LEADERSHIP
Regardless of which delivery system or combination of delivery systems is appropriate, which skill is required for effective use?
1. Flexibility
The hospital chief operating officer holds monthly focus groups with the purpose of gaining ideas and insights from nursing administration and staff nurses. Which type of communication does this indicate?
3. Diagonal communication
The nurse manager is reviewing the current staff to determine who should precept a newly licensed nurse. Which nurse is the most logical choice?
A nurse who is clinically competent and has the desire to assume the responsibility to train new staff
What is the best strategy the nurse manager can use to help retain nursing staff?
Closely review applicant's previous job history for length of commitment
The nurse plans to seek employment in an acute-care setting after graduation. Which form of communication would be most effective in applying for a position?
2. Send a written letter and resume in the mail
17. A staff nurse states, "I really enjoyed having dinner with the Chief of Medical Staff and the President of the hospital. We hope to meet again soon." Which source of power does this nurse possess? A. Expert B. Legitimate C. Connection D. Reward
ANS: C Correct: Connection power results from knowing or associating with power people such as the upper administration.
Which statements by a nurse in the emergency department are examples of groupthink? (SELECT ALL THAT APPLY)
1. We've already talked about this enough. we need to present a united front on this issue 2. The medical unit nurses wont like this decision because it is too much work 3. Let's all vote yes on this so we can get back to work
A nursing executive is comparing the entire hospital financials for the month and notes that the medical laboratory's revenue is higher than environmental services. What is a possible explanation? A. The laboratory has increased charges for its services. B. Environmental services is a non-revenue-producing cost center. C. The laboratory is a non-revenue-producing cost center. D. The nursing units affect the laboratory charges.
Environmental services is a non-renvue producing cost center
The director of quality improvement reports that the hospital will soon be using "dashboards" as part of the quality management process. How should the staff interpret this information?
2. This electronic tool makes it easy to aggregate and display data.
A nurse is working in a unit with several less-experienced nurses. Which attribute displayed by the senior nurse would make her leadership of the less-experienced nurses most effective?
4. Ability to inspire the others to commit to the team's goals
The nurse has established a reputation for advocating for clients through honesty and hard work. The nurse has worked in the organization for 30 years and often volunteers in local and national political campaigns. This nurse is using which attribute to increase political effectiveness?
1. Image
What action is necessary by a delegate accepting delegation?
3. Clarify the time line and expectations
A nurse recruiter is developing a handout to take to nursing schools in hopes of recruiting graduating seniors. The salary for a newly hired nurse is $18.15 per hour with a shift differential of 20 percent for working the 7pm to 7 am shift. The salary for those who would like to work this shift would be $____ per hour?
$21.78
The finance department of the hospital has distributed information for the next budget cycle that includes a projected 0.19 inflation factor in the cost of water. If the hospital spent $285,000 on water last year, the projected cost of water for this year would be $_____
$339,150
Which part of Six Sigma is vastly different from other quality management programs?
3. Failure is tolerated.
A group of nurses has been convened to solve a problem. As the first step in this process, the group leader asks for a definition of the problem to be solved. Which statement reflects the best problem statement?
4. Unit clerks have made 10 transcription errors in the last 6 months
A new nurse has conducted a series of interviews, but did not use an interview guide. Why would the manager's director by dismayed that no interview guide was used?
A list of standardized questions allows for reliability in comparing candidates
The nursing administration has instituted a horizontal promotion system within the nursing department. What benefit is this program to the staff nurse?
It rewards the nurse's clinical excellence
During an interview for night shift ICU position, the manager asks the job candidate, "will working the night shift interfere with your husband's schedule?" How should the candidate interpret this question?
It is an illegal question to ask
the unit has open shifts after staff members have signed up for overtime. The CNO does not want to hire agency nurses to cover these shifts. The nurse manager does not understand why the CNO is offering staff an incentive versus hiring agency nurses. Which would be a reasonable cconclusion?
Agency nurses are costly
An emergency department manager has an interview scheduled for 8 this morning. The manager's usual hours are 8 am to 4 pm. This manager has been working as staff due to an increased volume of clients. What action should the manager take to prepare for this interview?
Arrive to work early in the morning to prepare for the interview
It has been reported to the nurse manager that an employee is repeatedly parking in the patient/visitor parking area. What action should the manager take? A. Confront the employee. B. Check the parking lot each morning. C. Discuss the issue at the next employee appraisal. D. Provide an education session for all staff regarding parking policy.
Confront the employee
The RN leader of a team overhears one of the UAPs on the team say, "I'll sure be glad when I get my RN license. All they do is sit around doing paperwork." How does the RN interpret this comment?
2. As a common disadvantage of the team approach to nursing
The nurse manager is challenged to find an innovative way to adequately staff the unit and provide quality nursing care. Which ability would be most useful to the nurse in this situation?
1. Creativity
The nurse cared for Senator Bill Smith while he was hospitalized last year. The nurse now wishes to send him a letter supporting a bill that will be voted on in the current legislative session. Which salutation should the nurse use in the letter?
1. Dear Senator:
A nurse hears screaming from a client's room. A male visitor leaves the client's room. Which is the nurse's priority action? 1. Call the police. 2. Notify the client's physician. 3. Follow the visitor. 4. Check on the client.
4. Check on the client
The nurse manager is concerned about a family member's complaint regarding the professional behavior of a nurse on the unit. Which is the most effective method to address this issue?
4. Discuss the complaint with the individual nurse face to face
One main difference between an ideal leader and an organization-focused manager is that an: A. Ideal leader maintains the status quo B. Organization-focused manager is creative C. Ideal leader is a risk-taker D. Organization focused manager is a visionary
Ans: C Intellectual Stimulation
A nursing assistant tells a nurse, "I am going to have to call in sick tomorrow because I don't have a babysitter." How should the nurse respond to this information? A. The assistant's sick time is earned and should be used in any way the assistant wishes. B. The assistant should use personal time, not sick time for this situation. C. The assistant's absence will not be a major problem for the unit as long as only one day is missed. D. It will be okay for the assistant to miss a day because it will help another assistant get overtime wages.
The assistant should use personal time, not sick time for this situation
The nurse has received a commendable progress evaluation and will receive a 3 percent merit raise. The base salary for an RN is $48,000. Based on this information, the new projected base salary for this RN will be ____________________
$49,440
An organization has adopted the peer review process of evaluation. The manager shares which information with staff?
Begin to work on a portfolio, If you are a member of a peer review committees, you will submit a written evaluation to me, this change has occurred as a result of our move to self-governance
A human resources manager knows which method of recruitment is most likely to productive and inexpensive?
Employee referral
The nurse manager needs to delegate specific tasks to the charge nurse of the unit. Which action is an appropriate use of delegation?
. Having the charge nurse lead a nursing quality assurance task force
A staff nurse says, "I have so much to do. Why should I spend time being politically aware and active?" Which response by the nurse manager would be most appropriate?
1. "Being politically active helps you influence events and the decisions of others."
Why would the strategic planning committee choose shared visioning as a strategy for change?
1. Shared visioning makes change easier.
The chairperson of the nursing faculty leads the monthly meetings of the curriculum committee. This permanent group, which is designed to meet organizational goals, is which type of group? 1. Competing group 2. Command group 3. Task force 4. Informal group
2. Command group Rationale 2: The purpose of a command group is to accomplish tasks in an organization, and these groups are recognized as legitimate organizational entities.
A nurse asks an unlicensed assistant to help with discharging clients since so many are going home at one time. The nurse states, "Can you help get these clients ready to go home by helping them pack?" Which option best describes the statement with regard to effective delegation?
2. Delegation would have been effective has the nurse been more specific about which clients and when it should be completed
Which statement regarding the use of electronic medical records (EMR) is accurate as associated with quality improvement?
2. Much more research must be done before the impact of EMR on quality can be determined.
Which statement reflects a characteristic common to all methods of quality management?
2. None of the methods are designed to place blame on an individual.
Which statement reflects the most important use of power in nursing?
2. The nurse can use power to impact and improve client care.
The nurse has a concern regarding the quality of care being provided in the hospital. What should the nurse consider first before communicating this concern?
2. The relationship between the nurse and the receiver of the message
In a leadership training class, which statement by a student indicates learning has been successful?
3. "Relationship building is essential to successful leadership."
The nursing faculty would like to incorporate problem-based learning into the curriculum. Which action is essential?
3. Add more information to existing care plans as the study unfolds
Which nursing care delivery situation best reflects the concept of a clinical microsystem?
3. An inpatient burn unit
A manager is following up on an employee's injuries. The manager has contacted HR to initiate the process of worker's compensation. Which action would be appropriate by the manager? 1. Contact the employee's physician and inform him or her of the injuries. 2. Follow up with human resources regarding scheduling staff to cover the employee's absences. 3. Follow up with the employee to express concern and answer any questions regarding the situation. 4. Follow up with the worker's compensation nurse.
3. Follow up with the employee to express concern and answer any questions regarding this situation
The nursing group has been charged with the task of solving a patient care problem on the units. Which step should this group take first in this process?
3. Gather information to define the problem
Which is the most important reason that practicing and mastering effective delegation skills is essential for nurses?
3. Higher client satisfaction
Which statement by the formal leader of a nursing unit reflects the personality required to energize the staff and promote creativity? (SELECT ALL THAT APPLY)
3. I would like to thank everyone for your hard work and dedication while we have been short staffed 4. I am certain that our assignment system is going to make the workload more equitable 5. I know this week has been rough. I feel a little like sandpaper myself
A nurse says, "at last I feel like I am beginning to harvest some of the benefits of my career. I love sharing what I have learned with the new generation of nurses." Someone hearing his statement would interpret it to mean the nurse has likely practiced for at least _____ years
30
The leader of the task force group announces that tentative plans for Nurses' Week activities have been approved by the hospital administration. The task force has also been given a new task of developing criteria for the nursing awards. What must the group accomplish now? 1. Forming 2. Adjourning 3. Rebuilding 4. Re-forming
4. Re-forming Rationale 4: In the re-forming stage, the group must refocus its activities and recycle through the four stages. The leader explains the new direction and provides guidance in the process
Which action is most likely to undermine the political power of a nursing department?
4. The nurse executive does more talking than listening in meetings.
In which situation would a "meeting before the meeting" be advisable? 1. The nurse is managing a standing committee on the unit. 2. The nurse is meeting with a social group to establish a plan for weight loss by walking. 3. The nurse has written information to distribute to members before the meeting. 4. The nurse expects the disagreement that started in the last meeting to carry over into this meeting.
4. The nurse expects the disagreement that started in the last meeting to carry over into this meeting. Rationale 4: If there was dissension in the last meeting that may affect this meeting, a meeting before the meeting may be necessary.
Which situation is an example of the overall goal of quality management in today's health care activities?
4. The nurse wipes up a spilled drink before clients are allowed to enter a room.
An ICU unit has experienced an influx of aggressive behaviors by visitors against nurses. The ICU manager has instituted a policy to limit visiting hours. An employee asks the manager why the change in visiting hours has been implemented. Which response is likely the most accurate? 1. "The unit has been so busy, I must allow for the nurses to have time to provide client care." 2. "The visitor hours have not been adjusted in years. It was time to change them." 3. "The physicians have requested limited visiting hours." 4. "The visiting hours allowed for added stress and commotion to the nursing staff."
4. The visiting hours allowed for added stress and commotion to the nursing staff
The nurse manager is determining the day's nursing care hours by analyzing the client workload. The unit census is 30 and there is a total of 220 nursing care hours. The average nursing hours per client per day figured to the nearest hundredth decimal point
7.33
The hospital is conducting a drill of its emergency operations plan. A nurse is acting as a triage officer. Which client would be triaged for immediate care?
A client with a minor forearm laceration that will require a simple bandage and a tetanus immunization
The nurse manager is concerned about the apparent lack of staff motivation to improve client care on a unit. How should this manager use motivational theories to help improve this situation?
Combine theories to develop a plan for this specific unit
which information is an example of what should be included in the position desccription for the RNs who will staff a newly opened hospital unit? Select all that apply.
Communication changes in client condition to appropriate staff, reports directly to the nurse manager of the unit, must maintain ACLS certification
As part of the disaster plan, the nurse executive is planning an education session on the core competencies for nurses established by the National Emergency Preparedness Education Coalition. Which topics should be included in the handout being written for this session?
Communication, Technical skills
A female nurse has an interview for a new job scheduled next week. What should the nurse plan to wear to this interview?
Dark pants and gray jacket Simple jewelry
The nurse manager identified that the census was higher than anticipated and the client acuity level was also high; however, there were fewer nursing hours paid. This variance is an example of which budgetary variance? A. Efficiency B. Nonsalary expenditure C. Rate D. Volume
Efficiency
A nurse manager wished to use a model of job performance to help match employees and tasks to achieve the greatest effectiveness. What should the manager do first?
Establish, in writing, the expectations of each task
A certified nurse's aide (CNA) has been reported to the nurse manager for refusing to perform hand hygiene between clients when providing morning care. Which statement by the nurse manager would be the most effective? A. "Do you need a class on hand hygiene?" B. "Forgetting to perform hand hygiene between clients can spread infection." C. "Why do you refuse to perform hand hygiene?" D. "If I hear of any more instances of you not performing hand hygiene, I will write you up."
Forgetting to perform hand hygiene between clients can spread infection
The hospital has elected to use the demand management staffing system instead of the patient classification system. Because of this decision, the nurse manager who is staffing must focus on which of the following?
Historical date of expected client outcomes
The manager senses that a nurse is very anxious at the beginning of the performance interview. How should the manager proceed?
I Have looked back over all of my notes and interactions with you to prepare for our interview
A nurse manager lists several preferences for hiring employees. The human resources manager would advise this manager that which practices do not meet the bona fide occupational qualification regulation
I like to hire all female nurses to work in labor and delivery and postpartum, I hire only strong young men as transport workers, I prefer to hire nurses who have served in the military, I prefer to hire women as unit clerks
A nurse manager believes that a staff nurse is rude to clients. In the past year, other nurses and staff from other departments have reported that the nurse has treated them rudely. The manager reviews the staff nurse's employee file and finds last year's appraisal as exceptional. What is the manager's best course of action during this year's evaluation?
Include documentation of these issues in the evaluation that is discussed with the nurse and provide a plan of action
A nurse who has worked in the dialysis unit for the past 5 years is considering a career change. The nurse is unsure whether to follow a management or a clinical career path. Which would be a good beginning step for this nurse?
Investigate careers by talking with nurses in those positions
A nurse manager is investigating the application principles of equity theory to rewarding staff. Which options are rewards that the manager could influence?
Job satisfaction, Prestige
A nurse manager gives a staff nurse an exceptional appraisal. The other nurses learn of the appraisal and are upset because this nurse has had numerous complaints from peers regarding laziness. The manager informs a colleague the nurse obtained an exceptional appraisal because the nurse will always work for me when I need extra help to come in. This is an example of which problem in evaluating?
Leniency error
The nursing faculty member requires that last semester nursing students create a resume. One student submits a resume that includes education, past employment, and accomplishments. Which additional information will the faculty member recommend the student include in this resume?
Long-term career goals
An employee has called in to report being unable to come to work due to care trouble. This is the third time this has happened in the last 2 weeks. The manager should question which variable in this employee's attendance?
Motivation
There is substantial unrest among the staff of an intensive care unit that has resulted in negative client outcomes. Which employee factors should the manager assess first?
Motivation and ability to be effective on the job
Which group determines the level of nursing care and hours necessary to meet the needs of the hospitalized client?
Nurse managers
A nurse manager is discussing the hospital's changes to peer evaluation with nursing staff. Which comment by a staff nurse would the manager interpret as evidence of understanding this process?
Our evaluations will be more objective
The OB manager is looking at staffing for night shift. The post partum unit is busy and the labor-delivery unit has four clients in labor. The manager collects data from the nursing staff regarding the acuity of their clients. These data assist the manager in determining the staff for the next shift. This is an example of which type of system?
Patient classification
A hospital administrator has attended a conference on bullying and wishes to address the most likely bullies in the organization. Whom would the administrator invite to the first meeting about bullying behaviors?
Physicians, Managers, Senior manager
The nurse manager has identified physical assessment skills lacking in a new registered nurse. Using goal-setting theory, which statement by the manager would be the most effective in enhancing the nurse's assessment skills?
Plan to study one body system a week and demonstrate you assessment skills to me every week
Hospital administration is working with a university school of nursing to establish a nursing residency program. Why is this a desired action?
The Institute of Medicine has proposed residency programs for nurses. The IOM has made this proposal.
A director has performed an annual appraisal of the ICU manager, which reflects several issues in regard to the manager's attitude. At the end of the interview the manager expresses disagreement with the appraisal. The director instructs the manager to sign the appraisal and ends the interview. The manager reports this situation to the human resources director for which reason?
