager, you chair the unit meetings. For each meeting, you consider and establish the purpose of the meeting. Second, you prepare an agenda. Arrange the following steps in an order that would make the meetings productive and successful. 1. Distribute an agenda. 2. Distribute minutes. 3. Select team members. 4. Start on time. 5. Keep the meeting focused and directed toward accomplishing the set objectives. a. 1, 2, 4, 5, 3 b. 4, 1, 2, 5, 3 c. 3, 1, 4, 5, 2 d. 3, 4, 2, 1, 5

c. 3, 1, 4, 5, 2

Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement the following steps that help to alleviate uncivil behavior on a unit. (A) Suspending the staff member from work, (B) Providing written admonishment that is discussed and placed in the employee's file, (C) Providing verbal admonishment, (D) Terminating the staff member a. A, B, C, D b. B, A, C, D c. C, B, A, D d. C, A, B, D

c. C, B, A, D

Nurses generally experience difficulty in identifying behaviors and actions that could signal chemical dependency in a co-worker. Which of the following is not a behavioral change that occurs with chemical dependency? a. Personality and behavioral changes b. Job performance changes c. Changes in educational involvement and pursuit d. Absenteeism

c. Changes in educational involvement and pursuit

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

c. Found in all social organizations

A nurse manager must be familiar with the agency's policies regarding termination. Termination procedures include which of the following? a. Following specific procedures from other organizations b. Having an attorney present at the termination meeting c. Having adequate written documentation to support the action d. Having a friend present during the termination meeting

c. Having adequate written documentation to support the action

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

c. Home care

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

c. Making a long overdue return call to a former colleague who is now a chief nurse executive

A nurse manager approves two staff nurses to attend a national conference. When reviewing the budget, the nurse manager looks at which line item? a. Cash budget b. Capital budget c. Operating budget d. Supply and expense budget

c. Operating budget

What would be the most appropriate focus in developing a business plan for a nurse-owned home healthcare service? a. Programs to educate the community on preparing healthy meals for a limited cost b. Reduction of injuries from alcohol-related accidents c. Pain management for patients with low back pain d. Reduction of falls among seniors

c. Pain management for patients with low back pain

In what situations would you expect low morale and frustration? a. Statement of philosophy indicates "We value our staff." When staff members leave, careful evaluation is done to determine whether staff should be replaced by full- or part-time employees. b. Practices include annual staff recognition celebrations. During times of change, staff members are actively included in issue identification and solution finding. c. Recruitment ads promise opportunities for advancement for everyone. Promotions are given only to individuals with long-standing service and entrenched relationships. d. The vision indicates that there is strong commitment to lead in research. The organization has tried to implement a strong campaign to attract leading nurse researchers but has experienced difficulty in doing so.

c. Recruitment ads promise opportunities for advancement for everyone. Promotions are given only to individuals with long-standing service and entrenched relationships.

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

c. Referent, expert, and information

The nurse manager places a staff member on probation because of reports of chemical dependency. The nurse manager should be aware that which of the following statements is true regarding chemical dependency? a. The chemically dependent employee usually hides any changes in behavior. b. When confronted with the issue, the affected employee is usually relieved to have someone to talk to about the problem. c. The chemically impaired nurse affects the entire healthcare organization. d. Hospital policy, state laws, and nurse practice acts address procedures for the chemically dependent employee in the most general terms.

c. The chemically impaired nurse affects the entire healthcare organization.

A group of patients with early Alzheimer disease and their spouses approach you regarding help with the establishment of a local Alzheimer Society for the support and education of affected individuals and their families. As a manager in an ambulatory care clinic, what suggestion or advice would you offer this group? a. Self-help groups are, by nature, directed, funded, and led by those requiring help, and therefore, the patients and families should need no help from your clinic. b. Your healthcare organization would be pleased to help as long as your organization financially takes over responsibility for direction, leadership, and management. c. Through partnership, you will provide supports, if possible, that the patients and spouses themselves identify as necessary in the establishment of the group. d. The services that the patients and spouses are proposing are likely being offered somewhere else already.

c. Through partnership, you will provide supports, if possible, that the patients and spouses themselves identify as necessary in the establishment of the group.

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

c. a consequence or response to an event or stimulus that can be positive or negative.

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

c. a variety of scheduling options.

Healthcare organization XYZ provides women's health services on an inpatient basis (average stay of less than 30 days). This facility would likely be considered: a. primary care, specialized. b. tertiary care, long-term. c. acute care, specialized. d. public care, specialized.

c. acute care, specialized.

