Exam 2 Ch. 9, 11-16, 20, 24, 26

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

A 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 conflict develops between an associate nurse and a primary nurse over the assessment of a patient with pulmonary edema. Based on her assessment of the patient, the associate nurse insists that it is her role to change the care plan because she is the one who has made the assessment. As the nurse manager, you clarify that: a. It is the role of the primary nurse to make alterations based on assessment data and input. b. The associate nurse is accountable and responsible while the primary nurse is off duty and therefore is able to alter the care plan. c. Neither the primary nor the associate should make changes without first consulting you as the manager. d. It really does not matter who alters the nursing care plan as it depends on situation and time to do so.

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 nursing unit is interested in refining its self-medication processes. In beginning this process, the team is interested in how frequently errors occur with different patients. To assist with visualizing this question, which organizational tool is most appropriate? a. Histogram b. Flowchart c. Fishbone diagram d. Pareto chart

A nursing-led classification system that has led to greater reliability and standardization in data utilized for QI processes is: a. NANDA. b. AHRQ. c. NIOSH. d. Nursing process.

A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him and then provides a written plan of care. What type of educational preparation best fits the role of primary nurse? a. Baccalaureate b. Associate c. Diploma d. LPN/LVN

A recent nursing graduate in a busy emergency department triages a patient who has sustained a large, deep puncture wound in his foot while working at a construction site. He is bleeding and is in pain. The nurse enters the triage data that she has obtained from the patient into a computerized, standard emergency patient classification system. After she enters the assessment data, she notices an alert on the computer screen that prompts her to ask the patient about the status of his tetanus immunization. What system of technology is involved in generating the alert? a. Clinical decision support b. WL technology c. Computerized provider order d. Electronic health record

A survey of staff satisfaction is conducted. The survey indicates that staff members are satisfied, are loyal to the organization, and feel that they have reasonable control in their individual responsibilities. The findings best exemplify: a. Clarity in roles and valuing of contributions. b. Satisfaction but not empowerment. c. Effective coaching of new staff. d. Role attachment.

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.

An example of an effective patient outcome statement is: a. Eighty percent of all patients admitted to the Emergency Department will be seen by a nurse practitioner within 3 hours of presentation in the Emergency Department. b. Patients with cardiac diagnoses will be referred to cardiac rehabilitation programs. c. The hospital will reduce costs by 3% through the annual budget process. d. Quality is a desired element in patient transactions.

An outpatient clinic advertised for RN positions. Before authorizing an open position, the nurse manager should: a. Review the position description and performance expectations for the opening. b. Place an ad in the local newspaper and on the telephone job line. c. Review all current applications on file. d. Look for employees within the system who might best fill the position.

As a manager, you are interested in developing behavioral questions for an interview. Knowing that there is team conflict at times on your unit, which of the following questions would satisfy your interest in behavioral questions? a. "Tell me about a time you were involved in a conflict related to a project. What was your role in the conflict? In the resolution of the conflict?" b. "If you were to employ one strategy for managing conflict, what would it be?" c. "What is your preferred style of conflict resolution?" d. "How effective are you in working in a group? In dealing with conflict?"

As a nurse manager representative on a clinical information system selection team, you would be particularly concerned if the favored system: a. Involves screen displays that are best configured for non-clinical users. b. Requires an upgrade to servers in the facility. c. Requires staff orientation and training during implementation of the software. d. Minimizes the amount of data entry necessary.

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

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.

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

Case managed care may enhance profit in a for-profit health organization by: a. Minimizing costs in high resource consumption areas. b. Combining licensed and non-licensed care providers in delivering patient care. c. Increasing reimbursement from third-party payers. d. Reducing the amount of technology used to support clinical decision making.

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

During times of nursing shortages and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny? a. Case method b. Team nursing c. Functional nursing d. Nurse case management

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.

For a nurse manager in the functional nursing model, an approach that will assist in maintaining staff satisfaction in this specific model is: a. Rotation of task assignments. b. Frequent opportunities for in-service education. c. Orientation to job responsibilities and performance expectations. d. Team social events in off hours.

Hospital ABCD is a Magnet™ hospital. This designation has been applied to Hospital ABCD because it: a. Facilitates active staff participation in decision making related to quality nursing care. b. Has implemented a graduate nurse orientation program. c. Espouses commitment to excellence in patient care. d. Is establishing career ladders for nurses.

Hospital Magnet™ decides against creating a separate department to lead and monitor quality activities because: a. Total organizational involvement is critical to QI. b. Data generated by a single, separate department are generally flawed. c. Monitoring and commitment to QI can come only from senior-level managers. d. Staff resent suggestions for improvement that originate outside of their unit.

In an ICU, you order new devices to measure heart rhythm and rate, respiratory rate, oxygen levels, and intracranial pressure. These devices involve: a. Biomedical technology. b. Telecommunications. c. Retrieval of patient history information. d. Internet.

In comparing team and functional models of care, a nurse manager favors the team model. In particular, she finds that the team model: a. Can be effective in recognizing individual strengths and backgrounds of staff. b. Promotes autonomy and independence for the RN. c. Avoids conflict because of role clarity. d. Is efficient in delivering care to a large group of patients, utilizing a staffing mix.

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

In determining the relationship between injury-producing falls and proposed preventive measures as part of the QI process, a QI team might turn to which of the following for confirmatory evidence? a. NDNQI b. NANDA c. NIOSH d. AHRQ

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.

Leaders in nursing must advocate for information and knowledge systems that support nursing practice. This is best accomplished by: a. Participating in organizational information technology committees. b. Submitting written requests for needed information systems. c. Requesting budgetary funds needed for systems. d. Sending staff nurses to conferences that discuss cutting-edge technologies.