The appraisal could be interpreted as discriminatory
A manager has conducted a nurse's evaluation, focusing a large portion of the appraisal on the nurse's personality. The nurse does not agree with the appraisal and contacts the human resources director. What is the soundest basis on which to dispute the appraisal?
The appraisal is not valid
Computerized charting will be initiated on select units of the hospital. Orientation to this new system will be provided to each nurse by a team of nurses educated in nursing informatics. This is an example of which type of change strategy?
The assumption of the empirical-rational model is that people are rational and will follow their rational self-interest if that self-interest is made clear to them.
The hospital is hiring several new nurses for an expanded OB unit. The manager explains to the current staff that due to a shortage of nurses, salary compression is occurring. How should the current nurses interpret this statement?
The new nurses' starting salaries will be close to what the current nurses are making
The nursing staff of a medical-surgical unit would like to work four 10 hour shifts each week. For which reason would the unit nurse manager probably deny this request?
This staffing pattern would not be cost-efficient
The nurse manager is creating the budget for the next fiscal year. Because the client census has been higher in the past year, more supplies were used. Which type of cost does this reflect? A. Fixed costs B. Variable costs C. Direct costs D. Zero-based costs
Variable costs
A nurse is frequently absent on Fridays. The nurse phones and reports as sick, but the manager discovers that the absences are due to child care issues. How should the manager document this on the critical incident form?
Voluntary absence on multiple Fridays due to child care issues
The nurse manager of a critical care unite creates the operating budget with the knowledge that minimum of two professional nurses must be paid per shift regardless of the patient census. What group determines this standard? A. Hospital administration B. Nursing administration of the hospital C. The Joint Commission D. Nursing personnel of the special care units
hospital administration
According to the behavioral view of leadership, how are leaders formed? Select all that apply.
1. By being educated 3. With training 4. Through life experiences
What is the most important reason that excellent communication skills are essential for nurses?
2. All nursing activities occur in relationships
The nurse manager makes an error that results in the unit being $20,000 short on operating budget for the fiscal year. When asked about the error, the nurse takes full responsibility This statement reflects which component of emotional intelligence?
2. Transparency
A tornado destroyed 65% of the businesses and homes in a small Midwestern city. Aid would be requested based on categorization as level ____ disaster
3
Which situation is an example of reverse delegation?
3. The licensed practical nurse asks the nurse manager to administer insulin to her client
After the second week of orientation the nurse witnesses the death of a child in the ED. Which role should this nurse's preceptor focus on at this time?
Counseling the new nurse
A hospital successfully implemented its disaster plan to manage providing care during a massive 3 day snow storm. What is the most likely way additional costs for this service will be paid?
The hospital will absorb the additional costs
A manager has documentation to suspect substance abuse by a nurse. The manager meets with the human resources director to determine which course of action should be taken to abide by the organization's policies. This statement by the HR director is appropriate?
We should meet with the nurse and offer access to the employee assistance program
A CNO has received numerous complaints by staff regarding their manager. The staff describes behaviors such as not granting requested days off, favoring other staff members, and allowing lateral violence in the department. Which statement by the CNO to the manager would specifically describe a lack of civility?
Your behavior is rude and disrespectful towards your staff
Which statement would be inappropriate for a manager to write on an employee's performance appraisal?
the nurse is shy and quiet
a nurse has been asked to teach newly hired nurses how to operate some client care equipment that the unit has just received. the nurse says i'd love to do this, but someone else will need to take my clients today. how should the manager respond?
you will need to work the education into your day as you take care of clients
Which situations would cause concern about liability with regard to delegation? (SELECT ALL THAT APPLY)
1. The nurse asks the LPN to change a central line dressing 2. The nursing supervisor asks the nurse for details about a client's history 4. The supervisor asks the change nurse to give a nurse a difficult assignment
Which event would likely improve a nurse's position power within an organization?
1. The nurse is promoted to nurse manager.
The nurse educator has recruited nursing preceptors to work with senior nursing students. The educator is teaching the preceptors about power and the education process. Which statement by a preceptor indicates learning has been effective?
2. "I can use power to teach the student how to motivate, communicate, and achieve outcomes."
As part of a career advancement strategy, the nurse has identified a need to increase personal power in the organization. Which abilities should the nurse focus on improving? Select all that apply.
2. Technical competence and knowledge 3. Ability to access data 4. Relationships with people who are influential in the organization 5. Being friendly, helpful, and likable
A successful nurse manager is mentoring a newly promoted nurse manager. Which comment by the mentor reflects the most important consideration of all nurse managers?
3. "Your most important role is to ensure client care accountability."
Which statement explains why nurses must be leaders to be successful in client care?
4. "To direct client care activities and get the outcomes you desire, you need good leadership skills."
Which factor best represents a driving force in the process of change?
A budget in the red necessitates change and pushes participants in the desired direction.
Which employee is eligible for leave under the Family and Medical Leave Act ?
A female employee who has worked for a large metropolitan hospital full time for 1 year and requests 3 months' leave to care for her dying mother
A nurse is suspected of abusing narcotics. A thorough investigation has been performed, and the nurse will now be notified of the suspicion and investigation. How should this notification be handled?
A nurse should be approached at work with no prior notice and asked to come to the nurse executive's office
4. An explosion just occurred at the local factory, and hundreds of employees have sustained varying degrees of injury. Which type of nursing leadership is most effective in this situation? a.Autocratic b.Democratic c.Laissez-faire d.Referent
ANS: A Correct: The dynamics of the situation demand that the leader take control and direct employees to specific actions in response to the emergency.
5. An RN with excellent assessment and psychomotor skills would derive power on the basis of which source? A. Rewards B. Coercion C. Expert D. Legitimate
ANS: C Correct: Seven primary sources of power are known. Expert power is based on knowledge, skills, and information.
A nurse has always been interested in the legal nurse field. What would be the best program in which to lean about this field?
An accredited program by a legal nurse association
Which question is considered appropriate to ask during an interview?
Do you speak any language in addition to English
The staff nurse has challenged the appraisal rating given by a new nurse manager. What should the nurse manager do?
Investigate the staff nurse's challenge and change the rating if it justified
An emergency department has been notified that hundreds of injuries have occurred following the collapse of bleachers at a football game. The emergency department nurses should prepare to make which types of assessments?
Physical, Mental, situational, family
A new graduate nurse is preparing for an interview by the nurse recruiter. The applicant should be ready to be asked questions about which topic?
Willingness to work all shifts
What characteristics would cause the manager to classify an employee as marginal?
the employee's work does not improve with coaching, the employee just made an error for which discipline has already been done twice
A nurse has interviewed with the nurse manager for a position and is very interested in obtaining it. After the interview, what would be an appropriate action to take?
Send a post-interview thank you letter the following day.
A newly hired certified nurse's aide (CNA) has been 15 minutes late returning from mealtime 4 days this week. The nurse manager coaches the employee and finds the CNA thought meal breaks were 45 minutes. What is the most appropriate response from the nurse manager? A. Document the tardy behavior in the CNA's record. B. Show the CNA the break hours in the employee handbook. C. Warn the CNA tardiness is not tolerated and follow up in 2 weeks. D. Warn the CNA that the charge nurse will be timing future meal breaks.
Show the CNA the break hours in the employee handbook
The chief nurse officer (CNO) is planning the budget for the coming year. A new position has been added to the nursing administration cost center. The CNO is determining how many benefit hours should be allocated for this new position. Which days should the CNO include in this calculation? A. Sick days B. Weekend days C. Vacation days D. Holidays E. Bereavement days
Sick days; Vacation days; Holidays; Bereavement days A, C, D, E
A nurse who has worked on a unit for 8 years has just accepted a position as a nurse practitioner at an indigent clinic. How should the nurse handle leaving the current position?
Tell the manager as soon as the decision is made
A newly promoted nurse manager is overwhelmed by the amount of paperwork that must be submitted to the director. The nursing unit is very busy and short staffed, so the manager also takes a client assignment. This additional work makes the paperwork load even more daunting. Which statement is the most important lesson this manager to learn?
The job requires the nurse to adjust, respond to change and remain flexible
A nurse says I don't see what all the fuss is about bullying. Every new nurse has to go through it. It is just a part of the history of nursing. How should the manager respond?
The joint commission does not tolerate disruptive or abusive behavior, The American nurses association does not approve of bullying behaviors, new nurses bring new ideas - why would you bully them
A nurse has been in practice for 14 years and has worked in three different departments in the hospital. The nurse is a member of a professional organization and is considering running for an office next year. According to Shirey, this nurse is in which career phase?
The momentum phase
A nurse has been discovered using drugs on the units. Investigation reveals the nurse has likely been diverting and abusing narcotics for some time. What is likely the worst outcome for this nurse?
The nurse is terminated with no report made
The nurse manager knows that maximum power will be needed to achieve a desired change and has identified a key person on the organizational chart who will be affected by the change. What is important for the nurse manager to do?
The people just above and just below this person will be important to the way this key player reacts to the change.
The nurse manager tells a newly licensed nurse that having a mentor is a benefit to career development. What should the new nurse expect from a mentor- protégé relationship?
The relationship will develop through stages
On two recent occasions, the experienced nurse manager has found it nearly impossible to discuss upcoming events with all the staff on the unit. What is a common reason for this problem?
The unit has just adopted combined staffing patterns
What is the primary reason a nurse manager would confront a nurse who has been reported for violating infection control policy? A. To punish the guilty B. To protect the institution from liability C. To set an example for other employees D. To encourage the correct behavior
To encourage the correct behavior
A nurse who has been abusing narcotics is in the nurse executive's office discussing the charges. The nurse executive is trying to convince the nurse to seek treatment for the abuse. Which statement should the nurse executive make?
Treatment is your best chance at returning to practice
True or False Two nurses have agreed to share a schedule in which each will work 4 hours each day for a total of 20 hours a week. In 2 weeks, FTEs will be generated by these nurses.
True
The nurse manager is reviewing the previous month's budget and notes a favorable efficiency variance of the full-time equivalents (FTEs). Which options may be reasons for this favorable variance? Select all that apply. A. Greater client acuity B. Extravagant use of resources C. Understaffing the unit D. Low client acuity E. Use of agency nurses to supplement staff
Understaffing the unit; Low client acutiy C, D
The night nurse on the pediatric unit has resigned. The night staff is pleased, because this nurse constantly complained about workload and alienated most staff members. What consequences may result from the loss of this nurse?
Use of agency nurses, Opportunity for overtime, Increase in enthusiasm, Unit performance improves
A nurse manager has had issues with a marginal employee. Staff members have complained several times to the manager regarding this employee's competence. Which action by the manager would be appropriate?
Use progressive discipline to manage the employee
A medical unit nurse manager is conducting an interview of potential employee. Which strategy should the manager use?
Use work sample questions to determine knowledge
A nurse manager has provided education to emergency department nurses regarding disaster management. Which statement would the manager interpret as indicating understanding of this education?
We should treat as many clients as possible as quickly as possible
The nurse executive and the human resources manager of a hospital meet to discuss the recent increase in nursing turnover. Which statement reflects the best source of information about this increase ?
What are the reasons given in the survey mailed out 6 weeks after resignation?
The human resources director is planning on attending a career fair and has asked the director of nursing to attend as well. The nursing director replies, I really dont have time to attend, do you really need a nurse to go with you? Which response by the HR director is most appropriate?
Your attendance is necessary to answer specific nursing questions
Which step should be taken first when recruiting and selecting nursing staff?
become familiar with the position description for the jobs available
In order to delegate, which must be present? (SELECT ALL THAT APPLY)
1. Accountability for the assignment on the part of the delegate 2. Accountability for the assignment on the part of the delegator 3. Authority by the delegator to assign the task to the delegate 5. Authority of the delegate to accomplish the task as assigned
As part of the process of promoting quality improvement, the nursing manager is comparing data between two hospitals on average length of stay for a total hip replacement. This comparison is an example of which process or step?
1. Benchmarking
Which is the most important consideration in choosing a structure for nursing care?
1. Client need
One of the nurses often fails to attend educational offerings available to the staff. The nurse manager who implies the nurse may receive a negative evaluation is using which type of power?
1. Coercive power
As the RN team leader, identify potential disadvantages of using team nursing to deliver care to assigned clients. Select all that apply.
1. Continuity of care may suffer. 2. Client/staff communication may be an issue. 4. Delegation is necessary.
The day shift nurses and night shift nurses are in clear opposition regarding the responsibilities that each shift should be assigned. This opposition has created a "we-they" distinction on the unit. This is an example of which phenomenon? 1. Distancing 2. Suppression 3. Group withdrawal 4. Unification
1. Distancing
During the first staff meeting, a newly promoted nurse manager says, "I would like a commitment from all the nurses to review and improve the way delegation is done on the unit." Why would the manager be interested in delegation? (SELECT ALL THAT APPLY)
1. Effective delegation allows the manager to focus more time on management tasks 2. Efficiency is increased by effective delegation 3. If the manager has more time to focus on managerial duties , there is no more chance of career advancement 5. The manager is interested in developing the entire staff to its maximum potential
A nursing supervisor has introduced a needed change in policy to the nurse managers. The managers have met maximum resistance when attempting to gain support for the change. Which options reflect valid strategies for the nurse managers?
1. Meet with the supervisor and discuss modification of the proposed change. 2. Slow down the change process. 4. Work together to identify strategies to overcome resistance. 5. Proceed with the change.
Which is the most effective method of creating a blame-free environment?
1. Work to develop a just culture within the organization.
Which statement indicates understanding of how a nurse could improve personal decision-making skills?
2. I should practice making decisions by developing potential solutions and then choosing one
The leader of a continuous quality improvement (CQI) team has asked that an information packet be distributed to members of the resource group. The secretary would prepare packets for which people? Select all that apply.
2. The hospital CEO 3. The vice president in charge of finance
Which situation indicates the nurse needs additional training on effective delegation?
2. The office nurse calls in orders for admission on a client following a surgical complication
The nurse manager has instituted a policy of sending information to the staff via e-mail. Many misunderstandings have occurred since this policy was implemented. What technique should the manager use to reduce this miscommunication?
3. Being certain that emails go only to the intended recipients
Which situation represents an obstacle to delegation?
3. There is a budget shortfall for the current fiscal year
The mother of a staff nurse is critically ill and the nurse must miss several shifts of work. If the leadership style of the nursing manager is transactional, which approach to covering these shifts is most likely?
4. "If you work overtime tonight I will authorize double your hourly pay rate."
A nurse manager has received the following email from the finance department: " You unit's budget for travel is $1,500 for the fiscal year. The units actual expenditures have been $2,120. The unit is over budget by _____
41
The unit employs 35 FTEs based on an 8 hour shift. The average benefits for these FTEs are 12 vacation days, 10 holidays, 6 sick days, and 4 personal days. Based on these figures, the FTE required per employee to replace benefit time is ______ FTE. Round to nearest hundredth FTE
0.12
A small creek has flooded, requiring the rescue of one person from a stranded automobile. Electrical service was interrupted for a short period and traffic will be diverted around flooded roads for a period of several hours. Local law enforcement and fire departments have been well equipped to manage the disaster. The newspaper should report that the town suffered a level ____ disaster.
1
12. Which action represents the key management function of strategic planning? A. Determining that all nurses on the unit understand the current organizational philosophy B. Evaluating the communication process between the pharmacy and the nursing departments C. Monitoring data from the quality management initiative related to the last three orientation programs D. Developing a 5-year plan that will incorporate the clinical nurse leader as a part of all nursing units
ANS: D Correct: A strategic plan is a written document that details organizational goals, allocates resources, assigns responsibilities, and determines time frames. The strategic plan generally looks 3 to 5 years into the future.
14. A clinical nurse leader (CNL) enters the workforce and hopes to use her interdisciplinary skills to participate on a quality improvement committee. The coordinator of the quality group invites the CNL to join the group. Which type of power is demonstrated by the coordinator of the group? A. Coercive B. Transformational C. Laissez-fair D. Legitimate
ANS: D Correct: The coordinator of the committee has an official position within the organizational committee.
An ICU manager is discussing a nurse's frequent absences and tardiness, which the nurse explains results from unreliable child care. The nurse states, None of the other nurses mind if I am late or have to miss a shift. My kids are important to me. I'd do the same for any of them. This is an example of which situation?
Absence culture
The nursing supervisor identifies ineffective communication as a problem among the managers. According to Lippitt's phases of change, which action by the supervisor reflects the final stage of improving this issue?
According to Lippitt's phases of change, the final stage is terminating the helping relationship.
A nurse manager is aware that U.S. citizenship is required by a job position being filled. How should the manager handle this requirement during the job interview?