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

c. ask the nurse to meet with you for a few minutes before she leaves for the day.

The most important approach that a nurse manager can take with an emotionally troubled employee is to: a. act as a therapist for the employee. b. adjust the standard of care to assist the employee. c. assist the employee in obtaining professional help. d. adjust the employee's work schedule to decrease stress.

c. assist the employee in obtaining professional help.

A hospital is working toward becoming a Magnet® hospital. The chief nursing officer is aware that professional nursing departments in Magnet® hospitals will: a. not be directed by nurses. b. be virtual organizations. c. be designed to maintain nursing standards of practice. d. be entitled to have client care departments.

c. be designed to maintain nursing standards of practice.

In the Unity Healthcare organization, decisions, including those at the unit level, are made by a group of senior executives. Rules for employees are clear, and nursing care is delineated by procedures and protocols. This exemplifies: a. transformational leadership. b. transactional leadership. c. bureaucratic organization. d. Chaos theory.

c. bureaucratic organization.

In an inner-city area, a group of nurses meet and develop a plan to negotiate with local businesses to support a breakfast program for young elementary schoolchildren. This is an example of: a. community development. b. collective bargaining. c. collective action. d. shared governance.

c. collective action.

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

c. combines interventions and time required for interventions to determine levels of care required.

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

c. communication with on-call providers.

The Emergency Department nurses' decision to organize for the purpose of collective bargaining is being driven by a desire to: a. establish the staffing pattern that will be used. b. determine the hours that one is willing to work. c. create a professional practice environment. d. protect against arbitrary discipline and termination.

c. create a professional practice environment.

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

c. decides that more information is needed before a conclusion can be reached.

A nurse manager at a home healthcare service has resigned to take a position at a local ambulatory care center. She has been hired because of her expertise in TJC accreditation. To initiate the changes, the nurse manager has to be knowledgeable about the differences between a home healthcare institution and an ambulatory care center, which is a primary care institution. Primary care institutions are facilities that provide: a. rehabilitative or long-term care. b. disease-restorative care. c. first access to care. d. only outpatient services.

c. first access to care.

Collaborative partnerships between hospitals and schools of nursing are examples of hybrid organizational structures. A hybrid organizational structure: a. has many divisions of labor. b. best fits long-term care units. c. has a mixture of the characteristics of various organizational types. d. places the authority for decision making closest to the places where workers perform

c. has a mixture of the characteristics of various organizational types.

The facilities department is experiencing some challenges and is undergoing reorganization. Because of your familiarity with systems theory, you: a. know that this challenge is their issue and that it has nothing to do with your unit. b. understand that such events are localized and do not have an impact on the organizational culture. c. know that the nature of challenges and reorganization in facilities will have an impact on other areas. d. anticipate that your prior experiences with facilities have no effect on the current situation.

c. know that the nature of challenges and reorganization in facilities will have an impact on other areas.

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

c. networking.

A new CEO has been hired at Valley Hospital who proposes to change the centralized organizational structure that was put in place 10 years ago, based on widespread consultation with staff. The proposed structure involves substantial flattening of the organizational structure, with significant decision making being made at the point-of-care and an emphasis on interprofessional collaboration. There is a great deal of discussion about the balance between hospital-wide budget decision making and unit-based decision making. This discussion represents: a. Chaos theory. b. organizational redesign. c. organizational reengineering. d. restructuring.

c. organizational reengineering.

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

c. outline the number of individuals by classification on a per-shift basis.

While making rounds, a night supervisor finds a unit with a low census and too many staff members. The night supervisor is performing as a statutory supervisor when he or she: a. assigns nurses to care for specific clients. b. develops a protocol for unlicensed personnel. c. recommends transferring a nurse to another service. d. teaches a nurse to use a new piece of equipment.

c. recommends transferring a nurse to another service.

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

c. reflects the essential process of power.

A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a: a. verbal reprimand. b. written reprimand. c. reminder of employment standards. d. day off without pay.

c. reminder of employment standards.

In Hospital STV, senior administration is strongly oriented toward fiscal and social conservatism. The nursing department is deeply concerned with the provision of quality to the community, which includes a high number of poor and unemployed. To accomplish the goals of the nursing department, resources need to be allocated that administration is not able to allocate. Nursing and administration: a. are engaged in shared governance. b. are involved in an irreconcilable conflict of interests. c. represent separate subcultures in the institution. d. represent union and nonunion conflict.

c. represent separate subcultures in the institution.