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

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

Northwestern Hospital has decided to implement peer review. As a clinical leader in the Emergency Department, you have overall responsibility for ensuring that this is in place by next month. The most important step in this process is to: a. Provide an educational session for staff on peer review. b. Revise the mission statement, objectives, and performance standards. c. Develop objectives and performance standards with employees. d. Implement objectives and performance standards.

Planning is a process designed to achieve goals in dynamic, competitive environments. As a new manager, what is the first step you will undertake to develop a strategic plan of action for a congestive heart failure program? a. Search the environment to determine changes that may affect the organization. b. Appraise the organization's strengths and weaknesses. c. Identify the major opportunities for and threats to the organization. d. Identify and evaluate the various strategies available to the organization.

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.

The biggest challenge in the recruitment of staff is: a. Finding well-qualified candidates who can function well within your particular work culture. b. Recruiting individuals with the appropriate qualifications and experience. c. Screening out candidates who are unable to function well within a team. d. Determining if candidates have had previous negative experiences in a work environment.

The chief nursing officer has to write a strategic plan. The most difficult stage in the strategic planning process is: a. Assessment of the external and internal environment. b. Review of mission statement, goals, and objectives. c. Identification of strategies. d. Implementation of strategies.

The clinic nurse understands that the advantages of planning include: a. Assisting staff in critical thinking and improving decisions. b. Orienting people to react instead of act. c. Forcing managers to be cost-efficient and effective. d. Focusing on activities, not results.

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.

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

The nurse manager schedules evaluations of staff members using a newly developed performance appraisal tool. The development of a performance appraisal tool should include: a. Organizational mission, philosophy, and position requirements. b. A generalized overview of the duties of a position. c. A skills checklist and accreditation requirements. d. An ordinal scale that ranks all employees.

The nurse on the 7-7 shift is assigning a component of care to an unlicensed nursing personnel (UNP) employee. The night nurse should remain: a. Accountable. b. Responsible. c. Authoritative and liable. d. Responsible and task-oriented.

The reasons cited by nursing administrators for not planning in a systematic manner include: a. Lack of understanding of the planning process. b. Lack of knowledge regarding the internal and external operations of the organization. c. Not enough hours in the day for both day-to-day operations and planning. d. Delegation of the task to subordinates.

The relief charge nurse has assigned a newly licensed baccalaureate-prepared nurse to be one of the team leaders for the 3-11 shift. In making this decision, the charge nurse has overlooked this nurse's: a. Clinical expertise. b. Leadership ability. c. Communication style. d. Conflict-resolution skills.

The validity of comments and ratings related to performance is enhanced by: a. Maintenance of anecdotal notes over the entire evaluation period. b. Quantity of information gathered for appraisal purposes. c. Agreement of the employee with the ratings and comments. d. Whether or not other individuals have contributed to the observations.

Through the QI process, the need to transform and change the admissions process across administrative and patient care units is identified. In this particular situation, what method of data organization will be most effective? a. Flowchart b. Histogram c. Narrative d. Line graphs

To improve outcomes on the stroke recovery unit, the unit manager leads an evidence-based practice (EBP) project. The goal of this project is to: a. Enable detection of variations in clinical outcomes from well-researched standards that are supported by confirmatory evidence. b. Gain quick access to literature based on studies of patients and families who have experienced stroke. c. Develop a list of articles that could be accessed to address clinical issues and problems with stroke patients. d. Advance the development of staff who are able to conduct independent nursing research on stroke outcomes.

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

To meet the social and human needs of a target market, it is critical to: a. Assess the needs and priorities of the target market. b. Revise the organization's mission statement to reflect external needs. c. Assess the internal culture and needs. d. Develop highly sophisticated media.

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.

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

Which of the following represents an effective goal statement? a. Involve patients and families in planning health care. b. To revise clinical guidelines for incontinence care from evidence within 6 months c. Patients and families are partners first in care planning. d. To acquire $4 million in additional funding within 12 months to support clinical education programs for dementia

Which of the following would be most in line with Hersey and Blanchard's concepts? a. The team of caregivers on day shift are familiar with their roles and with the patients. The nurse manager decides to work on the unit budget in her office. b. After a year of working on the unit, Shari, an LPN, is still hesitant about many policies and procedures. The charge nurse decides to challenge Shari with more difficult patients. c. The nursing supervisor asks one of her charge nurses to lead a technology integration project. The supervisor continuously demands involvement in decisions that the charge nurse is making in the project. d. Team members complain that Alysha, an RN, is unmotivated, and that she refuses assignments that are complex or difficult. The charge nurse suggests that Alysha is relatively new and that she needs time to adjust.

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

You have hired Chelsea as a new staff member on your unit. Although she is an experienced ICU nurse, this is her first educator role. A month into her new position, she confides that she feels really incompetent in her new position and bursts into tears. Your response is based on application of your understanding of: a. Role acquisition. b. Role conflict. c. Role complexity. d. Performance appraisal.