Ask the applicant if he or she is a U.S. citizen
A disaster planning task force has been asked to focus on communication. Which instruction should this group provide to nursing staff?
Be certain to maintain the client tracking system
An organization has not updated its sick day policy in the last 5 years and has experienced an increase in employee days off for illness over the last year. Which change to the sick leave policy might have a positive effect on the organization's absenteeism?
Change the policy to award personal use days rather than sick days
The medical-surgical unit's census has decreased since the previous shift. The manager is reviewing the staffing grid. Which factor is used to determine staffing mix?
Client care needs
Which factors increase the stress associated with interpersonal relationships in health care? Select all that apply. 1. Longer length of stay for clients 2. Few assistive personnel 3. Job redesign 4. New technology 5. Unrealistic expectations of other disciplines
Correct Answer: 3, 4, 5 Rationale 1: A shorter length of stay for clients is more likely to increase staff stress. Rationale 2: Having to supervise assistive personnel is very stressful. Rationale 3: Trying to do more with less is very stressful. Rationale 4: New technology can be very stressful during the learning curve. Rationale 5: Unrealistic expectations from anyone can increase the nurses stress.
A hospital is experiencing a high nursing turnover rate. One manager suggests offering sign-on bonuses to fill positions. Why would the nurse executive veto this suggestion?
Current nurses can be discourages by this program, Sign-on bonuses do not recognize achievement and loyalty
Several months ago, the nurse accepted a management position in the neurological care unit. The nurse has been very challenged and stressed and is unsure the position change was the correct choice. That should the nurse do now?
Discuss the matter with the director of the unit
A newly hired nurse manager is being mentored in this new role. How should the mentor advise this manager regarding staffing for the next shift?
First you must because familiar with the classification system we use
A nurse knows that both experiences and plan are important when building a resume. Which attributes are the most important for the plan part of this endeavor?
Flexibility Long-term
The hospital's new management company has assigned a "leadership coach" to groups of current nurse managers. Which statements made by a manager would the coach interpret as indicating the manager does not value this opportunity? A. "Why do I need a coach?" B. "I've been a manager longer than our coach has been a nurse." C. "I'm getting burned out with the way we manage." D. "Another new program to waste our time." E. "Coaching has helped my nurses improve their practice."
I've been a manager longer than our coach has been a nurse, Another new program to waste our time B, D
An organization has elected to use a behavior-oriented self-evaluation system for nurses. Which statement would be included on the evaluation form?
Maintain confidentiality of information, Demonstrate care, respect, and compassion in all interactions, works well on multidisciplinary teams
A nurse who is a chronic complainer comes back from lunch 20 minutes late. When confronted by the manager the nurse says, The nurses who smoke always take longer lunches, no one say anything to them What is the manager's major consideration before replying to this statement?
Policies must be consistently applied to all employees
A group member has failed to complete assigned tasks for three of the last four meetings, despite reminders that incomplete work slows down the entire team. At each meeting the noncompliant member promises to complete tasks for the next meeting. What group actions are likely to occur? Select all that apply. 1. The remaining group members may begin to use manipulation to get the tasks done. 2. The other group members may attack the noncompliant member. 3. Other group members will quietly complete the noncompliant member's work. 4. The remainder of the group will ignore the noncompliant member. 5. The group members will extend patience and understanding to the noncompliant member.
1,2,4 Rationale 1: If rational argument does not work, group members may resort to manipulation of the deviant member. Rationale 2: When lack of compliance increases or slows the remainder of the group, attacks are likely to occur. Rationale 4: This ignoring behavior is a final step of frustration with the noncompliant member.
A nurse manager is using Homans's framework to evaluate the need for team building in a group appointed to work on accreditation issues. Which strategies should the manager use as part of this evaluation? Select all that apply. 1. Observe group member behaviors during a meeting. 2. Listen to how group members interact with one another. 3. Compare the group to a similar group from the last accreditation cycle. 4. Review the group's final report. 5. Ask a team member how the work of the group is proceeding.
1,2,5 Rationale 1: Activities are an essential component of a group system that should be evaluated. Rationale 2: Interaction is an essential component of a group system that should be evaluated. Rationale 5: Team member attitudes are one of the three elements of Homans's framework.
Which activities are expected from the nurse manager as team leader? Select all that apply. 1. Offering constructive criticism 2. Settling all employee conflicts 3. Encouraging group discussions 4. Facilitate group processes 5. Foster team dependence
1,3,4 Rationale 1: The nurse manager is expected to evaluate the outcomes of the team and to offer constructive criticism about needed improvement. Rationale 3: The nurse manager encourages group discussion. Rationale 4: The leader's influence on group processes may be the determining factor in whether or not the group is effective
A staff nurse is the manager of a command group consisting of other staff nurses, a nurse manager, a physician, and physical therapist. What line authority does the group manager hold? Select all that apply. 1. The group manager has line authority in relation to the group members individually. 2. The group manager has line authority in relation to the other nurses in the group, but not in relation to the other disciplines in the group. 3. The group manager has no line authority in this group. 4. The group manager has line authority in relation to all members of the group except the physician. 5. The group manager has line authority in relation to all member of the group collectively.
1,5 Rationale 1: The manager of a group has line authority within that group. The authority extends to individual members and to the members collectively. Rationale 5: The group manager has line authority in relation to the group members as a group.
The nurse is working on a committee tasked with making a major organizational change. Which comments by the nurse would help to advance the work of this committee?
1. "Have we looked at all available data in order to make an informed decision?" 2. "What are the obstacles to implementing this change within the organization?" 3. "Are we including the opinions of all stakeholders in this decision?"
A nurse manager is faced with the task of introducing an unpopular change to a staff that includes several nurses who have acted as rejecters to previous changes. The manager expects resistance but hopes to identify these rejecters early in the process. The manager should be particularly alert to which statements?
1. "I don't care what they say; I'm not giving care that way." 2. "I bet I can make it very difficult for this change to occur."
A nursing administrator overhears nurses conversing during a break in a seminar on change. The administrator would interpret which statement as meaning that the nurse who made it is ready to become a change agent?
1. "I know that suggesting this change may backfire on me." 3. "I see an opportunity to make a difference in the way this facility provides nursing care." 5. "This change is certainly going to be a challenge, but that's okay."
The nurse has been asked to assume a first-level management role on the nursing unit. Which statement indicates that this nurse will need further mentoring in the new role?
1. "I won't be able to increase my team's motivation. That has to come from within them."
The nurse is assigned to the Risk Management Team. Which events would be addressed by this team? Select all that apply.
1. A client's hand is injured during an arterial blood gas draw. 3. A client leaves the hospital against medical advice (AMA).
Which statement describes the primary difference between group and individual decision making, besides the number of individuals involved? (SELECT ALL THAT APPLY)
1. A decision made by a group is often better than a decision made by one person 3. Groups can provide more input into the process 4. A decision made by a group can create a greater obligation to achieve results 5. Routine decisions are more often made by individuals
Which situation represents an exception to the blame-free environment? Select all that apply.
1. A nurse routinely changes nursing notes after a client is discharged. 4. A nurse does not complete an incident report after a medication error.
Which situations are examples of ineffective delegation? (SELECT ALL THAT APPLY)
1. After delegating committee attendance to a staff nurse, the nurse manager also attends the meetings 2. The unit clerks asks the nurse manager to listen for the phones so the clerk can go to the hospital's celebration of hospital week 4. The staff nurse asks the UAP to provide simple discharge instructions to a client 5. The staff nurse often bathes clients because I like to give bed baths
A disagreement has arisen between two staff nurses. Both have discussed the situation with the manager. The manager feels that that problem is likely self-solving. How should the manager approach this situation? (SELECT ALL THAT APPLY)
1. Allow some time to pass to see if the situation resolves 2. Support both nurses as they work through this issue 3. Provide any resources the nurses may need to help solve the problem 4. Intervene if the problem begins to impact client care
The nurse is using critical thinking skills to decide which of several options is the best. Which question is most important for the nurse to take into consideration?
1. Are there different situational effects or contexts to be considered
The nurse manager is working on a committee whose task is to review and revise job descriptions for nursing employees. In which job description would the committee most likely include the phrase "Management responsibilities include shift-by-shift coordination and promotion of quality client care"?
1. Charge nurse
In the morning care conference, the nurse instructs the assistant to feed breakfast to the clients in beds 2234, 2230, and 2241. The assistant indicates understanding of the assignment and repeats the bed numbers back to the nurse. What is the nurse's next step?
1. Check with the assistant to see how the assignment is going during the time breakfast is served
The medical residents on a particular unit do not answer pages very quickly, and sometimes do not answer them at all. The nursing staff complains to the nursing supervisor. After several weeks, this conflict has spiraled into a heated disagreement. Which is the most important reason to make the necessary changes to settle this conflict? 1. Client care and satisfaction will suffer should it be allowed to continue. 2. The residents cannot be allowed to continue such unprofessional behavior. 3. Residents who do not answer pages do not get the most out of the experience. 4. Physicians do not know what is going on with clients if the residents do not tell them
1. Client care and satisfaction will suffer should it be allowed to continue
A nurse manager states, "I cannot stand all these conflicts in my department. Nothing good can come out of it." Which indicates the best reason the manager's statement is untrue? 1. Conflict can stimulate more people to become involved in a situation, thus creating more innovative solutions to the issue. 2. When people are in conflict, they tend to work harder just to avoid the conflicting situation. 3. Groups in conflict spur competition, which is always beneficial to the units from which the groups emerged. 4. When there is conflict in an organization, people are more open to discussion, thus conflict can open the lines of communication.
1. Conflict can stimulate more people to become involved in a situation, thus creating more innovative solutions to the issue
The nurse manager assesses that two staff nurses are engaged in a conflict that is having a negative impact on client care. The manager meets with the nurses involved and identifies the conflict. An attempt is made to resolve the conflict through knowledge and reason. What strategy is this manager using? 1. Confrontation 2. Resolution 3. Negotiation 4. Forcing
1. Confrontation
The nurse manager is listening to new nurses discussing nurses as managers and overhears one state, "I don't care how long I am a nurse; I will never be a manager." In which ways do nurses manage regardless of their official role? Select all that apply.
1. Deciding on priorities 2. Being a liaison 3. Coordination of client care 5. Delegation responsibilities
Which strategy is best for the newly licensed nurse who wishes to develop power in the organization?
1. Develop a "can do" attitude and reputation.
The health care facility has elected to make a significant change in organization strategy. The change has been thoroughly researched and all levels of leadership have been included in the decision. Which roles are commonly undertaken by the nurse manager when such a change is necessary?
1. Disciplinarian 2. Fact manager 3. Liaison 4. Support person 5. Discussion leader
A long-term-care facility is considering implementing total patient care. Prior to implementing this system, what must be available?
1. Enough RN staff to provide all the care to the residents
How can a nurse best influence policies in an organization?
1. Follow the nursing process.
A health care organization has provided intensive education to staff regarding benefits and correct methods of delegation. Why has the organization spent the time and money to sponsor these sessions? (SELECT ALL THAT APPLY)
1. Good delegation helps to reduce overtime 2. Absences decrease when delegation is used correctly 4. Patient satisfaction scores increase when care is efficient and effective 5. Good delegation increases productivity
The person who has just been promoted to nurse manager is male. If this nurse communicates in a way that is considered typical for men, what can the staff expect?
1. He will focus more on the issue than on personal experience
Which directions given by the nurse to the assistant are most likely to be understood and completed correctly? (SELECT ALL THAT APPLY)
1. Here are your directions for this morning. Please give the clients in rooms 2156, 2158 and 2159 total bed baths 2. Go to the diet kitchen and get a cup of apple juice for the client in room 2112
What should the nurse executive consider when planning the nursing care delivery system of a new hospital? Select all that apply.
1. How to optimize use of nursing knowledge 3. How to ensure that clients receive optimal care 4. Skill sets likely to be present in the nurses who will be employed at the hospital 5. What groups of nurses are available for employment
Which is the most important factor in whether a conflict will be perceived or felt between two nurses? 1. How well the nurses know and trust each other 2. If the nurses are on the same job level 3. The congruence of the nurse's values and beliefs 4. Whether or not the nurses perform the same roles
1. How well the nurses know and trust each other
A nurse manager approaches the nursing supervisor with a request for approval to incorporate 12-hour shifts into scheduling. The supervisor denies the request, stating this staffing pattern was used previously with poor outcomes. Which responses by the nurse manager may positively influence the supervisor? (SELECT ALL THAT APPLY)
1. I agree it was not effective years ago, but other units now have success with it 2. What were your specific concerns about the 12 hour shifts
Which statements exemplify the attributes of critical thinking essential to nurses? (SELECT ALL THAT APPLY)
1. I am always curious about why we do things the way we do 3. Can you help me understand your perspective a little better? 5. I don't think I can make that decision until I have more information
Part of the facility's performance evaluation is based on the nurse's strength in the three types of decisions. During a nurse manager's performance evaluation the supervisor says, "You are very good at adaptive decisions, but you need to be more precise in routine decisions. When the situation calls for really innovative decisions, you do not seem sure of yourself." How should the manager interpret this information? (SELECT ALL THAT APPLY)
1. I am not following the policies and rules well 2. I should review the procedures manual 3. I'm good at using my previous experiences to guide my decisions
A task force leader says, "At the beginning of our next meeting we are going to do some team-building exercises." Which comment by a group member indicates a need for further education about team building? 1. "I don't see anything wrong with the way our team works. Why do we have to go through team building?" 2. "That should help us meet the goals we have written." 3. "I did some team-building work a long time ago. I probably need a refresher." 4. "I hope the men on our task force will cooperate."
1. I don't see anything wrong with the way our team works. Why do we have to go through team building?" Rationale 1: Team-building exercises were originally used to improve interpersonal workplace relationships and this group member may still think of them in that vein.
The female nurse identifies that many of the power positions in her organization are held by male nurses. Which strategies should the nurse use to improve her image and increase her power? Select all that apply.
1. Identify what she really wants 3. Prioritize her needs in order of importance 4. Identify her current resources 5. Determine who stands in the way of what she wants
The staff nurse is unsure of the correct protocol for calling in sick to work. The nursing supervisor told the nurse to call the nursing office; however, the nurse manager told the nurse to call the unit. This issue is likely the result of which distorted communication?
1. Intersender conflict
The nurse manager asks the staff nurse to work a double shift because the census is high. Although the nurse realizes the staffing for the night shift is low, the nurse has already made a family commitment for the same night. This is an example of which concept? 1. Intrapersonal conflict 2. Interpersonal conflict 3. Intragroup conflict 4. Intergroup conflict
1. Intrapersonal conflict
In which ways can nurse managers reduce risks for the organization? Select all that apply.
1. Investigating a complaint about nursing care from a client's spouse 3. Talking to physicians about ways to improve client care 4. Keeping staff members on task throughout the workday 5. Making sure staff members work minimal overtime
A nurse enters a client's room and sees a visitor threatening the client. The nurse questions the visitor in a nonthreatening manner. The visitor begins to threaten the nurse. What should the nurse do in this situation? 1. Keep a safe distance from the visitor. 2. Yell for another nurse to assist with the visitor. 3. Leave the room. 4. Threaten the visitor with assault charges.
1. Keep a safe distance from the visitor
Which strategy could be used by nurses to promote nursing's power image?
1. Maintaining expertise by attending continuing education events 3. Encouraging all disciplines to work towards organizational goals 4. Attending local events with influential people 5. Asking questions about reasons behind processes and policies
During an evaluation conference, the nurse manager observes nonverbal messages, including nodding in agreement and smiling. These behaviors are examples of which aspect of communication?
1. Metacommunication
The staff nurses and nursing administration are attempting to construct a method of scheduling that meets the needs of both the clients and the nursing personnel. Because nurses and nursing administration have experienced conflict about the issue, their intent is to arrive at an agreeable solution between both parties. Which option does this process best exemplify? 1. Negotiation 2. Accommodation 3. Forcing 4. Consensus
1. Negotiation
A nurse manager is orienting newly hired staff nurses to the organization's total quality management program. As part of orientation, the manager has assigned the nurses to interview the organization's internal customers. Which group would the nurses interview? Select all that apply.
1. Newly hired radiology technicians 4. Nurses who have worked at the facility over 5 years
As part of a presentation on health care workplace violence, the speaker says injuries to nurses from violent acts in the work place are probably underreported. What rationale should the speaker offer for this statement? Select all that apply. 1. Nurses may not clearly understand what constitutes workplace violence. 2. Nurses may be unaware of how to report violent actions. 3. Nurses may feel that dealing with violence is an expected part of the job. 4. Nurses may believe that reporting a violent act will mark them as a weak employee. 5. Most violence against nurses is initiated by physicians, and nurses are afraid to report them.