A primary care clinic is established in Pleasantville to provide comprehensive services to infants, children, and families within the community. The executive director of the clinic oversees physician and nursing services for infants, children, and families; a neurodevelopmental clinic; psychology, family counseling, and social work services; nutritional counseling; speech and hearing services; and physiotherapy. This type of organizational structure is known as: a. hierarchical. b. bureaucratic. c. service-line. d. matrix

c. service-line.

In reviewing the current delivery model, the nurse manager is aware that a demographic change that will have a significant effect on healthcare delivery systems of the future is: a. changes in staffing patterns. b. increasing reports of violence in the workplace. c. the increasing percentage of the population that will be over age 65. d. escalations in the cost of health care.

c. the increasing percentage of the population that will be over age 65.

In the Unity Healthcare organization, communication flows: a. laterally. b. bottom to top. c. top to bottom. d. intermittently.

c. top to bottom.

To prepare staffing schedules, a nurse manager needs to calculate paid non-productive time. When calculating paid non-productive time, the nurse manager considers: a. work time, educational time, and holiday time. b. paid hours minus worked hours. c. vacation time, holiday time, and sick time. d. paid hours minus meeting time.

c. vacation time, holiday time, and sick time.

What would be the most appropriate mission statement for a nursing center? a. "At Plentyville, we provide rehabilitative services for addicted adolescents." b. "Georgiatown provides treatment and prevention services for county residents." c. "At Heart, our aim is to provide services that lead the nation in health education and research." d. "At Coeur, we strive to achieve optimal pain management with patients who are experiencing chronic pain."

d. "At Coeur, we strive to achieve optimal pain management with patients who are experiencing chronic pain."

At Orangetown Hospital, the nursing department is developing a mission statement for nursing. What would be a suitable mission statement? a. "Nursing provides services for patients admitted to Orangetown Hospital." b. "To participate fully in the professional services offered by Orangetown Hospital." c. "To lead by the lamp; services for seniors." d. "At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership, education, and interprofessional collaboration."

d. "At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership, education, and interprofessional collaboration."

The American Nurses Association has advocated for the Registered Nurse Safe Staffing Act. This legislation is based on ANA Safe Staffing Principles and takes what factors into consideration for planning staffing on a nursing unit? a. Patient acuity and complexity b. Education and training of the nurses c. Technology available and use on the unit d. All factors listed are to be considered

d. All factors listed are to be considered

Time management is very essential for the nurse manager. Which of the following is not a good time-management technique? a. Decide what not to do. b. Learn to say "No." c. Learn to delegate. d. Break down your workload into smaller, manageable tasks.

d. Break down your workload into smaller, manageable tasks.

A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. This item would typically be included in which budget? a. Operating b. Strategic c. Unit of service d. Capital

d. Capital

What patients would most likely be covered under Medicare? a. Jim, who lives on the street and has occasional infections b. Alysha, who is on social assistance and has a 5-year-old daughter with frequent ear infections c. Karen, a housewife, 45 years of age, whose husband recently abandoned the family d. Dan, who is 68 years of age and in good health

d. Dan, who is 68 years of age and in good health

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

d. Depersonalization

Ellen is a novice nurse on your unit. Even though she has come to you highly recommended, as her supervisor, you have noticed some knowledge and skill deficiencies. These deficiencies have been noticed by her peers as well, who cover for her because she is new and they like her. Which of the following is likely to be the greatest asset to Ellen in improving her performance? a. Ignore Ellen's errors until she has more experience. b. Instruct staff to avoid working with Ellen until she learns to how do things herself. c. Ask Ellen to complete a self-assessment, using a standard skills checklist. d. Encourage staff to report every behavior of Ellen's that is different from theirs.

d. Encourage staff to report every behavior of Ellen's that is different from theirs.

You are a nurse manager in a facility that is part of a national system of specialized hospitals that provide services to children and that is funded and managed through a religious charity organization. This system emphasizes compassionate, faith-based care. What level of consolidated system is represented in this example? a. First level b. Second level c. Fourth level d. Fifth level

d. Fifth level

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

d. Identify the informal leaders on her unit and how they affect care decisions.

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

d. Jerry speaks with his supervisor about his supervisor's concerns related to bedside reporting before presenting a proposal to change this process.

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

d. Join a nurse executive interest group to meet other executives for support and for sharing ideas of expertise.