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? (Select all that apply.) 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, b, c, d

An example of a care activity that would likely not be delegated by an RN to a UNP is (select all that apply): a. Teaching self-catheterization to a patient with paraplegia who has limited English. b. Basic care for a patient with a head injury who is rapidly deteriorating. c. One-to-one observation with a suicidal patient. d. Assessment of patients being admitted through the Emergency Department. e. Basic hygienic care for a patient who is post MI and stable.

a, b, d

Examples of sentinel events include (select all that apply): a. Forceps left in an abdominal cavity. b. Patient fall, with injury. c. Short staffing. d. Administration of morphine overdose. e. Death of patient related to postpartum hemorrhage.

a, b, d, e

Your organization has made a decision to implement TCAB in your hospital. As a manager, what strategies would you use to implement TCAB? (Select all that apply.) a. Encourage recognition among staff of their knowledge of the patient-care environment. b. With staff, select small changes for consideration. c. Select only projects that have widespread impact. d. Secure external advisors to evaluate innovation. e. Present ideas based on best practices and ask staff for advice on implementation.

a, b, e

A clinic nurse developed objectives for a diabetic education program. The characteristics of well-written objectives include that they should be what? (Select all that apply.) a. Achievable b. Understandable and specific c. People-oriented d. Manager-oriented e. Means-oriented f. Measurable

a, b, f

During the performance appraisal session, the manager should (select all that apply): a. Maintain a relaxed and professional manner. b. Inquire about the employee's personal life and how it is affecting performance. c. Allow the employee to express opinions orally and in writing. d. Plan to give specific examples only for poor performance.

a, c

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

a, d, e

A new RN staff member asks you about the difference between QA and QI. You explain the difference by giving an example of QI. a. "Last year, the management team established new outcomes that addressed issues such as medication errors." b. "At a staff meeting last year, two of our staff commented on the number of recent falls and asked, 'What can we do about it?'" c. "A process audit was done recently to determine how much time was being spent on patient documentation." d. "Errors are reported on our new computerized forms, and I follow up with staff to make sure that they understand the seriousness of their error."

A nurse manager is excited by the possible use of speech recognition (SR) systems for documentation of patient care, especially during crisis situations when staff members need to focus on performing rapid assessments and implementation of procedures. She learns, however, that SR systems would be impractical at this point. What would lead to this conclusion? a. SR systems are not available outside pilot projects. b. The type of speech required for voice recognition is unlikely to occur in a pressured situation. c. The hands-free function has not been perfected in SR technology. d. Wireless communications are prone to unreliability in transmission.

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

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

A nurse manager wants to decrease the number of medication errors that occur in her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a total quality management philosophy by: a. Explaining to the staff that disciplinary action will be taken in cases of additional errors. b. Recommending that a multidisciplinary team should assess the root cause of errors in medication. c. Suggesting that the pharmacy department should explore its role in the problem. d. Changing the unit policy to allow a certain number of medication errors per year without penalty.

A nurse manager was orienting new staff members to computerized charting. To understand computerized charting, staff members must understand informatics. The three core concepts in informatics are: a. Hardware, software, and printers. b. Data, information, and knowledge. c. Decision making, data gathering, and reporting. d. Wireless technology, voice recognition, and handheld devices.

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.

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.

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

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%.

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

Anecdotal notes: a. Should be completed only when there are performance concerns. b. Can be used to support and justify fairness in termination discussions. c. Are unnecessary if the evaluation instrument is thorough. d. Need to be completed at the end of a performance period.

As a nursing leadership student, you have had the opportunity to develop a palliative care manual that will be utilized by the palliative care network (PCN) in your region for teaching healthcare professionals. The PCN has requested that you provide a prioritized plan of action for marketing the manual on a regional and state basis. What is the first priority? a. Motivate the target market. b. Research the target market. c. Communicate benefits to the target group. d. Package the product.

Assessment of the needs of the consumer or client (in developing a strategic marketing plan) focuses on: a. Present needs only. b. Present and future needs. c. The development of surveys. d. Secondary analysis of existing data.

At a newly built outpatient surgical center, an integrated information system has been purchased. The chief nursing officer creates a series of staff development classes to orient the staff to this new system. One of the advantages of an integrated information system is that client-care data from all sites can be stored in and retrieved from a: a. Nursing information system. b. Central data repository. c. Nurse expert system. d. Handheld device.

Before beginning a continuous quality improvement project, a nurse should determine the minimal safety level of care by referring to the: a. Procedure manual. b. Nursing care standards. c. Litigation rate of unsafe practice. d. Job descriptions of the organization.

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.

During a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on: a. Supportive behavior by the leader and immature followers. b. The development level of the followers and the type of behavior of the leader. c. Well-developed followers combined with a strong leader who acts quickly. d. The leader's ability to evaluate personnel and communicate that evaluation.

During a performance appraisal, Joanne, the nurse manager, indicates that Alysha has difficulty mentoring students on the unit. Alysha responds that this is not her responsibility. In responding to Alysha, Joanne needs to consider: a. Alysha's level of confidence. b. Whether mentoring is included in the position description. c. Whether mentoring is an essential component of the position description. d. Whether mentoring can be accurately observed and measured.

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

During staff development programs, staff nurses verbalize their frustration about their workloads and having to delegate so many tasks to others. One of the main reasons that delegation has emerged as an issue is because of: a. The amount of paperwork required to complete care. b. The complexity of client care. c. Earlier discharge practices. d. The numbers of other disciplines present on a given unit.

Functions such as "delegates tasks to assistive personnel" that are outlined in a position description for an RN Team Leader would be considered: a. Active delegation. b. Passive delegation. c. Passive accountability. d. Active responsibility.

Healthcare organization X is committed to improving patient outcomes and, as part of the QI process, examines its executive structure and organizational design. This approach recognizes: a. The importance of decentralized structure in QA. b. That structure influences nurse burnout and participation in quality improvement initiatives. c. The need to ensure sufficient supervisory staff to respond in a corrective manner when mistakes occur. d. That a narrow hierarchy ensures accountability for errors and outcomes.

In assessing the internal environment, the strategic planning team at Pacific Hospital discovers that 90% of staff members have no idea what the current mission statement means. This is most likely related to: a. The level of abstraction inherent in mission statements. b. Development of the statement by the administration team with no other staff involvement. c. Outdated goals and objectives contained in the mission statement. d. Failure to provide action statements within the mission statement.