1. Nurses may not clearly understand what constitutes workplace violence 2. Nurses may be unaware of how to report violent actions 3. Nurses may feel that dealing with violence is an unexpected part of the job 4. Nurses may believe that reporting a violent act will mark them as a weak employee
The nurse manager tells a newly hired nurse that the unit practices functional nursing. What should the new nurse expect? a. One nurse has responsibility for all the medications on the unit. b. One nurse has responsibility for all the needs of three patients. c. Once charge nurse and one respiratory therapist have responsibility for all patients. d. One nurse and one nursing assistant have responsibility for ten patients.
1. One nurse has responsibility for all the medications on the unit.
Which topic would likely appear on the agenda for a staff meeting chaired by a nurse manager who follows transactional leadership theory? Select all that apply.
1. Progress on request to increase personal day benefits 2. Review of policy and procedure for unit evacuation 3. The value of teamwork 5. Standardized first of shift assessments
A nurse manager is committed to establishing an environment that supports critical thinking and creativity. What strategies would help in this effort? (SELECT ALL THAT APPLY)
1. Provide opportunities for staff to interact with nurses from outside the facility 2. Give the nurses freedom to design their work environment 5. Be receptive to ideas even if they seem seem strange at the beginning
The nurse manager consistently refocuses the staff on achieving outcomes and directly involves the staff in decision making to achieve those outcomes. How would this style of leadership be described?
1. Quantum
Two nurses are in the day room when a visitor approaches and starts yelling about the care his mother is receiving. One nurse says "I'm sorry you are upset, what can I do for you?" This visitor continues to complain more loudly. What should the other nurse do? Select all that apply. 1. Quietly direct other people out of the room. 2. Leave the room and call security. 3. Say, "Who are you?" 4. Move toward the visitor and say, "Keep your voice down." 5. Stay next to the other nurse.
1. Quietly direct other people out of the room, 2. Leave the room and call security
A highly intoxicated client is brought to the ED. Paramedics report that the client was violent during transport and tried to kick the door out of the ambulance. How should the nurse prepare before seeing this client? Select all that apply. 1. Remove any hemostats from the pocket. 2. Take off the stethoscope and place it in the pocket. 3. Ask the paramedics to place the client in leather restraints. 4. Enter the room calmly, with a smile. 5. Give the client 20 minutes or so to calm down before the assessment begins.
1. Remove any hemostats from the pocket 2. Take off the stethoscope and place it in the pocket 4. Enter the room calmly with a smile
An ICU nurse has just assisted the physician in placing a central line in a client. Over the past few days the client's son has become increasingly verbally abusive to nursing staff. The unit secretary tells the nurses that the son is at the nurse's station demanding to see the client. Which action by the nurse is most important? 1. Remove the central line tray from the room. 2. Inform the son regarding the client's condition. 3. Ignore the son as he enters the client's room. 4. Limit the son's visitation.
1. Remove the central line tray from the room
A nursing team consists of an RN, two LPNs, and two UAPs. Which work would be completed by the RN? Select all that apply.
1. Reviewing the client's plan of care with the UAPs 2. Discussing the client's increasing shortness of breath with the LPN 3. Updating the care plan of a client who will undergo surgery tomorrow 5. Calling the physician to discuss the client's response to a new treatment
The nursing unit has experienced high stress and a higher than normal turnover rate. The manager asks a longtime member of the nursing staff to analyze the manager's job performance. What is most likely the reason for this request? 1. The manager is questioning his or her leadership style and its effectiveness. 2. The manager is required to ask for input on his or her personal job evaluation. 3. The manager is attempting to show concern about unit conditions. 4. The manger is inquiring about other leadership styles the nurse has encountered.
1. The manager is questioning his or her leadership style and its effectiveness.
One of the nurse competencies of the synergy care delivery model is "moral agency." Which action is an example of that trait?
1. The nurse commits a medication error and reports it to the charge nurse.
Which situation requires an adaptive decision?
1. The nurse manager discovers that two clients require the use of a new piece of equipment and that the one the hospital has is the only one in the state
A nursing unit has just completed a 6-month trial of using team nursing to provide care. The overwhelming opinion of the staff is that the experiment was a disaster. What are the most common reasons team nursing is not successful? Select all that apply.
1. There are problems with delegation. 4. Communication on the team or with the nurse manager is flawed.
The supervisor of critical care services tells the unit manager, We must cut costs, so I am asking you to arrange your day so that you provide care to two or three clients and cover for lunch and rest breaks. Also dont forget that your budget estimates are due next week, as are your preliminary schedules for the winter holidays. Two days later, the nurse manager is stressed and exhausted. What should the manager do? Select all that apply. 1. Think through the roles being required. 2. Confront the supervisor and ask for clarification of status. 3. Try to improve work organization. 4. Tell the supervisor, I cant work this hard, Get someone else to be manager. 5. Call in sick for a day to rest.
1. Think through the roles being required. 2. Confront the supervisor and ask for clarification of status.
What is the primary belief behind the evolution of the clinical microsystem as a nursing care delivery system?
1. Those who deliver the nursing care make the most educated decisions for a particular unit.
The nurse manager has determined the need to hire two staff nurses. Which factor is most critical as the nurse manager prepares to submit the request to administration?
1. Timing of the request
A nursing committee has been organized to help plan a new intensive care service at the hospital. Which questions are essential for this committee to consider? Select all that apply.
1. Where will the service be housed? 3. When will the service begin? 4. Who will provide the services?
The nurse manager has determined that changes are necessary in the way holiday shifts are assigned. When assessing the political climate surrounding this potential change, the nurse manager would ask which questions?
1. Who is in control of the way holiday shifts are being assigned? 2. Who will lose when holiday shift assignments are changed? 3. Who is benefiting the most from the way holiday shifts are currently assigned?
The job description of the staff nurse states the nurse is responsible for attending hospital committee meetings as assigned. The nurse manager asking the staff member to attend a risk management meeting is an example of which concept?
1. Work assignment
An acute care nursing unit has determined that an acuity level III client requires 6 hours of nursing care per shift while a level IV client requires 8 hours. Today the unit has seven level III clients and nine level IV clients. The manager should staff for _____ hours of nursing care for the next shift?
114
A newly licensed nurse is considering a job offer at a hospital that offers a residency program. The nurse should expect to be in this program for up to ____ months
18
A nurse manager is focused on team building activities with a group chosen to write new unit policies. As a beginning step in this process, the manager should ask which questions to assess the group's context? SELECT ALL THAT APPLY 1. "How well has this group been able to relate to similar groups across the organization?" 2. "What are the group's current goals?" 3. "How have the members organized the group?" 4. "What is the general culture of the group?" 5. "How complex is the job the group has been assigned?"
2,3,4 Rationale 2: Goals are a part of the group context. Rationale 3: Organizational structure is part of the group's context. Rationale 4: It is important to assess the culture of the group, which is part of its context.
Which statements reveal that the nurse being described has real power? Select all that apply.
2. "I have such respect for her and the work she does." 3. "It is an honor to work with her." 4. "She had an opportunity to go to another hospital, but she chose to stay here and help us through accreditation."
Which situation would be included in reporting for Joint Commission mandatory national patient safety goals? Select all that apply.
2. A client is left waiting in the hallway because the transport person did not make contact with the client's nurse. 3. A nurse gives a medication by the wrong route. 4. A client developed sepsis after insertion of a urinary catheter. 5. Surgery is done on a client's right eye instead of the left eye.
The hospital has an annual campaign in which the staff is divided into two teams to raise money for hospital special events. The team raising the most money gets possession of a "trophy" designed by the administrative staff. This is an example of which type of conflict? 1. A conflict that is disruptive to the work of the hospital 2. A competitive conflict that is positive to the work environment 3. An intragroup conflict that is not appropriate in health care 4. A felt conflict that will result in unresolved feelings of frustration
2. A competitive conflict that is positive to the work environment
The health care organization's monthly newsletter has a headline reading "Nurse Promoted to Leader of Specialty Care Units." What is the error inherent in this headline?
2. A person cannot be promoted to the role of leader.
A nurse believes that milk is part of the healthy adult's diet. The nurse frequently offers milk to adults as a between-meal beverage. This action is based on which concept?
2. An underlying assumption
A client has been told that chemotherapy must be postponed until he is hydrated. The client refuses the intravenous hydration and demands to go home. How would the nurse best categorize this situation?
2. As a medical-legal incident
The nurse appears in the nursing station with multiple facial lacerations and says a visitor hit me. What is the manager's priority action? 1. Ask the nurse why the visitor became violent. 2. Ask a nurse to accompany the employee to the ED 3. Call security to report the incident. 4. Call administration and inform them of the incident.
2. Ask a nurse to accompany the employee to the ED
A nurse working in a rehabilitation center notices clients frequently asking for something to drink. Which response indicates the use of creativity in finding a solution to this problem?
2. Asking all employees to write down their ideas about a solution
The nurse is caring for a client who is aggressive, demanding and verbally abusive toward staff and visitors. The client says "I'm getting out of here, I am going to end it all." What immediate action should the nurse take? 1. Attempt to block the exit door. 2. Call security. 3. Attempt to administer a sedative to the client. 4. Notify the client's family.
2. Call security
A nurse manager is looking for evidence-based information regarding wound care. Which criteria should be used to evaluate the usefulness of an intervention? Select all that apply.
2. Can the manager find two or more research studies that support the use of the intervention? 5. Is the research study that recommends the intervention rigorous in design and execution?
A difference in opinion has arisen regarding methods to care for clients who are on mechanical ventilators. The nurse manager asks a group of nurses to meet and review evidence-based practice related to this client care situation. Each nurse volunteers to gather data prior to the next meeting. This is an example of which type of problem solving? 1. Negotiation 2. Collaboration 3. Compromise 4. Forcing
2. Collaboration
When a nurse enters the room, the client states "he has a gun" and points to a male visitor. The nurse does not see a gun. What should the nurse do? 1. Question the visitor regarding the statement. 2. Contact security. 3. Call for another nurse to assist in confronting the visitor. 4. Notify the client's physician.
2. Contact security
A nursing task force has been created to determine whether a new model of differentiated practice would be more effective than the current model. The task force analyzes data as a basis to examine alternatives. Which activity does this represent?
2. Critical thinking
An emergency department client is demanding pain medication and threatening to harm staff if they do not provide it. The ED physician calmly continues to ask the client about the level and location of pain as the nurse steps away and notifies security. What is the physician attempting to do by asking these questions? 1. Distract the client. 2. De-escalate the situation. 3. Determine the client's real reason for seeking treatment. 4. Assess the client's level of pain.
2. De-escalate the situation
The hospital's management team wishes to institute case management to improve the quality of nursing care. As a beginning step, the team is choosing specific medical diagnoses on which to focus. What criteria should the team use when choosing these diagnoses?
2. Diagnoses that carry high risk for the client and the provider
A serious disagreement has arisen between two staff nurses. The unit manager elects not to make a decision regarding the disagreement until more evidence is collected. Which part of the nursing process does this manager's critical thinking reflect?
2. Diagnosis
When the nurse manager orders supplies for the unit, which communication mode is best?
2. Email
A staff nurse tells the manager, "I don't want to be promoted. I am a much better follower than I am a leader." How should the manager interpret this remark?
2. Followership is a valuable skill in nurses.
A CNO is contacted by the organization's supervisor on a Saturday night regarding a problem in the hospital's emergency department. The supervisor describes an incident in which an orderly was assaulted. Why is the CNO not surprised about this report? 1. This is a typical occurrence in the emergency department. 2. Health care violence is more likely to occur in EDs 3. Health care violence generally occurs on the weekend. 4. Health care violence is likely to occur on the night shift.
2. Health care violence is more likely to occur in EDs
An ED has doubled its client visits within the past year. This has led to an increased wait time and overcrowding in the ED waiting room. Which recommendation by the ED nurse manager to the CNO would be the most effective? 1. Increase the size of the waiting room and add more beds to the ED unit. 2. Hire more ED nursing staff to manage the increased volume of clients. 3. Hire another ED physician. 4. Hire another registration employee to improve the intake process and reduce the volume in the waiting areas.
2. Hire more ED nursing staff to manage the increased volume of clients
Although the postoperative assessment of a client reveals no abnormalities, the nurse believes the client's condition is deteriorating and orders frequent vital signs. This intervention was made on the basis of which type of problem solving? (SELECT ALL THAT APPLY)
2. Intuition 4. Past experience
A conflict has arisen between two staff nurses who work on the same unit. Which strategy is most important for the nurse manager to consider? 1. Address the conflict in the break room. 2. Make a timely decision regarding if and when to intervene. 3. Accept full responsibility for developing a solution. 4. Redirect expressions of disagreement between the participants.
2. Make a timely decision regarding if and when to intervene
A nurse manager is delegating a new, complex task to the unit secretary. Which strategies should the manager use? (SELECT ALL THAT APPLY)
2. Make eye contact with the secretary when explaining the task 3. Talk to the secretary in person rather than by telephone or in email 5. Discuss the importance of the task to the organization
A nurse is overheard saying, "I just don't want to be involved in this power struggle. I don't want power; I just want to do my job." What is a common reason nurses may feel power is not desirable?
2. Many nurses view power as oppressive.
An ICU nurse manager noticed a competent nurse has become forgetful and has made medication errors in the past few months. This type of behavior is unusual for this nurse. What action should the manager take? 1. Issue a written warning to the nurse. 2. Meet individually with the nurse to discuss the behavior. 3. Ask other staff members if they have noticed the behavior. 4. Report the nurse to the human resources department.
2. Meet individually with the nurse to discuss the behavior. Rationale 1: It is premature to issue a written warning. Rationale 2: Meeting with the nurse will provide information. The nurse may be experiencing unusual stress at home, may be unaware of his or her behavior, or may have a medical condition. The first step should be to address and assess the situation. Rationale 3: It is not appropriate for the manager to involve other staff members. Rationale 4: It is premature to report the nurse to the human resources department.
The nurse manager assesses that there is conflict between two of the charge nurses. The decision is made to postpone an intervention and allow the conflict to escalate. Why might the nurse manager make this decision? 1. Allow sufficient time for the problem to spontaneously resolve. 2. Motivate the participants to seek resolution. 3. Give the nurse manager time to identify problem-solving strategies. 4. Relieve the nurse manager of the time commitment necessary to intervene.
2. Motivate the participants to seek resolution
Which nurse has legitimate leadership authority in the organization? Select all that apply.
2. Nurse manager 3. Case manager
A home health agency has a policy requiring nurses to make routine visits at night. How might politics be used to change this policy?
2. Obtain research material to provide reasons why routine nursing visits at night are not as effective as during the day.
The nurse manager gave the unit secretary complete responsibility for the unit's staffing, including finding replacements for call-ins and disciplining nurses with excessive call-ins. This is an example of which type of delegation?
2. Overdelegation
A problem has arisen on a unit whose nursing staff is composed primarily of members of Generation X. Which strategies should the nurse manager employ to get staff input into solving this problem? (SELECT ALL THAT APPLY)
2. Post a notice on the bulletin board explaining the issue 3. Ask nurses individually for input
In a group meeting, one of the members always arrives early and places the chairs in a circle so all members can interact. This person is responsible for confirming that the room is available for the monthly meetings. Which person does this describe? 1. Gatekeeper 2. Procedural technician 3. Coordinator 4. Initiator-contributor
2. Procedural technician Rationale 2: The role of the procedural technician is to support group activities by arranging the environment and providing necessary tools.
The nurse manager asks a nurse to become a charge nurse, but then frequently questions the nurse's daily decisions. This situation reflects which problem that will increase the nurses stress? 1. Reality shock 2. Role ambiguity 3. Role conflict 4. Burnout
2. Role ambiguity
The nurse manager asks staff members to work as a group in planning the activities for Nurses' Week. The nurse manager should report to the supervisor that which type of group has been formed? 1. Command group 2. Task group 3. Competing group 4. Informal group
2. Task group Rationale 2: The purpose of a task group is to deal with specific issues involving a specific need within a given time limit. Because this group is working on "Nurses' Week," the project is time limited.
A registered nurse will be the case manager of a group of ten clients. What will the nurse expect as part of this assignment? Select all that apply.
2. The nurse will meet with other disciplines to agree on the choice of critical pathways for each client. 3. The nurse will work to build consensus with the physicians caring for the clients on the team. 4. The nurse will define the expected nursing outcomes for the clients on the team. 5. The nurse will collect and analyze data regarding the clients on the team.
The nurse manager should be most careful not to hold preconceived beliefs when listening to which person? 2. A staff nurse the manager has worked with for 25 years
2. The staff nurse the manager has worked with for 25 years
A hospital increased its RN-to-client ratio 1 year ago. What effects is the hospital likely to see as a result of that choice? Select all that apply.