What is an example of an HMO? a. Nurse practitioners are paid promptly at discounted fees for each service rendered at a women's health clinic. b. Physicians in a large urban center are reimbursed for visits made to their clients. c. Physicians are paid for each service delivered to enrolled patients through a prepaid plan. d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.

d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.

A nurse belongs to several professional organizations, serving on a state-level committee of one group and on two task forces at work. The nurse is committed to a range of health issues and knows the state senator from the nurse's district, as well as the name of the representative in Washington, DC. This nurse exemplifies which level of political activism in nursing? a. Gladiator b. Buy-in c. Self-interest d. Political astuteness

d. Political astuteness

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

d. Rising Medicare costs

Because of rapid turnover and the ongoing hiring of new graduates, the skill levels of staff in a busy CCU are varied. Senior staff are becoming burned out with the need to provide mentorship and guidance to new staff. As the manager, you propose the addition of a nurse in advanced practice to provide consultation and education for staff. What is this position considered? a. Hierarchical position b. Ancillary c. Line position d. Staff position

d. Staff position

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

d. Stress triggers such as self-criticism and overanalyzing

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

d. Stressors that are identical do not necessarily have similar effects on each individual.

Which of the following are considered variable costs? SATA a. Salaries for the minimum number of staff b. Utilities and rent c. Managed care d. Supplies e. Medication and treatment supplies

d. Supplies e. Medication and treatment supplies

Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement steps that help to alleviate uncivil behavior on a unit. Which of the following would not be an appropriate first step? a. Suspending the staff member from work b. Providing written admonishment that is discussed and placed in the employee's file c. Providing verbal admonishment d. Terminating the staff member

d. Terminating the staff member

As a nurse manager, you have been asked to assist in designing a subacute facility for open heart patients who require further complex care after hospitalization. In setting up the facility, what would require reassessment? a. Patients admitted to the facility must have adequate health insurance to cover the services provided. b. A local nurse education program asks you if nursing students can gain clinical experience with recovering surgical patients in the facility. c. Public funding will be provided to enable care of patients who have an ordinary course of recovery. d. The facility is an older house that is more than 30 minutes away from the acute care center.

d. The facility is an older house that is more than 30 minutes away from the acute care center.

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

d. They are closest to the front line of health care and see how it affects clients and families.

Awareness and use of power have been challenging for nurses in general because of: a. incidences of punishment by authority figures. b. too little time in the workplace to collectively develop power strategies. c. lack of cohesiveness and unity among nurses. d. a tradition of obedience to authority.

d. a tradition of obedience to authority.

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

d. adequate staffing to meet acuity levels.

Collective action is effective in: a. ensuring that needs of nurses are placed ahead of other disciplines. b. defining nursing as a profession. c. advising patients of the needs of nurses. d. amplifying the influence of individuals.

d. amplifying the influence of individuals.

In looking at an organizational chart for her institution, Jennifer notes that nursing is led at the senior level by a non-nurse executive. Jennifer expresses concern that this is a reflection of how nursing is viewed within the organization. Jennifer's comments reflect: a. a concern that resource allocation will be made on a business and not a professional model. b. the dissatisfaction that occurs when lack of autonomy is given to nurses. c. concern with the nonadvancement of nursing practice in the institution. d. an awareness of how organizational culture is reflected in organizational structure.

d. an awareness of how organizational culture is reflected in organizational structure.

You are the nurse manager for a not-for-profit health service for the homeless and for drug users in an impoverished neighborhood. As the manager, your concern about sustainability is related to: a. the possibility of violence. b. an increase in prescription drugs available for abuse. c. decisions of the public board. d. an increase in uncompensated care events.

d. an increase in uncompensated care events.

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

d. an increased number of RN positions.

Sarah is a clinical nurse educator in the dialysis unit at Pines Health Center and provides education, consultation, and training support. Sarah has: a. direct responsibility for patient care. b. direct accountability for patient outcomes. c. an authority relationship to staff. d. an influence over patient outcomes.

d. an influence over patient outcomes.

As a nurse manager, you have been asked to be part of a design team for health services that have vertical integration. In planning for these services, your team will design a proposal that will: a. cluster like services together, such as outpatient clinics for the care of children with various developmental and medical needs. b. plan for the smooth transition of patients from the emergency services department to other units in the hospital. c. ensure that funding follows the patient from acute care to long-term care services. d. bring together acute care, ambulatory, home care, and palliative care services for the management of patients diagnosed with cancer.

d. bring together acute care, ambulatory, home care, and palliative care services for the management of patients diagnosed with cancer.

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

d. collegial.