In hiring nurses during the transition from team nursing to a primary nursing model, Benner's work would suggest that you give priority to nurses who are at least at which level of competency? a. Advanced beginner b. Competent c. Proficient d. Novice

In transitioning to a primary nursing model, it is important for a nurse manager who enjoys a high level of control over patient care to understand that his or her decision making at the patient care level: a. Is increased. b. Is decreased. c. Is relinquished. d. Remains the same.

Joanne, a new nurse manager, writes certain assumptions regarding the organization's objectives into her budget. Her supervisor tells her that the objectives implied in her assumptions are not entirely consistent with the organization, and that she needs to clarify these objectives with her supervisor. Joanne apologizes and says she had more latitude with the budget where she previously worked. This is an example of: a. Role complexity. b. Role ambiguity. c. Role conflict. d. Time-dependent roles.

John's performance was satisfactory during the first month, but after that time, he was found to be very inconsistent in the provision of nursing care. One month before the end of the rating period, he cared for a very wealthy and influential client, who is best friends with the clinical manager. This client donated new furniture for the staff lounge in John's name to show appreciation for his care. John's subsequent performance appraisal resulted in outstanding ratings in all areas. This is an example of: a. A performance rating based on justifiable evidence. b. A bias related to recent events. c. The impact of personality on the appraisal of performance. d. The effective use of a behaviorally anchored rating scale.

John, a new graduate, reviews the employee evaluation for his new position. The first section requires that he list his own specific objectives to be accomplished. This is an example of: a. The traditional rating scale. b. Learning goals, or management by objectives. c. A forced distribution scale. d. A behavior-anchored rating scale.

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.

On your unit, despite efforts to build a strong sense of team, conflict between some of the staff is ongoing. Nonetheless, you want to proceed with developing a systematic and effective performance appraisal system. Which of the following approaches would be most appropriate for you to implement? a. Peer review b. A combination of tools c. Anecdotal notes d. Rating scale

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

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

Shifts such as changes in the percentage of seniors in the population, governmental initiatives in health care, and the influence of income on health status are factors in the __________ environment. a. Public b. Macro c. Competitive d. Social

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

Sue, a nurse manager, discusses her concerns about the hospital's employee appraisal system with her work group, noting that it includes only one rating scale and that it means nothing unless the manager has effective relationship skills. Sue's concerns reflect which best practices associated with performance appraisal? a. Rating scales are too generalized to be considered valid or reliable. b. The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills. c. BARS is considered superior to simple rating scales in terms of performance appraisal. d. Rating scales need to be designed by users to be well accepted.

The chief nursing officer establishes a shared governance model to help empower the nursing staff, thus empowering the organization. Common characteristics of empowered organizations are: a. Shared values, high salaries, and a human focus. b. Shared values, flexibility, and a human-capital focus. c. Commitment to communication, high salaries, and flexibility for evaluations. d. Creation of community and of effective stress management in the midst of divergent goals.

The day shift nurse asks an LPN/LVN to complete a component of care for a client. The day shift nurse is engaging in what function? a. Delegating b. Assigning c. Sharing d. Authorizing

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.

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery. According to quality improvement (QI), to correct the problem, the educator, in consultation with the patient care manager, would initially do which of the following? a. Talk to the staff individually to determine why this is occurring. b. Call a meeting of all staff to discuss this issue. c. Have a group of staff nurses review the established standards of care for postoperative patients. d. Document which staff members are not recording vital signs, and write them up.

The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model. Which of the following methods would be the most cost-effective? a. Functional method b. Case management method c. Primary care method d. Team method

The outcome statement "Patients will experience a ten percent reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding" is: a. Physician-sensitive and nonmeasurable. b. Measurable and nursing-sensitive. c. Precise, measurable, and physician-sensitive. d. Patient care-centered and nonmeasurable.

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.

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

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

When interviewing an applicant for a position, the nurse manager describes the unit's care delivery system as one in which each nursing assistant is cross-trained to perform specific tasks, and the RNs do all treatment, medication administration, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be: a. The case method. b. Functional nursing. c. Primary nursing. d. Nurse case management.

Which of the following indicates safe delegation? a. The nurse supervisor for a large urban acute care department asks the unit manager to accept two new acutely ill patients, which the manager does. The unit is short two staff, and the replacement is inexperienced. b. A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit manager's unit is fully staffed and patients are stable. c. The nurse supervisor asks the head nurse for Unit A to make do without a replacement for an ill staff member because Unit A was originally overstaffed anyway. Patient acuity levels are very high on Unit A and two staff are orientating. d. The nurse supervisor asks the charge nurse on Unit B to cover Unit F, which is two floors up, because the charge nurse for Unit F is ill. The charge nurse for Unit B is an experienced manager but has no experience with the nursing care required on Unit F.

Which of the following strategies might be effective in empowering staff? a. Communication book in which new information on policies and processes is communicated and mistakes are highlighted. b. Monthly staff meetings during which a portion of the agenda is devoted to sharing ideas and presentations on best practices for implementation on the unit. c. Once-yearly summative evaluations based on what the manager best likes about the individual. d. Focus on discussion of errors in care with direction as to how errors are to be prevented in the future.

With delegation, responsibility and accountability remain with the: a. Physician. b. Professional who delegates. c. Individual who receives the delegation. d. Individual who previously performed the task.

With the rise of violence in the psychiatric department, the nurse manager decides that she should work with the risk manager in violence prevention. The nurse manager should: a. Request all staff to accept new risk management practices. b. Hold staff accountable for safe practices. c. Document inappropriate behavior. d. Hire more police security.

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

You are considering putting forward a proposal to move the model of care from team nursing to a primary nursing hybrid: patient-focused care model. In considering this proposal, you recognize that significant costs specific to operationalizing this model are related to: a. Implementation of an all-RN staff complement. b. Significant changes in the physical structure of units. c. Orientation of staff to new roles and responsibilities. d. Testing and piloting technology at the bedside.