2. There has been a decrease in client deaths. 4. The overall quality of care has increased. 5. The nosocomial infection rate has dropped.
A newly licensed nurse working on a unit committee challenges every detail of a proposal the committee is developing. How should other committee members interpret this behavior?
2. This nurse is learning to be creative
The hospital organization has developed a philosophy based on the client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. In which quality management process are these characteristics typically seen?
2. Total quality management (TQM)
The nursing supervisor is planning an education session on collaborative communication between nurses and physicians. Which topics should be on this agenda? (SELECT ALL THAT APPLY)
2. Understanding the role of the physician 3. Understanding the role of the nurse 4. Communication across disciplines 5. Active listening skills
Which statement may reveal that the team member making the comment has a hidden agenda? 1. "I don't understand the second of the goals we are discussing." 2. "Are we voting on this outcome or has it already been decided?" 3. "I have to remember to add membership on the team to my resume." 4. "Are there other teams working on similar projects on other units in the hospital?"
3. "I have to remember to add membership on the team to my resume." Rationale 3: Concern over adding items to one's resume could indicate that the team member is more interested in personal achievement than in the goals of the team.
At a strategic planning meeting the nurse executive recommends instituting patient-centered care as a model of care delivery in the hospital. Which statement by the hospital CEO indicates understanding of this concept?
3. "I'm concerned about the increased time and leadership our nurse managers will have to provide."
A nurse manager has just posted the membership list for a newly formed quality management task force. Which statement, overheard by the manager, indicates the most potential for problems on the team? 1. "I'm glad I didn't get chosen for this task force. I'm so busy with my kids right now." 2. "I was on one of these teams at my last hospital." 3. "This is certainly an interesting choice of people to put together." 4. "She is such a good nurse; I hope she doesn't work herself too hard."
3. "This is certainly an interesting choice of people to put together." Rationale 3: This statement may reveal that members assigned to the team have problems working together. The manager should be watchful for any personality issues that might arise.
The nurse manager has completed a series of team-building exercises with a command group. Which statement by a group member indicates that cohesiveness is occurring? 1. "I think I understand the work of the group now." 2. "I have gotten to know my group members better during these exercises." 3. "We have so much work to do in this group." 4. "I like the members of the group."
3. "We have so much work to do in this group." Rationale 3: A "we" statement indicates that the group member feels like a part of a cohesive group.
Which statement reveals the most dangerous result of using measured standards as part of the CQI process?
3. A nurse manager says, "I'm not going to change this process, because I'd have to change the CQI monitors."
Which action would help the nurse work with public officials to influence policies? Select all that apply.
3. Address only one issue in each correspondence. 5. Always make an appointment before visiting an elected official.
A nurse manager notes that staff is struggling with caring for an increased client load while a new management system is being implemented. What managerial action would help reduce this stress? 1. Asking a nursing faculty friend to use the unit for a student clinical 2. Hiring two newly licensed nurses for each shift 3. Asking for nurse input into decisions that directly affect care 4. Instituting a method of shift rotation that increases staff on each shift
3. Asking for nurse input into decisions that directly affect care Rationale 1: Helping to manage and supervise students is stressful for many nurses. Rationale 2: Helping to orient newly licensed nurses is stressful for many nurses. Rationale 3: Involving staff in decision making is one way to identify and reduce stress. Rationale 4: Working rotating shifts is very stressful to many nurses.
A hospital has been acquired by a new management company. As part of this acquisition, several different types of equipment have been introduced into the client care area. How can the manager best plan to reduce the stress of using this equipment? 1. Have all the equipment put into service at one time so learning will be compressed. 2. Teach the nurses with the most seniority to use the equipment and let them teach the other nurses. 3. Be certain that all nurses attend training sessions on the use of all equipment. 4. Post written instructions in the break room on how to use the equipment.
3. Be certain that all nurses attend training sessions on the use of all equipment.
In order to organize services needed to achieve specific client outcomes, hospital administrators should consider what type of client care delivery system?
3. Case management
At the beginning of a brainstorming session, the manager lists the rules to be followed. Which rule should be included and enforced?
3. Do not critique any ideas presented
A newly licensed nurse is concerned about the legal aspects of delegation. What is the most important question for the nurse to consider prior to delegating a task?
3. Does this task involves nursing judgment?
The nurse is working on a unit with a blame-free environment and makes an error that puts a client at risk. What should the nurse do first?
3. Ensure the client's safety as fully as possible.
The nurse is always intimidated when asking a physician to clarify orders. Which statements should the nurse use to help counteract this feeling? (SELECT ALL THAT APPLY)
3. How often did you want the furosemide given? 5. Doctor, what rate did you want the IV?
Which statement made by the nurse manager is an example of the first step of delegation?
3. I am going to delegate the responsibility of creating the vacation schedule
Which example represents a qualifier that may interfere with the message to be communicated?
3. I hate to bother you with this, but we have a problem
A nurse manager is trying to manage a conflict between a staff nurse and a medical student. Which statement by the manager would the nursing supervisor interpret as following the rules of basic mediation? 1. "Both parties need to grow up. They are so immature." 2. "The problem is partially the fault of both parties." 3. "I stopped the conversation frequently to have the parties summarize what was being said." 4. "They just went on and on. I had to stop the discussion because I was out of time."
3. I stopped the conversation frequently to have the parties summarize what was being said
The RN working on an orthopedic unit is caring for a postoperative client with a hip replacement who is not transferring well from bed to chair. The client is behind on the mobility training program. What action is the nurse's priority?
3. Inform the case manager of variance in the critical pathway.
After several near-incidents during procedures, the nurse manager is increasingly concerned about how nursing staff communicates with physician staff. Which advice from the manager would be most beneficial to the nursing staff?
3. Lets review the steps of the procedures that we know are the biggest problem
The nurse asks the nurse manager if he can go home early because the census is low. When the request is denied, the nurse states, "I don't understand why I can't leave early. I will use vacation time and this will help minimize personnel costs for the shift." This statement is an example of which technique of influencing the supervisor?
3. Negative inquiry
Which data would be of most interest to an organization using Lean Six Sigma as a means of quality improvement?
3. Nursing overtime hours increased by 25 percent in the last quarter.
The group leader often arrives several minutes late to meetings with excuses about workload, telephone calls, or traffic. Today's meeting was scheduled to begin 5 minutes ago and the leader has not arrived. What should the group members do? 1. Call the leader's cell phone to see when arrival is expected. 2. Wait until the leader is 10 minutes late and then cancel the meeting. 3. One of the members should start the meeting. 4. Wait for the leader to arrive.
3. One of the members should start the meeting. Rationale 3: The work of the committee should not be delayed because the leader is late. One of the members should begin the meeting.
The nurse manager generally uses a stepwise method to arrive at decisions that are logical and that serve to maximize the achievement of the desired objective. Which decision-making model does this manager use?
3. Rationale decision-making model
An assistant nurse manager has relieved a staff nurse for lunch. After the nurse leaves, the assistant manager realizes there is a nursing administration meeting at noon. Which stress-producing event does this exemplify? 1. Poor leadership 2. Mismanagement of the unit 3. Role conflict 4. Miscommunication
3. Role conflict Rationale 1: The unit was managed effectively so staff could get to lunch, which reflects good management and leadership skills. Rationale 2: The unit was managed effectively so staff could get to lunch, which reflects good management and leadership skills. Rationale 3: Role conflict occurs when an individual has two competing roles. The assistant manager was caught between the role of being a helper to staff and attending the meeting. Rationale 4: There was no miscommunication.
A charge nurse has been trying to please all the nurses, physicians, clients, and staff of the unit. This has caused considerable stress for this nurse. After a few days off, the nurse decided to manage the role differently. What has occurred to the nurse over these days off? 1. Role conflict 2. Role definition 3. Role redefinition 4. Interrelated conflict
3. Role redefinition
The unit nurses take turns filling the charge nurse role. Which statement reveals risk for development of role conflict in these nurses? 1. I think I do a better job as charge nurse than the other nurses. 2. I like being charge nurse better than being a staff nurse. 3. Sometimes it is just faster to do things myself. 4. I have difficulty with understanding report from the previous shift.
3. Sometimes it is just faster to do things myself.
As part of a shared visioning initiative, a new medication administration system has been adopted. A staff nurse has been chosen to relay the unit's dislike of the system to the evaluation committee. Which would be the most effective method to communicate the unit's disapproval?
4. "There has been a 40 percent increase in medication errors on 3M since the new system began. We believe there is a problem."
The nurse manager orienting newly hired nurses has explained the organization's blame-free environment. Which remark by one of the nurses indicates understanding of the policy?
4. "When I make a mistake, I should report it and look for ways to prevent it from recurring."
A nursing supervisor is seeking staff input while developing policies regarding violence prevention. A staff nurse says "we have lots of threatening behavior on our unit." What is the most important question for the supervisor to ask? 1. "Why is so much threatening behavior happening on your unit?" 2. "Why haven't you reported that?" 3. "Where do you work?" 4. "When you report threats to your manager, is action taken quickly?"
4. "When you report threats to your manager, is action taken quickly?"
The nursing supervisor would like to delegate an information-gathering task. All the people listed have the ability to perform the task. In general, whom should the supervisor ask to do this work?
4. An unlicensed nursing assistant
A nurse says, "I am always worried that I will be liable if someone I delegate a task to does something that hurts the client." What is the manager's best response to this concern?
4. As long as you follow the five rights of delegation, your liability is minimal
The staff nurse would like to improve personal communication with peers, patients, and the medical staff. Which strategy would be most effective for this nurse?
4. Attend the hospital-based communication training
Which statement by the nurse managing a unit conflict indicates that the integrative decision-making strategy is being used? 1. "I've heard all I need to hear. I'll have a decision tomorrow." 2. "Once you have signed this informed consent, the issue will go to mediation." 3. "This will all blow over if everyone just tries to get along better." 4. "Both parties should come up with as many alternative solutions as possible before our next meeting."
4. Both parties should come up with as many alternative solutions as possible before our next meeting
The novice nurse manager is hesitant to delegate tasks to competent, experienced staff nurses. Fear of which factor is most likely to explain this hesitancy? 4. Competition and criticism
4. Compeition and criticism
To address the problem of increasing costs of staffing agencies, a hospital has developed a plan for an internal float pool of nurses to be used when scheduled staff nurses call in sick. What type of planning has the administrative staff done?
4. Contingency
The nurse and a client are discussing instructions for self-care after discharge. The client's husband says, "I can't take care of her by myself. We need home health like we had before she came to the hospital." This statement reflects which antecedent condition? 1. Task interdependence 2. Resource competition 3. Structural conflict 4. Differences in values and beliefs
4. Differences in values and beliefs
A staff nurse has experienced disagreements with one of the medical residents about several issues. The resident reacts to this conflict by belittling the nurse in front of colleagues. This behavior is most characteristic of which type of conflict? 1. Competitive 2. Role 3. Perceived 4. Disruptive
4. Disruptive
The nurse has been concentrating on improving personal communication skills. Which option represents the final step in this nurse's work to improve communication?
4. Ensure the communication is understood
This is the first meeting of a task force. What should be the leader's primary objective of this meeting? 1. Determining when the task force has to complete the assignment 2. Identifying the expected outcomes in terms of measurable objectives 3. Asking members if they have time to serve on the task force 4. Establishing a standard of total participation
4. Establishing a standard of total participation Rationale 4: During the first meeting a standard of total participation should be established.
During the first meeting of a newly created task force, the nurse manager notices that individuals tend to cluster with members of their specific nursing units. The nurse manager begins the meeting with an explanation of the focus of this group. These behaviors are characteristic of which stage of Homans's group process? 1. Norming 2. Storming 3. Performing 4. Forming
4. Forming Rationale 4: Forming occurs in the initial stage of the group process; the members are cautious in approaching each other as they come together as a group.
The nursing staff is continually upset about inability to provide clients with supplies needed because third-party payers will not reimburse for those items. This is an example of which conflict antecedent? 1. Task interdependencies 2. Distancing 3. Role 4. Incompatible goals
4. Incompatible goals
The nurse manager has scheduled a series of meetings with employees to solve a unit problem. The manager purposefully created a 2-week gap in the meetings to allow which portion of the creative process to occur?
4. Incubation
The nurse manager has decided that the only way to deal with an issue is to use coercive power. What strategy is important for this nurse manager to employ?
4. Investigate to get the facts of potential infractions before responding to them.
During an annual performance review, the staff nurse admits to being very stressed by the demands of the job, marriage, and four teenage children. Which comment by the nurse manager is indicated? 1. We need to figure out what you can give up in your personal life to help decrease your stress. 2. You need to be more flexible with the hours you work. 3. You should not let your personal problems affect your work. 4. Let's talk about how we can help you develop some resiliency.
4. Let's talk about how we can help you develop some resiliency.
An accreditation visitor observes the following situations in a health care organization. Which situation would this visitor interpret and document as evidence of the shared governance type of shared leadership?
4. Nurses formally organized to make decisions regarding practice standards
The ED staff has been caring for a client who exhibited violent behavior when pain medication was denied. Once the situation was resolved, which action by the ED manager would be appropriate? 1. Arrange an agreement with law enforcement for rapid response on these incidents. 2. Post a sign stating that pain management medications are not given unless the client is admitted to the hospital. 3. Develop a team of staff who would be on call for these types of situations. 4. Organize a training program to educate staff on how to manage these types of situations.
4. Organize a training program to educate staff on how to manage these types of situations
A newly licensed RN is beginning a job search. This nurse would be best served by working in an organization that provides which nursing care delivery system?
4. Practice partnerships
The nursing task force is developing measurable goals for each client on the orthopedic unit. The statement "Each client will have a written assessment and plan of care document within eight hours of admission" is an example of which component of quality management?
4. Process standard
A nurse who transferred from the medical-surgical unit completed orientation to the ICU 6 weeks ago, but is stressed and unsure of personal skill competency. The nurse manager learns of this lack of confidence. Which action by the manager would best benefit this nurse and the unit? 1. Reduce the nurses client assignment. 2. Transfer the nurse back to the medical-surgical unit. 3. Provide written instruction regarding the desired unit specific skills. 4. Provide additional weeks to orientation with a focus on skill development.
4. Provide additional weeks to orientation with a focus on skill development.
The nurse has set a goal of becoming a clinical nurse leader (CNL). What actions should this nurse plan to reach this goal?
4. Return to school to obtain a master's degree.
There is a shortage of nurses on weekends. The unit manager asks nurses to work every other weekend in return for an additional 8 hours of paid vacation per month. Which type of power is this manager using?
4. Reward power
The nurse manager is calculating the cost of offering two bonus incentives to nursing staff for covering call-ins for sickness. After reviewing the statistics, the manager finds that option A is more cost-effective than option B but decides to implement option B because it seems safer. Which option best describes the basis of this decision?
4. Subjective probability
The manager is watchful of compassion fatigue among the nursing staff of the emergency department. What is the best indicator to the manager that this disorder is occurring? 1. Nurses complain of being too tired to work. 2. Clients complain that nurses are not compassionate. 3. Physicians complain that the nurses are not taking good care of clients. 4. Symptoms much like severe burnout occur in the staff.
4. Symptoms much like severe burnout occur in the staff.
An inexperienced speaker is practicing the delivery of a speech. Which statement indicates a lack of understanding about how easily communication is distorted?
4. The topic is not complicated so I don't have to worry about misunderstanding
A community hospital has been purchased by a large health care conglomerate. Nursing administration has the task of changing the nursing practice model that has been followed for 50 years. To best achieve this change, administration should appoint a nurse executive whose leadership style follows which theory?
4. Transformational leadership
A nurse has decided to relocate to another state. Which entry on this nurse's resume will be most useful in searching for a new job?
6 years work experience as nurse manager in ICU
A nurse has agreed to work on the Baylor plan. The nurse should arrange day care for which shifts?
A 12 hour shift on Saturday, Shifts every weekend
The hospital has initiated a new fall risk assessment tool. The nurse manager would like to reward those staff members who use the tool regularly. Which methods of reinforcement would be most successful in getting long term compliance?
A coupon for a free lunch for staff members who, according to a medical record review of nursing documentation, consistently use the tool correctly
A unit requires a great deal of staffing flexibility. To fill this need, the manager should use which strategy?
A high RN-skill mix
The CNO notes that the nursing department has exceeded budget in salary expenses for the last 3 months and asks the hospital nurse managers why this occurred. Which would be a cause for increased salaries?
A higher turnover rate in nursing staff
The director of two nursing units is off on medical leave. The morale on these units has decreased over the past year. During the director's absence the CNO notices a marked increase in the staff's morale. This causes the CNO to be concerned about which factor on these two units?