A new director of nursing in a small rural hospital wants to make changes from the traditional model of governance to a shared-governance model. Select the characteristic below that best describes the traditional organizational structure in which a staff nurse is assigned to carry out nursing tasks for clients but is not given the chance to provide input into forming the policies and procedures by which care is delivered or the standards by which care is evaluated: a. bureaucratic. b. decentralized. c. delegated authority and responsibility. d. delegated responsibility but no authority.

d. delegated responsibility but no authority.

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

d. department of Health licensing standards.

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

d. determine her personal and professional goals.

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

d. determine the number of hours available for patient care.

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

d. external

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

d. financial plan.

The chief nursing officer understands that clinical incompetence is best prevented by a(n): a. flexible protocol for evaluating competency skills. b. standardized clinical skills checklist. c. administration of personality tests and competency assessments at point of hire. d. formalized competency program with established standards for practice.

d. formalized competency program with established standards for practice.

The Wellington Mental Health Institute is fully accredited by the AOA and not directly by the CMS. This means that the Wellington facility: a. cannot accept mental health patients who are Medicare beneficiaries. b. can care for only Medicaid and not Medicare beneficiaries. c. has not met the standards set by the CMS as determined by an external review panel. d. has been reviewed and accredited by the AOA, which is a deeming authority for CMS.

d. has been reviewed and accredited by the AOA, which is a deeming authority for CMS.

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

d. have good information literacy skills.

A nursing informatics specialist hired by Blue Cross/Blue Shield Insurance System (a form of third-party payers benefit package for a prepaid fee that uses specific standards to approve a period of time for the use of inpatient and community health services) is participating in: a. critical pathways. b. healthcare networks. c. health maintenance organizations. d. managed care.

d. managed care.

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

d. more powerless and devalued.

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

d. number of RNs and number of RNs with experience on the unit.

The staff members in a local Emergency Department are experiencing stress and burnout as the result of excessive overtime. The staff decides to unionize to negotiate for better working conditions. The increase in unionization within health care may be attributed to the: a. movement from being "blue-collar workers" to being "knowledge workers." b. excess profits in health care. c. level of risk that exists for health care. d. number of people who are involved in health care.

d. number of people who are involved in health care.

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

d. of unlimited capacity when shared with others.

A nurse manager working for a not-for-profit organization should be familiar with the regulations that impact the organization. Not-for-profit organizations: a. pay dividends to stockholders. b. can refuse clients who are unable to pay. c. have no paid employees. d. pay no taxes.

d. pay no taxes.

The nursing director calls a meeting with one of the new unit managers. She is very concerned about a report of substance abuse on the manager's unit, and she reviews the procedures involved in dealing with chemically dependent staff. Which of the following statements would NOT be included in the discussion? "As a manager, you: a. need to be aware of ADA issues." b. should check with human resources regarding chemically dependent employees and employment practices." c. check the nurse practice acts for the state in which the nurse resides." d. should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff.

d. should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff."

The chief nursing officer reviews the policy about "progressive discipline process." The progressive discipline process includes which of the following? The manager: a. acts as a counselor and friend to the employee. b. should reprimand and suspend the employee as a last resort. c. should rehire the employee after a reasonable length of time. d. should terminate the employee if the problem persists.

d. should terminate the employee if the problem persists.

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

d. submit the schedule to a centralized staffing office for review.

In a nurse managers' meeting, strategies for ways to help retain staff are discussed. One strategy for assisting nurses in developing collective action skills is: a. accepting the practice of "going along to get along." b. attending as many workshops as practical. c. spending as much time as possible in clinical settings. d. taking the opportunity to work with a mentor.

d. taking the opportunity to work with a mentor.

When progressive discipline is used, the steps are followed progressively only for repeated infractions of the same rule. On some occasions, rules that are broken are so serious that the employee is: a. transferred to another unit. b. suspended indefinitely. c. asked to attend a union grievance meeting. d. terminated after the first infraction.

d. terminated after the first infraction.

The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that: a. using replacement personnel with new ideas may be beneficial. b. salary costs are lower because personnel are fewer, and outcome is favorable. c. absence on the part of the rest of the staff is decreased. d. unacceptable patient care may result.

d. unacceptable patient care may result.

To prepare for the orientation of newly hired nurses, the nurse manager plans a presentation outlining the concept of healthcare networks. Healthcare networks are: a. units that provide only primary care services. b. owned by the institutions. c. a feature of all public institutions. d. units that serve large populations.

d. units that serve large populations.