You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Before assigning Evelyn to Mrs. N.'s care, the most appropriate action of the care coordinator would have been to: a. Determine Evelyn's educational background and preparation for this role. b. Ask Evelyn if she has worked with inhalers before and to describe what she knows about them. c. Advise that if Evelyn has any questions about what to do with the inhaler, she should come to the coordinator. d. Advise Evelyn that working the inhaler is not really complicated and that she should ask the patient how to check medication levels in the inhaler.

A 39-year-old patient awaits a kidney transplant. Because he must immediately arrange to get to the hospital when a donor kidney is available, it is important that he can be reached anywhere and at any time. To ensure that he receives the message, what type of technology is most effective? a. Internet b. Telecommunications c. WL pager d. CDS

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.

A home health nurse has been assigned to cover a 300-square-mile area of remote Montana. Mrs. Baker has just been discharged home following bowel surgery and has a new colostomy. She will need daily contacts for at least two weeks and then regular weekly contact following that week. Because it is not possible to visit Mrs. Baker in person every day and see all of the other clients, the nurse gives her a laptop computer with net meeting software installed. Each morning, both dial in at an agreed-upon time and discuss her progress. The home health nurse assesses whether or not the client needs to be seen that day and is able to view the colostomy site. This type of technology is called: a. Distance learning. b. Knowledge software. c. Telecommunications. d. Biomedical technology.

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

A new graduate is asked to serve on the hospital's quality improvement (QI) committee. The nurse understands that the first step in quality improvement is to: a. Collect data to determine whether standards are being met. b. Implement a plan to correct the problem. c. Identify the standard. d. Determine whether the findings warrant correction.

A nurse is explaining the pediatric unit's quality improvement (QI) program to a newly employed nurse. Which of the following would the nurse include as the primary purpose of QI programs? a. Evaluation of staff members' performances b. Determination of the appropriateness of standards c. Improvement in patient outcomes d. Preparation for accreditation of the organization by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

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

A nurse manager questions the true difference between primary nursing and total patient care. After careful consideration of both models, the nurse manager concludes that primary nursing differs significantly from total patient care in: a. Breadth of nursing knowledge and expertise required. b. Intention to provide holistic nursing. c. Degree of task orientation. d. Levels and types of assessment.

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.

A patient complains to you that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." The nursing care delivery model most likely employed in this situation is: a. Differentiated practice. b. Team nursing. c. Functional nursing. d. Case management.

A private ambulance clinic established a few streets away from Pacific Hospital markets its services as quality-based within caring relationships. The clinic is part of the __________ environment. a. Public b. Macro c. Competitive d. Social

Ali, an RN on your unit, is consistently late to work and makes remarks such as "Do you really want me to do that?" when patients and care are assigned to her. You have spoken with her frequently about her: a. Ability. b. Skills. c. Attitude. d. Personal issues.

An RN colleague, who is a long-standing and collaborative member of your team, is performing a complex and novel dressing for the first time for the patient to whom she has been assigned. Which of the following would be the most appropriate communication with her? a. "How do you usually do this kind of dressing?" b. "The dressing needs to be done today and tomorrow with the supplies on this cart." c. "Here is what you need for the dressing, and I will show you what needs to be done." d. "I know you know what you are doing. Let me know if you have any problems."

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 staff.

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

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

At the beginning of its strategic planning processes, Pacific Hospital learns that nursing staff members are uncomfortable with utilizing evidence-based practice, and that staff perceives that only limited resources are available to support translation of evidence into their usual practice. Because this issue has been identified, the management team determines that a plan of action is required to address the issue. Who should be involved at this point? a. Nursing unit managers b. Staff nurses c. All staff d. Administration

County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah provides Colleen, her RN colleague with details regarding the patients to whom Colleen has been assigned on the day shift. This is an example of: a. Accountability. b. Responsibility. c. Assignment. d. Delegation.

County Hospital has position descriptions for all staff, including RN Team Leaders. Sarah, a team leader on the rehab unit, assesses the needs of the patients in her area, assesses the skills and backgrounds of each of the individuals on her team, and then assigns and delegates the appropriate care provider to each patient and task. Sarah's activity in the example described is termed: a. Passive delegation. b. Passive accountability. c. Active delegation. d. Active responsibility.

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

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

From your observation of planning activities in the organization, you have noticed that planning and decision making occur at various levels of the organization. The nurse manager has overall responsibility for which of the following? a. Sending out postcards b. Organizing a telephone follow-up c. Monitoring ongoing activities and projects d. Listing the patient population

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."

In a small rural nursing home, a director of nursing decides, because of a shortage of nurses, to implement a partnership model to help with basic tasks that comply with state rules regarding delegation. What type of design constitutes a partnership care delivery model? a. RN and LPN/LVN b. RN and RN c. RN and medication assistants d. RN and certified nurses' aides

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

In considering whether or not to accept a job offer as a nurse manager at a Magnet™ hospital, you look at an environment that you might encounter as a head nurse at the hospital. You determine that you could expect to: a. Find it difficult to recruit new staff. b. See rapid turnover of staff on your unit. c. Find nurses who exemplify interest in quality care. d. Find limited interest in excellence in the nursing environment.

In determining the fit of a candidate with the culture on your unit, which of the following interview questions might be asked? a. "Could you review your resume for us, highlighting your certifications and experience?" b. "If we were to ask your references, what would they list as your strengths? Weaknesses?" c. "We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?" d. "Tell us about your work and academic experiences and qualifications."

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.

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

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

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

Nurses are valuable partners in marketing strategies because they: a. Are more likely than other members of the organization to use marketing tools. b. Have a strong background in using evidence to support decisions. c. Have close involvement with patients, who are the target group for marketing. d. Constitute the largest staff group in most healthcare organizations.