A lack of authentic leadership
A nurse has joined the Sigma Theta Tau Organization. The nurse is hoping to find a mentor within the organization. Which person would be a good candidate?
A senior nurse who has the career experience that the nurse is interested in pursuing
A student who is about to graduate is discussing the future with a nursing instructor. The instructor asks the student, "what schedule are you interested in working? What organization is near your home?" The student says that salary is the most important thing. Which response by the instructor would be appropriate?
A small difference in salary is less important than working in an organization where you can obtain future goals
18. A nurse manager wants his nursing unit to be a place where all nurses want to work, where patient satisfaction is high, and care is innovative and interdisciplinary. Staff are encouraged to chair taskforces to improve quality of care and he counsels staff in areas of measuring patient outcomes. Other managers want to mimic this manager's approach to improve their own units. This nurse is which type of leader? A. Transformational B. Transactional C. Laissez-faire D. Authoritative
ANS: A Correct: Transformational leaders mentor followers through a vision and are admired and emulated.
20. A manager just finished the last annual performance review of the staff, reviews the unexpected expenditures for the month due to use of agency nurses, and shares the latest quality indicators with the staff nurses. This manager is performing which management function? A. Directing B. Planning C. Organizing D. Controlling
ANS: D Correct: Controlling is the final management function. It includes performance evaluations, financial activities, and tracking outcomes of care to ensure quality.
Coaching and discipline have failed and the nurse manager is faced with no alternative but to terminate an employee. Which aspect of this situation requires the most careful planning? A. When the termination will occur B. How to keep the human resources department informed C. Accurately documenting all stages of the situation D. Whether the termination will adversely affect unit staffing
Accurately documenting all stages of the situation
The medical-surgical unit is at capacity and the clients have a high acuity, requiring care such as turning, bathing, toileting, feeding. Which level of supplementary staff would be cost-effective?
Additional unlicensed assistive personnel
A nurse manager needs to supplement the staff for the next schedule. Which option would be the most significant drain on the unit's staffing budget?
Agency nurse
The nursing committee is planning a change in the unit's organization. Which statement reflects the priority expected outcome of these change agents' work?
All nursing responsibilities and changes have the expected outcome of improving client care.
A nurse with an associate degree in nursing is interested in obtaining more education but is unsure if it is wiser to obtain a baccalaureate degree in nursing or to pursue certification. The answers to which questions would assist the nurse in making a decision?
Am I interested in nursing management? Do I want to go to graduate school? What are my future options in my current position? Is either option available online?
A chief nurse officer is considering a collaborative effort with a school of nursing to offer externships to students. The Chief financial officer rejects the proposal because it will entail a cost to the organization. Which statement by the CNO would influence the CFO to reconsider this proposal?
An externship will allow the nursing students to work with nurses, learn about the organization, and create a positive impression of our facility
Ruiz (1997) defines the "four agreements" that leaders must make with themselves. They are as follows: A. Be impeccable with your word, take nothing personally, make no assumptions, and always do your best, no more and no less. B. Be impeccable with your actions, take nothing personally, make no assumptions and always do your best, no more and no less. C. Be impeccable with your word, take nothing personally, make assumptions, and always do your best, no more and no less. D. Be impeccable with your word, take nothing personally, make no assumptions, and be appreciative of your staff.
Ans: A
The four skill sets needed by good leaders are: A. Self-awareness, self-management, social awareness, and relationship management B. Self-awareness, self-management, social control, and relationship management C. Self-awareness, self-control, social awarenes, and relationship management D. Self-awareness, self-management, social awareness , and relationship performance
Ans: A
As a nurse, you are aware that one element that is common to the nursing process and the management process is: A. Identification of needs B. Identification of resources C. Planning D. Control
Ans: C Management Process: Identification of needs, Identification of resources, Planning, Organizing and Direction, Controlling Nursing Process: Assessment, Analysis/Nursing Diagnosis, Planning, Implementation, Evaluation.
Which of the following is NOT the middle-level manager's responsibility? A. People within the departments they supervise B. Liaison between upper management and first-level manager C. Establishment of organizational goals D. Activities within the departments they supervise
Ans: C The middle-level manager, also know as supervisor, director, assistant director or associate director of nursing. They supervise a number of first-level managers. They may spend more time planning, evaluating, and coordinating and less time with direct patient care. They are responsible for the people and activities within the departments they supervise on a 24-hours-a-day/7-days-a-week basis. Upper-level manage is responsible for establishing organizational goals.
During the interview a nurse learns there are several people interviewing for the position. Several days post interview the nurse is called for a second interview. How should the nurse prepare for this interview?
Anticipate questions in regard to the position that are situational and provide information regarding competence
A nurse manager has been working with a disgruntled employee for several weeks. today the employee comes to the manager's office with yet another complaint about a new hospital policy. The manager says I am sick of your complaining. Leave me alone so I can get some work done. What should the manager do now?
Apologize to the employee for being unprofessional as what the issue with the policy is
A nurse has frequent visitors while working. The manager has discussed with the nurse the negative effect of these visits on client care. What should the manager do next? A. Ask staff if the visits have decreased. B. Arrange a follow-up meeting with the nurse. C. Counsel all nursing staff regarding the limitations of personal visitors. D. Arrange to be visible on the nursing unit when this nurse is working.
Arrange a follow-up meeting with the nurse
Health care providers are preparing for a worldwide outbreak of H1N1 influenza. How would this outbreak be classified in planning literature?
As a pandemic, As a health disaster, As a natural disaster
A nurse admits to diverting narcotic drugs while working. The manager says All nurses who admit diverting narcotics have to be reported to the state board of nursing. How should the nurse interpret this statement?
As false, because in some states reporting depends on other factors
A nurse educator is asked by the chairperson of the department to submit a list of equipment that could be used to meet the department's goals. The list includes projectors, computers, office supplies, and computer-assisted programs. How would the educator categorize the materials? A. As an expense B. As part of revenue C. As part of the capital budget D. As part of the operating budget
As part of the capital budget
The nurse administrator has been asked to work with other administrators to make a change in a long-standing hospital policy. What should be the nurse's first action?
Assessment is always the first action for a nurse in any situation.
The nurse manager feels that changing the unit's method of assigning break times would benefit the flow of client care. What should be the manager's first action associated with this idea?
Assessment is the first step of the change process, just as it is the first step of the nursing process.
The unpredictability of the labor and delivery area requires a set staff mix for every shift. Which type of staffing pattern should the manager use to ensure this mix?
Block staffing
A nurse manager is interviewing a candidate who has much experience in other industries. The candidate was recently licensed and is interviewing for a registered nurse charge position. Which consideration is most important for the manager to bear in mind when regarding this candidate?
Can the candidate perform the job?
The registered nurse has had recent difficulty finishing and documenting client care during the assigned shift. The nurse has historically had very good appraisals, and the climate of the unit has not changed. Which would be the best approach to correct recent behaviors?
Clarify expectations
The nurse manager is facing resistance to change from many staff nurses. Why should the manager work hard to address this resistance?
Client care is always the most important reason that nurses do what they do. If the change does not improve client care in some respect, is it worth the effort?
A nurse executive is trying to convince the hospital management team that a clinical ladder system would work well in nursing. Which points should the nurse include in this argument?
Clinical ladders keep very good nurses at the bedside, These programs proven to be worth their cost, similar programs have been shown to improve nurse job satisfaction, quality of client care increases with these programs
The medical-surgical nursing manager notices the education expenditure for the month is over budget. How should the manager deal with this difference? A. Complete an expenditure report for the month. B. Complete a variance report for the month's budget. C. Forward a non-revenue-producing report to the administration. D. Forward the expense line budget to the administration.
Complete a variance report for the month's budget
A nursing applicant is scheduled for an interview with the nurse manager. Prior to the day of the interview, the human resources department reports that the applicant's references would not recommend her for hire. How should the nurse manager proceed?
Conduct the interview without telling the applicant that the references were poor, Conduct the interview and see if the applicant spontaneously explains why the references might be poor
The nurse has expressed job dissatisfaction to the unit manager. The manager assigns another staff member as a coach for this nurse. What is the most important aspect of the coach's job?
Conduct the relationship in a confidential manner.
A registered nurse is dissatisfied with the wages and health benefits available in his current position and decides to seek other employment. This employee's frustration is most linked to which motivational theory?
Content theory
An OB manager is interviewing a registered nurse for a labor and delivery position. The manager asks the interviewee "Tell me about the most challenging delivery experience in you nursing career" Which nursing skill will this exchange best assess?
Decision-making skills
Despite the nurse manager's best efforts to retain an experienced nurse, the nurse leaves for a job in a competing hospital. Which option reflects the most important thing the manager must do now?
Decreased the impact of the hospital grapevine
The hospital is caring for more high acuity clients due to the recent flu endemic. The CNO reviews the census from last year's flu season and instructs the manager to schedule more registered nurses for the weekend. Which system has the CNO used?
Demand management system
A newly hired nurse has incurred two absences with two pay periods. The nurse manager has scheduled a meeting with the nurse. What other action should the manager plan in addressing this issues?
Document the absences, review the attendance policy with the nurse, and provide a copy of the policy
A hospital has written a well-defined surge call-back system for employees to use in case of a disaster. What are key vulnerabilities of this system?
Employees may be unwilling to come back into the disaster, employees may be personally affected by the disaster, There may be no way to contact employees for call-back, the employee may not physically be able to return to the hospital
The state board of health requests the employees file of all agency nurses employed within the past year. At the end of the review the organization receives a sanction associated with these nurses. What is the most likely cause of this sanction?
Evaluation of the nurse's performance missing from the file
In an attempt to decrease tardiness, a hospital gives employees an extra hour's pay for each wage period that the employee has not been late for work. This incentive program is an example of which theory?
Expectancy
A nurse who has been working the evening shift on the hospice unit for 5 years resigns. The nurse says, "I just cant work here anymore. These clients are so sad." What is the best strategy for retaining this nurse?
Facilitating a transfer to another nursing unit
A hospital has sustained massive destruction after being struck by a tornado. The disaster plan has been activated. The administrator would expect help from which agency to coordinate the disaster efforts?
Federal Emergency Management Agency
A hospital on the gulf coast of the united states would list which situations among its top vulnerabilities?
Flooding, hurricanes, tornados, industrial accidents
The standard method of appraisal used by the facility rates a nurse's performance as satisfactory, but the nurse manager feels the nurse has room for improvement in many areas. What action should be taken by the manager?
Focus on developing a plan to improve the areas concerned
A hospital administrator initiated the emergency operations plan after being notified that a tornado struck a nearby community. Thirty minutes later law enforcement calls to report that while significant damage was done, there were only minor injuries. What should the administrator do now?
Follow the EOP to deactivate the plan
The nurse manager charged with hiring staff for a new nursing unit explains the unit's rigid structure and scheduling policies to all potential applicants. The manager is most likely to lose the interest of applicants of which generations?
Generation X, Generation Y
A level 3 disaster has occurred and the hospital is receiving clients by ambulance and those who have walked in to the emergency department. The wife of a man that is critically injured screams, "why doesn't someone do something for my husband? He is dying!" How should the nurse manager respond?
I am so sorry but your husband's injuries are very severe. We have to take care of the others first .
A nursing supervisor requests information technology support for posting all nursing scheduling online. What justification can the supervisor provide for this request ?
If schedules are posted online they are open for all to see, Posting schedules online will promote fairness in shift assignments, Open shift scheduling is easier to maintain if all schedules are online
A nurse manager is conduction her first interview. The manager is provided interview guidelines by the human resources director. Which advice from the HR director is most effective?
If you are unsure of a question, ask yourself if the question applies to job performance
A nurse manager does not like conflict and would like to allow instances of bullying to go away on their own. What rationale by the manager's supervisor is the most important?
If you let bullying go, it just gets worse and more frequent
A unit secretary is chronically late returning from breaks. the rest of the secretary's work is excellent and his is always helpful and supportive of nurses and client families. The nurse manager has discussed the lateness with hi,, but it has not stopped. Thinking this might be an attention-seeking behavior, the manager decides to use extinction as a strategy. What should the manager do?
Ignore the behavior, Plan to be away from the secretary's area during his break times
Two staff members have a long-standing dislike of one another. Generally they hide their feelings by occasionally they engage in name-calling and derogatory remarks. Today their dislike erupted into a shoving match in the break room. How should the manager handle this situation?
Immediately call for security
Hospital administrators are considering changing from the traditional method of creating work schedules to a system in which the nurses will choose their own workdays. Choices will be made according to seniority. Which change strategy would likely be best for this endeavor?
In most cases, the normative-reeducative approach to change is effective in reducing resistance and stimulating personal and organizational creativity.
A nurse manager would like to add the statement, "provide ongoing education to the client and the client's family" to the position description of RNs. Where would this statement be placed in this document?
In the Job descriptions
A night shift nurse is assuming a day shift's assignment, which includes two clients who pain is being controlled with oral hydrocodone. At shift assessment, both clients complain of pain. During shift report, the day nurse reports that both clients had just received two hydrocodone tablets for pain. What action should the night nurse take?
Inform the manager of the situation
A nurse has an interview with the nurse recruiter at a large metropolitan hospital. During the nurse's education, clinical practice was conducted in smaller facilities. Which topics would be good for the applicant to focus on during the interview?
Information regarding the position and the organization The nurse's past experiences The nurse's strengths and weaknesses
A candidate has arrived for an interview. The interview is conducted with various personnel within the organization. This is an example of an attempt to ensure which result?
Inter-rater reliability
The nurse has just interviewed with a nurse manager. The manager offers the nurse an opportunity to tour the unit and meet potential coworkers. Why is this beneficial opportunity?
It allows the candidate to learn more about the unit It allows the candidate to make some assessment of coworkers
An ICU nurse has been approached by a colleague to join the American Association of Critical Care Nurses. The nurse asks the colleague, "why would I want to join this organization?" What would be the best response?
It will help you to network and enhance your learning
During an interview, the manager has a strong impression that the applicant is a good fit for the position. How should the manager proceed?
Keep this feeling in mind but do not make a hasty decision
A night shift nurse frequently points out nurses' faults in front of co-workers. The manager of the unit has submitted a written warning to the charge nurse. What term should the manager use to label this behavior?
Lack of civility
A nurse manager has reduced absenteeism by increasing each nurse's job responsibilities. Why is this strategy effective?
Nurses who feel their job is important realize that others depend upon their presence at work, Having greater responsibilities enriches the job experience
The human resources department is considering motivating employees to maintain good attendance by changing some organization practices. Which items should HR consider?
Offering a discount on the host of on-site child care for employees with good attendance records, Banning an employee with more that two absences in a pay period from working overtime in the next pay period, Entering the names of employee who have no absences in a 3 month period in a drawing for a paid day off
A hospital has open shifts on its medical-surgical unit. The manager has listed open shifts on the hospital's intranet. This is an example of which type of scheduling?
Open shift management
An emergency department manager is looking over the next month's schedule and decides to supplement the schedule due to vacations. The manager decides to use decentralized pool staffing to lower costs and provide quality care. Which group of nurses is a part of this managers's decentralized staffing?
PRN staff from the emergency department nurses
A nurse manager and an employee meet to discuss the employee's appraisal. They disagree on the content of the employee evaluation. The disagreement turns into an argument. Which is the best managerial strategy in this situation?
Postpone the interview
the newly licensed is delighted to have been hired at a magnet hospital and says they even assigned me a mentor. What is erroneous about this statement?
Preceptors are assigned, mentors choose proteges
An ICU nurse does not follow policy when administering a medication intravenously. Which would be the most appropriate action by the manager to assist the employee? A. Provide written instructions for administering the medication. B. Remediate the situation with the ICU staff. C. Provide a copy of the policy and discuss the rationale for the policy as it relates to client care. D. Reprimand the ICU nurse for giving the medication.
Provide a copy of the policy and discuss the rationale for the policy as it relates to client care
What should a manager consider wen including a staff nurse in an interview of an applicant?
Providing the nurse with an orientation program on interviewing techniques
The administration of a health care organization has proposed a new client care area staffing system. Which components of this system do not meet the American Nurses Association requirements?
RNs will be required to accept flexible schedules that might require the nurse to practice on any unit in the facility, When low census occurs the unlicensed assistant category will be first to be furloughed
During the review of an organization's appraisal policies, a nurse consultant finds that the facility uses a traditional rating scale based on general performance. What would be consultant's greatest concern with this choice of appraisal style?
Ratings are based on the supervisor's idea of satisfactory performance
Which assignment would be in the best interest of a nurse reentering practice following treatment for abuse of mood altering drugs
Reassign the nurse for a period of time to a unit where no mood-altering drugs are given
Adopting which strategy would be helpful in reducing recency error in staff appraisals?
Recording critical incidents as they occur
A newly licensed nurse has submitted an application, letter of interest, and resume to the HR department of a hospital and has an interview schedule for next week. How should the nurse prepare for this interview?
Review the organization's website
A nurse manager has discussed behavioral and unprofessional behaviors with a nurse. During the performance appraisal the manager addressed these issues and the two nurses have developed a specific plan to address the performance areas that can be strengthened. What should the nurse manager's next course of action be?
Schedule a follow up session to determine if the nurse has made progress in the areas specified
The novice nurse manager is acting in the role of change agent for the unit. Which statement indicates that this manager needs further training in regard to change?
Staying available the whole time is not realistic and will make it difficult for the change agent to maintain the energy it will take to make the change more successful.
A nurse executive is assigned to a task fore working on a surge system for the hospital in case of disaster. this group should write strategies to cover which procedures?
Supplies, Physical space, Management infrastructure, Personnel
The nurse manager is conducting an interview for a position as a as a full time RN in a critical care unit. Which statements by the nurse manager would be most effective in selecting a qualified nurse for this position?
Tell me about your past work experiences, Please tell me about you most rewarding experience as a nurse
An OB manager discusses a nurse's performance with the chief nurse officer (CNO). The CNO learns the nurse has had multiple client and physician complaints that the manager investigated and for which counseling was provided. The behavior continues even though the nurse has received verbal and written warnings. Which course of action would be most appropriate at this time? A. Issue a written warning from the CNO. B. Place the nurse on suspension pending a new investigation into the complaints. C. Terminate the nurse. D. Transfer the nurse to another department under another manager.
Terminate the nurse
A nurse has two job offers. One will not be available for 6 months and the other is in an organization that the nurse does not think is a god fit. The client care in the second organization is not what the nurse would feel comfortable providing. What action should the nurse take in regard to the second organization?
Thank the manager for the offer, but decline it Send a letter to the manager, thanking the organization for the offer Tell the manager that the client care in the organization was not what was expected
A chief nurse officer receives a call that the candidate for a nurse opening has arrived, but that the unit manager who was to have interviewed the candidate had to work an unscheduled night shift and is unavailable. Which action by the CNO is appropriate?
The CNO should conduct an initial interview and arrange for a second interview with the manager.
A chief nurse officer of a rural hospital is meeting with department directions and the human resources officer to discuss the hospital's recruitment strategies. A newly promoted director suggests a recruitment fair at a metropolitan city 100 miles away. The CNO rejects this proposal. Which option is likely the CNO's rationale for this decision?
The CNO would prefer to focus on the local area initially.
A nurse has complained to the human resources (HR) director regarding unfair treatment by the nurse's manager. The nurse describes receiving a written warning, unlike other nursing staff who exhibit similar behaviors but are not reprimanded. Which concerns would the HR director discuss with the hospital chief nursing officer? A. The unusual management styles within the department B. Confronting the manager's direct supervisor about allowing this situation to occur C. The apparent inconsistencies in discipline within the unit D. The potential for litigation that arises from this complaint E. The need to terminate this problem employee
The apparent inconsistencies in discipline within the unit, The potential for ligation that arises from this complaint 3, 4
The budget committee of a hospital is holding the first meeting of the budgetary cycle in two weeks. The finance department is preparing an information packet to be distributed to members. What statistical information should be included? Select all that apply. A. The average daily census for the facility over the last year B. Current community wage ranges for employee classifications C. Changes in accrediting body or legislative regulations D. Number of nurses terminated for cause over the last year E. Current staff mix across the hospital
The average daily census for the facility over the last year; Current community wage ranges for employee classifications; Changes in accrediting body or legislative regulations; Current staff mix across the hospital A, B, C, E
The newly hired nurse manager is involved in the first budgetary cycle since being hired. The manager lists some capital equipment needs and is surprised when they are not available for staff use two months after the request. What is the reason for this? A. The equipment was not approved by the manger's supervisor. B. The budgetary cycle takes up to 1 year to occur. C. The hospital has experienced a downturn in revenue and it not fulfilling promises. D. The nurse manager failed to complete the correct request.
The budetary cycle takes up to 1 year to occur
A medical intensive care unit has a registered nurse position open. The qualifications for the position require a minimum of 1 year of acute care nursing experience, BLS, and ACLS certification, and the ability to administer intravenous cardiac drips. Which fact in an applicant's application would be sufficient reason to decline the applicant's request for an interview?
The candidate graduated from nursing school 9 months ago
During an interview the candidate informs the manager of a difficult experience between a client and a physician. The nurse had to negotiate between an unhappy client and a difficult physician. Which notation by the manager would describe this situation?
The candidate has good conflict resolution skills
In an activity log, a nurse records attendance at an education seminar as Class on arrhythmia recognition, State College, taught by Sue Smith, RN. What else would be valuable for the nurse to include?
The exact title of seminar or event Who paid for the course and what it cost The date Any certifications achieved
A new IV pump has just been purchased by the facility. Which statement by the nurse manager reflects Rogers' first step in making the change to this new equipment?
The first step of the diffusion of innovation occurs when the decision-making unit is introduced to the innovation and knowledge is gained.
A hospital administrator on a disaster planning team says "I am worried about our liability in using volunteers to provide care during a disaster." What should this team consider?
The hospital could have liability for the volunteer's performance and for his or her safety
A hospital administrator is investigating why the turnover rate is so high and why it is difficult to attract new nursing employees. Which situation is most likely to have resulted in this problem? 1. The hospital is in a poorer part of town and offers a great deal of charity care. 2. The hospital pays about $.25 per hour less than other hospitals as a starting wage for nurses. 3. The hospital has a reputation for allowing bullying behavior to occur. 4. The other hospital in town has a more modern building and campus.
The hospital has a reputation for allowing bullying behavior to occur
As a member of the budgeting committee, the nurse manager reviews the salaries for file clerks in the accounting department. These salaries should be included in which budget item? A. The fixed cost B. The variable cost C. The indirect cost D. The direct cost
The indirect cost
An ICU nurse manager has been struggling to correct client care issues on the unit and has asked the unit director for assistance. The director says, "Training and discipline on your unit is your responsibility. I have other things to do." Now, the manager is faced with disciplining a nurse regarding another client care issue. What is the most significant reason this manager is hesitant to administer this discipline? A. The nurse may quit. B. The nursing staff is a cohesive group and might retaliate. C. The manager is not comfortable with confrontation. D. The manager does not feel supported by the director.
The manager does not feel supported by the director
A hospital uses a results-oriented evaluation system. During a nurse's hiring process, the manager states, Once you have been officially hired, I want to meet with you regarding evaluation. What will be the focus of this meeting?
The nurse and the manager will work together to write work objectives for the nurse`
The manager has determined that a nurse is marginal, but elects to ignore the situation for now, hoping the nurse's work will improve. What risks has the manager taken by choosing this strategy?
The nurse may harm a client, Other nurses on the unit may become disgruntled by having to cover for this nurse, The nurse may never become a good employee, The morale of the unit may decline
During appraisal interviews, the nurse manager defends the choice of rating by emphasizing the negative aspects of the nurse's performance. What is the likely outcome of this strategy?
The nurse will pay less attention to maintaining what is done well
During a 3 month period, a nurse has missed work on six occasions due to unreliable child care. Another nurse has missed 10 days due to a minor food surgery. How should the manager categorize the reliability of these nurses?
The nurse with involuntary absences is more reliable
With the current health care industry focus on managed care, nurses must be more cost-conscious. Which option is an example of a nurse being cost-conscious? A. The nurse reviewing the client's itemized bill each day B. The nurse's decision to use fewer supplies when changing a dressing C. The nurse manager reviewing client costs on a daily basis D. The nurse manager requesting that the materials management director obtain quotes for less expensive items
The nurse's decision to use fewer supplies when changing a dressing
The nurse manager's goal is to adequately staff the unit and use minimal supplementary staff. The manager has added the cost of this supplementary staff to the unit's operating budget. A colleague informs the manager it should have been added to which budget? A. The personnel budget B. The operating budget C. The revenue budget D. The fixed budget
The personnel budget
A nurse manager and a human resources manager are developing an interview guide for registered nurse positions in critical care units. How should this document be structured?
The questions should be specific to the registered nurse position, Sufficient room should be allowed between the questions so that notes on the interview can be written directly on the guide, Questions should require independent answers and should not be leading
When the unit manager is on vacation, the charge nurse fills in the leadership role. While in this role the charge nurse senses a change in the nursing staff's morale. The staff appears happier, more energetic and productive. The charge nurse believes this change is a direct effect of which variable?
The staff's relationship with the nurse manager
A terminated employee files a grievance against the nurse manager. Which situations would benefit the employee's claim? A. The nurse manager wrote notes on the expectations discussed during disciplinary sessions. B. The terminated employee's last evaluation discusses problems with performance, but no coaching is described. C. When problems with the employee arose, the manager's average time of intervention was less than 1 day. D. There are notes in the employee's record from human resources indicating the nurse manager had discussed issues with the HR director. E. In one note, the manager describes the employee as "petulant, immature, and uncaring."
The terminated employee's last evaluation discusses problems with performance, but no coaching is described, In one note, the manager describes the employee as petulant, immature and uncaring 2, 5
A group of nursing students have just arrived on the unit. Which actions by staff would be considered uncivil to these students?
The unit clerk groans when the instructor enters the nursing station with the students, A nurse whispers - not students again today, A transport worker says, just great, more students to get in the way today
A nurse manager of a medical unit and a nurse manager of a critical care unit are discussing their personnel budgets. The medical unit budget is higher than the critical care unit budget. What are plausible reasons for this difference? Select all that apply. A. There is a higher turnover rate of nursing staff on the medical unit. B. Costs were incurred during a recent remodeling of the medical unit. C. The client acuity on the critical care unit is higher. D. The critical care manager is a better manager than the medical unit manager. E. More staff on the medical unit received premium pay this year.
There is a higher turnover rate of nursing staff on the medical unit; The critical care manager is a better manager than the medical unit manager; More staff on the medical unit received premium pay this year A, D, E
The hospital is preparing for a tabletop test of its emergency operations plan. What is the potential for an interruption in services from this drill?
There is little potential for interruption as the drill is all done in a meeting
A nursing supervisor is setting up a new unit and must make a blanket decision about whether the unit will be staffed on 12 hour shifts or 8 hour shifts. What should this supervisor keep in mind when making this decision?
There is not difference in the FTE required
An error made in client care last week has just been discovered. A nurse who cared for the client during that period is asked about the error and states, that probably happened when the nurse covering for me at or for me breaks was in charge. How should the manager interpret this statement?
This nurse is scapegoating the coverage nurse
Which personal characteristics would increase a nurse's potential for voluntary turnover?
Through task force meetings, the nurse has become friends with several nurses who work in different organizations in town, The nurse has few personal ties to the city of current employment, The nurse has worked at several job-fairs in the area as a hospital representative
A nurse manager looks through a file that contains information regarding critical incident reports filed within the past year. For which reasons does the manager review and use this information?
To decrease the possibility of lawsuits by the employee being evaluated, to increase manager-employee communication, to decrease recency error, to increase the accuracy of the evaluation
The supervisor is teaching managers about the use of critical incidents as part of the evaluation process. What information should the supervisor share?
Using these notes will help you identify little problems before they become big problems, You can expect some negative reactions from staff, It is okay to tell your staff that you cannot remember all the details of each encounter for evaluation and the notes will help, Having these notes will help you feel more confident in you evaluation of staff
The nurse executive of a hospital is surveying hospitals in a four-state area in regard to their disaster preparedness. The nurse would expect to hear which response to the question - What have you done to prepare for a disaster?
We conduct practice disaster drills
A manager is preparing to write a critical incident regarding a nurse who has voluntary absences for several scheduled shifts. What information should the manager determine first?
What was the frequency and time period of the absences
An emergency department manager interviews and hires a candidate who reports having several years of ED experience. Soon after hire, the nurse makes a series of errors and harms several clients. When investigating these errors, the nurse manager discovers the nurse falsified his experience and credentials. Is the hospital liable for this nurse's actions?
Yes, the hospital could be liable for negligent hiring if credentials were not checked.
in order to develop a succession-planning program as rapidly as possible, the management team has elected to divide the processes up among team members. Which assignments would be expected?
identify the most important things that managers do, decide which current nurses would make good managers, analyze management training opportunities
a nurse manager has scheduled several on the job instruction sessions. why would the nurse choose this format?
it is very cost-effective, travel expenses are minimized, transfer of learning issues are eliminated, the learners are motivated to learn
during strategic planning, the committee finds a need to develop a succession plan for the facility. what committee findings would draw attention to this need?
many of the facility's senior nursing managers indicate they will likely retire within 5 years, the nursing shortage in the area continues to worsen
A nurse manager has just completed a difficult assignment managing a group that was not cohesive. Which group should the nurse identify as likely having good cohesiveness? SELECT ALL THAT APPLY 1. Nurse who each have 7 to 8 years of experience 2. Nurses who work on different units throughout the hospital 3. Staff nurses who are interested in learning about the task of the group 4. Staff nurses who work with one another on a daily basis 5. Staff nurses who are all between 35 and 40 years of age
1,3,4,5 Rationale 1: This group has similar backgrounds, which will likely mean they have shared values regarding nursing. Rationale 3: People who have specific needs that can be satisfied by involvement with the group are more cohesive. Rationale 4: Those who must interact to achieve their goals and tasks are likely to be cohesive when working in a group. Rationale 5: Similarity in age increases cohesiveness.
A hospital is considering implementing the use of critical pathways and case management. Which statements by a nurse would indicate to the nurse manager that more education should be provided? Select all that apply.
1. "If we use critical pathways, we won't have physical therapy to help us ambulate clients." 3. "The critical pathway lists discharge outcomes but won't help us with day-to-day guidance of care." 4. "Once the client is on a critical pathway, we must follow it until discharge."
Which statement by a newly licensed nurse indicates an understanding of why it is necessary to structure nursing care? Select all that apply.
1. "It helps to coordinate care to a group of clients." 2. "It organizes care responsibilities." 5. "It provides skilled care by skilled staff."
Which statements by the nurse manager would demonstrate effective change management?
1. "We cannot lose sight of the mission and values of our institution as we begin to integrate these changes." 2. "Although this task is going to be difficult, we have the full support of our hospital administration."
Which statements by a hospital executive reflect power-coercive strategies to implement change?
1. "We must follow the federal guidelines in the way we bill for our services." 2. "If we don't reduce our nosocomial infection rate, Medicare won't reimburse us." 3. "Administration has to make this change or our accreditation status will be at risk."
A nursing supervisor would like the nurse manager to serve as change agent for a needed revision to unit policy. Which statements would alert the supervisor that this manager is not the best choice for this assignment?
1. "Well, we don't want to rock the boat too much." 2. "Do you think we can get enough support from the nurses to make this change?" 3. "We tried making a change like this before and it didn't work out well."
The nurse has just been notified that a client is to be admitted from the emergency department with a diagnosis of alcohol intoxication. The ED nurse says they have been unable to obtain much history because of the client's lethargic state. Which action is an appropriate intervention by the nurse? 1. Approach the client with caution when obtaining vital signs and shift assessments. 2. Place the client in a room farthest from the nurse's station so as not to disturb other clients. 3. Place the client in four-point restraints as a protective measure. 4. Post an armed security person at the client's door.
1. Approach the client with caution when obtaining vital signs and shift assessments
A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change?
1. Disperse information about the change as quickly as possible. 2. Remind staff that change is part of the health care environment. 3. Talk about the change in positive terms.
The nurse has attended a "how to" refresher course on successful delegation. Which statement indicates successful learning has taken place?
1. I knew that effective delegation made my job easier, but I never thought about how it could benefit the hospital
The nurse manager has asked that another staff nurse position be funded for the unit. The supervisor denies the request. Which statements by the manager are examples of negative assertion? (SELECT ALL THAT APPLY)
1. I know I havent been too careful in keeping personnel cost low, but we are really going to need another position 3. I realize that my staff is not always positive about organizational changes, but having this extra staff member might reduce some of their stress
An employee is sabotaging the work of a newly oriented charge nurse, and the charge nurse has not been successful in addressing the problem. When the nurse manager addresses the issue, which is the most appropriate statement?
1. I know it must be frustrating working with a new charge nurse, but how can we make this situation better?
Which statements would be important for the charge nurse to make when delegating a responsibility? (SELECT ALL THAT APPLY)
1. I think it would be important to our organization if you represent the unit on the policy and procedure committee 3. I think your attendance at the task force meeting will be a good reflection on our unit
After shift change the nurse discovers that a client's IV heparin has been turned off at the IV controller. The amount of fluid left in the IV bag indicates that the client received half of the dose ordered. Which statement should be documented in the client's medical record?