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

Nurses need to know how to operate a computer, compare data across time, and look for patterns in client responses to treatments. These are examples of: a. JCAHO standards. b. Information systems. c. Informatics competencies. d. Requirements for nursing licensure.

Pacific Hospital's team develops a process to include staff in development of the mission statement. Which of the following statements would indicate that the staff has been able to develop an effective mission statement? a. Pacific Hospital will increase its sustainability by increasing revenue streams within the next three years. Revenue streams are important to our hospital and are a driving force in our sustainability in the face of insurer and government funding changes. b. Pacific Hospital has a desire to relate to its community to enable appropriate identification of programming needs by July 2012. c. Pacific Hospital will provide family-centered care to the community of Pacific Rim. It is committed to delivering a full spectrum of services that foster collaborative partnerships among clients, families, and the hospital, and it utilizes evidence-based practice to guide planning and interventions. d. To provide health promotion programs for school-aged children

Patient perceptions are useful in: a. Determining disciplinary actions in QI. b. Establishing the competitive advantage of QI decisions. c. Providing one source of data for QI initiatives. d. Establishing blame for poor-quality care.

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

The case method of care delivery could be best justified in which of the following scenarios? a. Stable patient population with long-term care and family needs b. Acute care surgical unit with predictable postsurgical outcomes and many technical procedures c. Pediatric intensive care unit that heavily involves families as well as patients d. Home healthcare environment with patients at varying levels of acuity

The chief executive officer asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit. The nurse manager explains that nursing research has validated which statement about a low nurse-to-patient ratio? It: a. Promotes teamwork among healthcare providers. b. Increases adverse events. c. Improves outcomes. d. Contributes to duplication of services.

The executive team at Hospital XYZ develops a polished strategic plan that includes a mission statement, goals, and objectives.. The executive team involves the marketing team, so that the plan can be communicated internally and externally. After 2 years, no significant progress has been made toward any of the goals. What has been omitted in the plan? a. Planning b. Marketing c. Integrated financial planning d. Customer focus

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.

The nurse manager is concerned about the negative ratings her unit has received on patient satisfaction surveys. The first step in addressing this issue from the point of view of quality improvement is to: a. Assemble a team. b. Establish a benchmark. c. Identify a clinical activity for review. d. Establish outcomes.

The nurse manager is setting up the room assignments for the unit. She has one critical patient on the unit, who is going to require more care than the others. Before delegating a task, a nurse manager should: a. Delegate the admission assessment to the LPN. b. Review the employee's performance assessment for the most recent period. c. Assess the amount of guidance and support needed in a particular situation. d. Create a task analysis of critical behaviors for the individual.

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.

The unit manager is working in a large metropolitan facility and is told that two UNPs are to be assigned to work with her. Delegation begins with: a. Acknowledging the arrival of the second UNP on the unit. b. Providing clear directions to both UNPs. c. Matching tasks with qualified persons. d. Receiving reports from the prior shift.

To conduct assessment of the internal environment, the strategic planning team for Pacific Hospital: a. Invites community members and staff of the hospital to an evening focus group session. b. Discusses what it sees as the primary threats and opportunities in demographic shifts affecting the hospital. c. Invites all levels of staff to focus groups on the effectiveness of the hospital environment, including information systems and staffing. d. Asks the board to provide a summary of major opportunities for the future.

To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must: a. Be able to effectively communicate with patients. b. Build relationships with physicians. c. Be able to adapt to daily changes in staffing. d. Adapt in communicating information to her supervisor.

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

Which of the following exemplifies accountability? Karen, the nurse manager on 5E: a. Consistently submits her budgets on time. b. Gets along well with her staff and with other managers. c. Outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury. d. Actively solicits ideas regarding scheduling from her staff.

You are the nurse manager of a nursing service organization that provides around-the-clock care to clients in their homes. To achieve maximum reimbursement for a client who is recovering from a hip replacement, the nursing staff most likely will follow the nursing care guidelines presented in the: a. Nursing care plan. b. Physician's orders. c. Critical pathway. d. Clinical practice guidelines.

You document your patient's vital signs into a bedside documentation device and are able to compare your patient's vital signs with patients who have similar diagnoses and similar medications, and who are of a similar age. You are accessing: a. E-mail. b. Telecommunications. c. A database. d. Technology.

Your institution has identified a recent rise in postsurgical infection rates. As part of your QI analysis, you are interested in determining how your infection rates compare with those of institutions of similar size and patient demographics. This is known as: a. Quality assurance. b. Sentinel data. c. Benchmarking. d. Statistical analysis.

A community-based pain management program is being planned for your region. As a coordinator of a home care agency, you have been requested to develop a conceptual framework, mission statement, philosophy, and objectives for the program. In what order will you pursue this endeavor? a. Objectives, philosophy, and mission statement b. Philosophy, objectives, and mission statement c. Philosophy, mission statement, and objectives d. Mission statement, philosophy, and objectives

A key advantage that a nurse manager has in terms of delegating is that: a. Clients receive less attention because too many staff make it difficult to coordinate care. b. Nurses report less pressure to perform necessary tasks themselves. c. Administration can predict overtime more accurately. d. Team skills can be used more effectively.

A necessary, basic condition for successful integration of clinical information systems is: a. Software. b. Standard medical nomenclature. c. Confirmatory evidence from nursing-led studies. d. Strong interdisciplinary cultures.

A nurse manager in the ICU works with his staff to develop an appraisal instrument that includes quantitative data and respects standards for an RN working on that unit. This type of appraisal is a: a. Rating scale. b. Collaboratively based appraisal system. c. Narrative instrument. d. Behaviorally anchored rating scale.

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.

A patient complains to you that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." This nursing care delivery model employed in this situation might be particularly effective in: a. Promoting communication among diverse team members. b. Facilitating multiple perspectives on the total care of a patient. c. Avoiding patient-provider conflict. d. Developing competence and confidence in unskilled workers.

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

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.

After a year, the staff at Pacific Hospital is frustrated, and implementation of evidence-based practice has gone poorly. In responding to this situation, the strategic planning team at Pacific Hospital: a. Recommends that the mission, objectives, and goals of the hospital be reassessed. b. Revises the goal statements in the strategic plan. c. Consults an external team on preparation of materials on evidence-based practice. d. Holds focus groups with staff to determine what kinds of issues, challenges, and obstacles have occurred in implementation.

After an extensive campaign to ensure that the community surrounding Pacific Hospital has been exposed to the emphasis of excellence in clinical care that occurs through the use of evidence, the marketing team finds that the public perception has changed little. This determination is made possible through: a. Marketing surveys. b. Focus groups. c. Informal feedback. d. Comparison of data against benchmarks.

As a nurse manager, one challenge is to orient new staff to your agency's policies and procedures, as well as to provide training across various shifts. A cost-effective and effective learning strategy would be: a. Development of new learning modules and software to support document retrieval. b. E-mail distribution to staff home e-mail addresses regarding important policies. c. Preparation of DVDs that can be viewed on computers at the nursing station during "down times." d. Linking policies and procedures to the network for access when required at the point-of-care.

As a nurse manager, you know that the satisfaction of patients is critical in making QI decisions. You propose to circulate a questionnaire to discharged patients, asking about their experiences on your unit. Your supervisor cautions you to also consider other sources of data for decisions because: a. The return rate on patient questionnaires is frequently low. b. Patients are rarely reliable sources about their own hospital experiences. c. Hospital experiences are frequently obscured by pain, analgesics, and other factors affecting awareness. d. Patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff.

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

As part of an information technology implementation team, you are implementing a clinical decision support system. Particular considerations for successful implementation of this project include: a. Ensuring that the system is reliable. b. Ensuring that patient information is reliable. c. Developing unique identifiers for individuals. d. Developing rules that support inferences.

As part of orientation to your unit, you decide to administer Kolb's Learning Style Inventory (LSI) to new staff. The most likely reason for your decision is that the use of Kolb's LSI: a. Reduces the cost of orientation. b. Determines if there is fit between learner and organizational values. c. Develops the strengths of the new staff member. d. Enables individualization of learning to the learner's needs.

As the head nurse involved in leading determination of which patient surveillance systems to acquire for your unit, one of your aims is to avoid adverse events through the implementation of appropriate technology. This particular aim recognizes that: a. Human error is significant in contributing to adverse events. b. Documentation of patient data is often illegible and therefore, misinterpreted. c. Data systems provide backup documentation with adverse events that staff cannot provide. d. Physiologic monitoring systems enable detection of early changes before an adverse event occurs.

At Hospital Ajax, there has been a 20% increase in instruments and sponges being left in patients during surgery and surgeries on the wrong limbs. These are known as: a. Sentinel events. b. Medically sensitive events. c. Nurse-sensitive events. d. Never events.

Benchmarks in the strategic marketing planning process are useful in: a. Establishing programs. b. Setting targets. c. Rewarding employees. d. Measuring progress.

Complex care of acutely ill patients is required on a surgical unit, which utilizes differentiated nursing practice as its model of care delivery. The concept of differentiated nursing practice is based on: a. Licensure status. b. Experience in the agency. c. Leadership capabilities. d. Education and expertise.

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.

In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager's main responsibility is the needs of the: a. Department. b. Unit. c. Staff. d. Patient.

In delegating to a UNP in a home health setting, which of the following represents the most appropriate delegation communication? a. "You will be taking care of Mrs. S., who needs assistance with her bath." b. "You will need to help Mrs. S. get into and out of her shower. Ensure that you check the condition of her feet, and let me know if you have any concerns when you check in." c. "I am not sure that you know how to do this, but I am giving you Mrs. S. She is quite obese and needs skin care." d. "Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness."

In implementing the strategic plan for effective utilization of evidence to guide nursing practice at Pacific Hospital, the nursing unit managers take the next step, which is the implementation. Implementation most likely would involve: a. Revisiting the mission statement and objectives. b. Reevaluating external and internal factors affecting evidence-based practice. c. Preparing a budget to support implementation. d. Developing unit-based objectives related to the plan.

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.

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

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

John notes that the next section is specific to the organizational philosophy and has a four-point ordinal scale that describes performance from "always meets expectations" to "does not meet expectations." This type of evaluation is most commonly known as: a. A behavior-anchored rating scale. b. Management by objectives/learning goals. c. The forced distribution scale. d. A graphic rating scale.

Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and as a result, a suit is launched in which both Sarah (the delegator) and Leslie (the delegatee) are named. Sarah is named in the suit because she: a. Retains accountability for the care of the patient. b. Worked the same shift as Leslie. c. Has passive accountability for delegation. d. Retains accountability for the outcomes of care for the patient.

Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She is assigned David, a patient who has been admitted with a severe head injury. In communicating with Sally, you would: a. Provide a detailed explanation of what she needs to do with ICP monitoring. b. Tell her when she needs to provide an update about David's status. c. Ask her to tell you what she knows about ICP monitoring and share expectations about reporting. d. Advise her that you are available if she needs you.

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

The chief nursing officer reviews the policy about "progressive discipline process." The progressive discipline process includes which of the following? The manager: a. Is 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.

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.

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

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

The final section of a performance appraisal is a rating scale. This scale is very detailed and relates to competency standards specific to surgical clients. The scale is a summary of performance directly observed or documentation reviewed and is specific to client care situations in which the employee has been involved. This type of evaluation is most commonly known as: a. A traditional rating scale. b. Management by objectives/learning goals. c. A forced distribution scale. d. A behaviorally anchored rating scale.

The night nurse understands that certain factors need to be considered before delegating tasks to others. These factors include the: a. Complexity of the task and the age of the delegatee. b. Potential for benefit and the complexity of the task. c. Potential for benefit and the number of staff. d. Complexity of the task and the potential for harm.

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

The nurse case manager is working with a client admitted for end-stage renal disease. The case manager's major goal during this hospitalization is to: a. Implement the care pathway on admission. b. Provide direct nursing care throughout the hospitalization. c. Supervise the nursing staff members who implement the care map. d. Prevent additional hospitalizations resulting from complications of the client's disease.

The nurse gives an inaccurate dose of medication to a patient. After assessment of the patient, the nurse completes an incident report. The nurse notifies the nursing supervisor of the medication error and calls the physician to report the occurrence. The nurse who administered the inaccurate medication understands that: a. The error will result in suspension. b. An incident report is optional for an event that does not result in injury. c. The error will be documented in her personnel file. d. Risk management programs are not designed to assign blame.

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.

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

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."

The nursing manager of a surgical unit has been asked by administration to evaluate client outcomes post cardiac catheterization. Using data about client outcomes post cardiac catheterization for the past 6 months so as to modify practice is an example of: a. Information. b. Cost-effective care. c. Meeting standards. d. Evidence-based practice.

The turnover rate for RNs in the ICU is high. You discuss this situation with existing staff and you find out that because of the rapid turnover, new staff are frequently required to assume full responsibilities soon into the position and before training is completed. In considering approaches that will reduce turnover rates, the staff and you decide to implement: a. An employee recognition program. b. Coaching for new staff. c. A new performance appraisal system. d. A committed orientation and training program.

When comparing functional nursing and primary nursing, a nurse manager, after evaluating particular models of nursing care for potential adoption, determines that patient and nurse satisfaction in primary nursing are: a. Similar to those in functional nursing. b. Not of significance in either model. c. Low by comparison with functional nursing. d. High when compared with functional nursing.

When hiring a case manager for a rehabilitation setting, you would most likely consider a: a. Registered nurse with a master's degree. b. Physiotherapist with a background in stroke rehabilitation. c. Social worker with a background in counseling. d. Health professional with advanced background who is client and outcome focused.

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

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.

Which of the following represents a well-written objective? a. Hospital-acquired infections are reduced, and procedures to reduce infections are implemented. b. To increase staff satisfaction and to decrease burnout c. To increase the health of the community d. To implement evidence-based practice on nursing units, as evidenced by adoption of evidence-based processes, by June 1, 2015

You are a member of a team assigned to care for 15 general medical/surgical clients. You have all worked well together in the past in this same type of care. If you are assigned to coordinate this team's work, your best strategy, based on the Hersey and Blanchard model, would be to: a. Have a list of tasks to be accomplished and tell each member of the team what he or she must do. b. Encourage people to discuss their frustrations in providing this care. c. Ignore them—they've done it before. d. Provide minimal direction and let them come to you with questions.

As a nurse manager, you want to institute point-of-care devices on your unit. The rationale that you provide to support the point-of-care devices includes (select all that apply): a. Reduction in incidents of medication error. b. Immediate documentation of care. c. Comparison of patient data with previous data. d. Immediate access to staffing schedules.

a, b, c

Sarah, one of your RNs, tells you that she can't understand why Jim, an Aboriginal patient, wants to do a smudge. Sarah's response is based on her: a. Cultural marginality. b. Circle of familiarity. c. Cultural understanding. d. Acculturation.

As a nurse manager, you have to be effective in managing a culturally diverse staff. Which of the following nurse manager attributes would assist you in addressing the cultural needs of your staff (select all that apply)? a. Stereotyping of others b. Respecting others c. Understanding the importance of language d. Encouragement of potential in all staff e. Age bias f. Disrespect for others

b, c, d

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? (Select all that apply.) a. Employee morale is at a high level. b. Care will suffer and standards will be lowered. c. Existing staff have experienced little effect from the absenteeism. d. Replacement staff usually needs little supervision. e. Unit costs have increased because of staff replacements and overtime.

b, e

Which of the following might best conclude an interview? a. "Thank you for your interest. Someone will be in touch with you soon." b. "Before you go, we will make sure that we have your contact information. Thank you for coming." c. "I will be in contact with all candidates by telephone by next Friday. It has been a pleasure to meet you." d. "We have several excellent candidates so I am not sure about the outcome of the interview, but I will let you know. Thank you for coming."

A method commonly used in Quality Assurance to monitor adherence to established standards is: a. A Pareto chart. b. Brainstorming. c. Patient interviews. d. Chart audit.

You are working in a home health service and have three unlicensed nursing personnel (UNPs) assigned to your team. You have worked with two of them for 2 years; the third is new. The two experienced UNPs have patients with complex illnesses for whom they provide basic care. The third member of the team has been assigned to patients with less complex illnesses. Your best approach to supervising their care is to: a. Remain in the office and ask each UNP to check in with you upon arrival at their first patient care site. b. Ask another RN to supervise the two experienced assistants so you can be with the new person full time. c. Meet the new staff member at the first patient care site and ask the others to call if anything is unusual. d. Meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual.

You have hired a new RN to replace a well-respected and experienced nurse in your outpatient department. The new RN recently graduated and is nervous about stepping into a role that was previously filled by someone who was so competent. You recognize anxiety and set up regular, frequent meetings during which you explore how she is dealing with her anxiety, provide feedback, and discuss strategies/ideas that will enhance her performance. What development approach are you using? a. Performance appraisal. b. Counseling. c. Empowerment. d. Coaching.

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.

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