1. IV heparin restarted. Physician notified. Client's vital signs unchanged.
The nurse executive is reviewing client satisfaction surveys. Which trend would the nurse evaluate as indicating the nursing care delivery system in use is not effective?
1. Sixty percent of respondents replied with the name of an unlicensed assistant when asked the name of the RN who cared for them.
A newly hired nurse is asked to join a group working on unit protocols. This nurse is verbal and dominates the conversation of the group. The group leader identifies the disruption this nurse causes as being from which phenomenon? 1. Status incongruence 2. Group isolates 3. Emergence 4. Deviation
1. Status incongruence Rationale 1: Status incongruence means that the status of the newly hired nurse is not congruent with being a dominant player in the group. Status in the group is determined by conforming to group norms that often include higher status for those who have worked in the group for a longer time.
The chief nursing officer (CNO) recognizes a large increase in turnover on a given unit. The nurse manager of the unit says that this is just a coincidence and that the unit is fine. What action by the CNO is appropriate? 1. Talk to current nursing staff and review the exit interviews of those who have left. 2. Call the unit supervisor and inquire as to why the turnover rate is high. 3. Discuss the matter with other nurse managers. 4. Discuss the matter with the hospital chief administrator.
1. Talk to current nursing staff and review the exit interviews of those who have left.
The continuous quality improvement (CQI) coordinator is establishing quality measures for a unit. These measures would be written according to which criteria? Select all that apply.
1. The CQI coordinator has read two research studies that show the process improves client outcomes. 2. The CQI coordinator has evidence that a particular practice is effective in decreasing length of stay. 4. The process being measured produces a desirable outcome. 5. There are very few unexpected bad effects from the process.
Which statement represents a situation is which delegation is ineffective or inappropriate?
1. The RN asks the LPN to assist with admissions by assessing the clients as they get to their rooms
The nurse executive wishes to hire nurse managers who embody the service leadership mission of the organization. Which specific attributes should this nurse look for in applicants?
1. The ability to be empathetic to clients and staff 3. Awareness of the needs of clients and the organization 4. Use of persuasion as a leadership technique
Which quality improvement initiatives would help the health care organization meet Institute of Healthcare Improvement (IHI) goals? Select all that apply.
1. The amount of material opened and wasted for surgical procedures will drop by 25 percent this fiscal year. 3. Wait times in the emergency department will decrease by 15 percent this year. 5. Fewer than 5 percent of clients will report inadequate pain control while hospitalized.
A geriatric client in a long term care facility becomes increasingly confused and verbally aggressive as evening approaches. Which actions would the nurse interpret as potentially signaling a violent episode? Select all that apply. 1. The client is moving slowly toward the room door. 2. The client is staring blankly at the nurse. 3. The client suddenly becomes alert and oriented. 4. The client raises his fist. 5. The client says, "I know where there is a gun."
1. The client is moving slowly toward the room door 2. The client is staring blankly towards the nurse 4. The client raises his fist
The hospital administration is considering adopting primary nursing as its model of nursing care delivery. Disadvantages of this method are that: Select all that apply.
1. The client may have multiple primary nurses if transfers within the facility are necessary. 3. Staff nurses cannot be held legally liable for care provided outside their work hours. 5. All persons caring for the client must have excellent communication skills.
A new triage area has been built in the emergency department causing conflict between the nurse manager and the nurses who think the design is not "user friendly." After repeated complaints the nurse manager asks maintenance to change the arrangement of the room. What is the most important reason this change occurred? 1. The complaints motivated the nurse manager to make the change to increase unit effectiveness. 2. The room design was uncomfortable for the nurses, which convinced the nurse manager to change the design. 3. The nurse manager was afraid the nurses would refuse to work in the room so the room had to be changed. 4. The nurses would keep complaining so the nurse manager changed the room to stop the griping.
1. The complaints motivated the nurse manager to make the change to increase unit effectiveness
Currently clients on a unit are bathed in the morning between 8:00 am and 11:00 am. The nursing staff is contemplating changing that routine to bathing clients in the evening between 7:00 pm and 9:00 pm. Which statement reflects an underlying assumption that might affect the staff's ability to think critically about this change? (SELECT ALL THAT APPLY)
1. The day shift just wants to shift work onto the evening shift 2. Everyone likes to bathe right before bed 4. The physician staff will be upset if we change our morning routine 5. If we let them change this, they will want to make lots of other changes, too
A nurse manager is aware that there is a strong "grapevine" communication system on the unit. The manager elects to use this grapevine to distribute information about an upcoming change in unit policy. In making this decision, the manager should consider which possibilities? (SELECT ALL THAT APPLY)
1. The information may be rapidly disseminated 2. The information may be altered as it moves across the grapevine
A nurse manager is considering referring a nurse who is very stressed to the employee assistance program (EAP) offered by the institution. What does this consideration indicate? 1. The manager believes this service would promote the nurses health and well-being. 2. The manager thinks the nurse is abusing alcohol to cope with the stress. 3. The manager thinks that this referral will help the nurse avoid sanction by the state board of nursing. 4. The manager believes the nurse is abusing controlled medications to cope with stress.
1. The manager believes this service would promote the nurses health and well-being.
A nurse manager's supervisor reports that many staff members have complained about the manager's rigidity. What situations reflect this rigidity? (SELECT ALL THAT APPLY) 1. The manager has historically used trial and error as a
1. The manager has historically used trial and error as a decision-making strategy 4. The manager uses old ways of thinking to solve the day-to-day issues of the unit
Which situation best exemplifies the nurse manager as a team leader? 1. The nurse manager posts the unit's positive accomplishments from the past month in the break room. 2. The nurse manager controls the staff meetings so the staff can get back to work quickly. 3. Every year the nurse manager does staff member evaluations to determine pay raises. 4. The nurse manager encourages conjunctive task performance on the unit.
1. The nurse manager posts the unit's positive accomplishments from the past month in the break room. Rationale 1: Building the team up by praising team accomplishments best exemplifies the nurse manager as team leader.
A staff nurse is known for having temper tantrums when the unit is stressful. The nurse slams doors, grumbles, and is demeaning to coworkers. This behavior has never been violent, but today it's becoming more threatening. The nurse just came into the station and said, "my nurse assistant is stupid, I am not going to put up with that much longer, she needs to be put in her place." How should the manager respond to this situation? Select all that apply. 1. The nurse should be removed from the unit. 2. A critical incident report should be written about the behavior. 3. The manager should explain that this is a good nurse who has difficulty tolerating stress. 4. Security should be notified of the behaviors. 5. The manager should warn other staff to stay clear of this nurse for the rest of the shift.
1. The nurse should be removed from the unit 2. A critical incident report should be written about the behavior 4. Security should be notified of the behaviors
During the orientation a newly employed nurse asks about the process of reporting such things as bomb threats to the organization. The person conducting the orientation says "well I guess you call 911." What is incorrect about this statement? Select all that apply. 1. The person who is doing the orientation should be aware of the reporting policy. 2. The nurse should have been told to notify security. 3. The nurse should never call 911 from the hospital. 4. The nurse should have been told to follow the reporting policy. 5. The nurse should have been reported as suspicious for asking the question
1. The person who is doing the orientation should be aware of the reporting policy 2. The nurse should have been told to notify security 4. The nurse should have been told to follow the reporting policy
A risk manager generally uses root cause analysis to investigate incidents. What are the likely outcomes of this action? Select all that apply.
1. There is disagreement over the cause of the incident. 2. There are insufficient resources to make needed changes to prevent similar incidents.
The vice president for nursing services of a large teaching hospital has been aware that many of the problems in the nursing staff result from poor management at the unit level. What are reasons that nurse managers are sometimes ineffective in their role? Select all that apply.
1. There is little training available for nurse management positions. 2. Entry-level educational programs for nurses do not contain sufficient managerial content. 3. Management techniques are often learned "on the job." 5. Nurses often experience poor supervision in their own careers.
Fire departments from a three county area have responded to a wildfire that has threatened several homes and a hospital in a wooded area. The fire is now under control and the fire chief is completing the paperwork on the response. The disaster should be classified as a level ___
2
The work of a task force is completed and the leader has compiled a written report of findings and recommendations. What actions are necessary by this leader? Select all that apply. 1. Plan on the leader presenting the report to administrators. 2. Share the report with the full task force prior to presenting it to administrators. 3. Send the report to administrators by e-mail. 4. Brief key administrators regarding the report prior to the administrative presentation. 5. Print and bind the presentation in a professional manner prior to presenting it to the full task force.
2,4 Rationale 2: The full task force should have opportunity to review and comment on the report draft before it goes to the administration. Rationale 4: The leader should meet with key administrators to bring particularly important findings or recommendations to light prior to presenting the report to the full administrative panel.
Which ground rule statements by the leader will help the group meeting stay on task and on time? Select all that apply. 1. "We will wait until everyone who is going to attend is here before we call the meeting to order." 2. "We will always meet on the second Wednesday of the month at 1:00 p.m. as this is the time all members have indicated is most convenient." 3. "If you have information to distribute for discussion, please bring a copy for every member." 4. "We will limit verbal participation to designated key members each week." 5. "You can expect to receive an agenda for the meeting at least 1 week in advance of the meeting."
2,5 Rationale 2: The team leader should arrange to meet in a convenient but quiet place to minimize interruptions and distractions. Rationale 5: The meeting agenda should be distributed at least 1 week in advance.
Efforts to increase nurses' use of evidence-based practice (EBP) to improve client care in the hospital have failed. Which answers are nurses likely to give when asked why this is occurring? Select all that apply.
2. "I don't have time to finish everything I already have to do each shift." 3. "I don't want to practice nursing just like everyone else." 4. "The library at our hospital doesn't have many journals." 5. "If administration wanted us to use EBP, they would get us some more nurses to share the work."
The nurse manager is leading the monthly staff meeting for the professional nursing staff. Which statements by this leader reflect effective leadership? SELECT ALL THAT APPLY 1. "I will assume responsibility for developing the mission and goals of the group." 2. "I have created an agenda that identifies the amount of time allotted for each step of the problem-solving process." 3. "I realize there will be dissension; however, I prefer that we not take time from our agenda to address it." 4. "The meeting will be called to order at noon and be adjourned in 1 hour." 5. "It is important that each of you is fully engaged in the decision-making process."
2. "I have created an agenda that identifies the amount of time allotted for each step of the problem-solving process." 4. "The meeting will be called to order at noon and be adjourned in 1 hour." 5. "It is important that each of you is fully engaged in the decision-making process." Rationale 2: The effective leader begins and ends a meeting on time and promotes adherence to the proposed time allocation. Rationale 4: The effective leader begins and ends a meeting on time and promotes adherence to the proposed time allocation. Rationale 5: Group cooperation and engagement should be promoted.
Staff nurses have been asked to comment on the work of a nurse manager as part of the manager's performance review. Which comments by the staff nurses would indicate to the supervisor that the manager is also a leader? Select all that apply.
2. "I hope to be as good a manager as he is someday." 4. "His example has encouraged me to get to know people in other departments in the hospital."
The nurse is acting as team leader for a client care conference. Which opening statement is best for this meeting? 1. "We are all here to discuss the issues with this client's discharge. What issues are we facing?" 2. "The issue with this client is the time limit for Medicare to pay has almost expired, and we aren't ready for discharge." 3. "I don't really have time for this meeting today; is there anything I can do to expedite this meeting?" 4. "I will let you all decide what might be best, as I am not really as familiar with this client as I should be."
2. "The issue with this client is the time limit for Medicare to pay has almost expired, and we aren't ready for discharge." Rationale 2: The team leader is the meeting facilitator, teacher, and client advocate for the patient care conference. The team leader should know the issues with the client and be able to facilitate the meeting by listing those issues.
The hospital operator announced over the paging system "Dr. Strong, fourth floor, A-wing, Dr. Strong, fourth floor, A-wing." A newly hired nurse asks another nurse "who is Dr. Strong?" The nurse replies "this is the announcement that alerts security there is violent behavior on that unit." Which statement would be an appropriate report to this unit's manager? 1. "Our new nurse does not know what 'Dr. Strong' means." 2. "There was an incident in which a staff person did not know what 'Dr. Strong' meant. Could we have an in-service on this policy?" 3. "The operator paged a 'Dr. Strong' and we didn't know what to do." 4. "Why do they use 'Dr. Strong' when there is trouble? They should just call for help."
2. "There was an incident in which a staff person did not know what Dr. Strong meant. Could we have an in service on this policy?"
A nurse manager has required that all nursing staff attend an in-service dealing with verbal threats. A staff nurse wonders "why this is necessary since words don't hurt me - I just ignore them." What is the nurse manager's most appropriate response to this statement? 1. "Don't argue with me, I said everyone has to be in-serviced." 2. "Verbal threats often precede physical violence." 3. "I want my staff to be prepared to handle anything." 4. "This is a requirement from our accrediting agency."
2. "Verbal threats often precede physical violence"
The nurse is working on a committee charged with the responsibility for making policy decisions for the health care organization. During the work, the nurse has developed a strong belief that the focus of the committee is incorrect. Which statement by the nurse would be most appropriate?
2. "We are a good team, but we need to look at this problem from a different viewpoint."
A change in nursing care delivery system is being considered by hospital administrators. Which information should the nurse executive add to this discussion?
2. "We must look to the nursing process for guidance in nursing care."
A staff nurse finds a newly licensed, newly hired staff nurse crying in the break room halfway through a shift. The new nurse says, "I am just not getting this. I had no idea nursing would be this hard." The experienced nurse says, "reality shock is terrible, but you will get through it." What does the nurse mean by reality shock? 1. A period of time when it becomes clear the new nurse is not able to function as a registered nurse 2. A period of surprise and disequilibrium about the nursing role 3. A period when expectations of the role are unclear 4. A period of time when managers determine if the new nurse is a good fit for the profession of nursing
2. A period of surprise and disequilibrium about the nursing role Rationale 1: There is no indication that the new nurse cannot eventually function as a registered nurse. Rationale 2: Reality shock is the period of transition from a protected student role to a professional role in which the nurse is responsible and accountable for the care of several clients. Rationale 3: Being unclear about the role is role ambiguity. Rationale 4: It would be unfair for the manager to determine the nurses fitness for the profession during reality shock.
The procedures for managing client pain are being investigated as part of the hospital's total quality management program. Whom should the manager plan to invite to this meeting? Select all that apply.
2. A representative from pharmacy 3. A representative from the medical staff 4. A staff nurse who works with clients in pain
Which situations are examples of the nurse directing rather than delegating? (SELECT ALL THAT APPLY)
2. A staff nurse asks the assistant to sit with the roommate of a client who has just died 3. During a code blue situation, a nurse tells another nurse to start an IV 4. A nurse tells an assistant to move a client into the hallway during severe weather
Which actions diminish the image of power for nurses? Select all that apply.
2. Addressing colleagues in endearing terms 3. Using power plays to achieve goals 4. Aggressively advocating for clients 5. Accepting orders without question
The nurse executive of a for-profit hospital continually works to provide an environment that is better for the nursing staff. Why is this effort so important? Select all that apply.
2. An environment that is better for nurses is associated with lower mortality rates. 3. Nurses are more satisfied working in an environment that is better for nursing.
A nurse manager is investigating a report made by a staff nurse. The nurses state that a visitor backed the nurse against a wall and was verbally abusive but did not touch the nurse. How should the manager describe this incident to the HR director? 1. As an encounter with a disgruntled family member 2. As violence against the nurse 3. As an incident with a family member 4. As a physical attack against an employee
2. As violence against the nurse
The nurse prepares the medication ordered for the client. The nurse asks the nurse assistant to give the medication when the client receives breakfast and to report on the task at its completion. The nurse assistant agrees. Which component of the steps of delegation was violated by this request?
2. Deciding on the delegate
The nurse manager is counseling a male nurse about several recent incidents in which female nurses complained that he was abrupt and condescending. What advice should the manager give this nurse?
2. Don't feel as if you are responsible for fixing every problem
Which would be the most effective way for nursing to improve the power of its image? Select all that apply.
2. Dressing, speaking, and acting in a professional manner
A large metropolitan hospital uses differentiated practice as part of the structure of nursing services. Following this plan, nursing responsibilities are assigned based on which criteria? Select all that apply.
2. Educational level 3. Experience 4. Nurse preference
The nurse manager meets with the staff nurses to discuss ways to improve communication among the shifts. Which statement by the nurse manager best exemplifies the final stage of conflict management? 1. "We need to clearly define the nature of the conflict." 2. "I will evaluate the outcomes of our strategies on a monthly basis." 3. "Let's create a time line for the implementation of our strategies." 4. "Hopefully, each group can understand each other's perceptions of the issue."
2. I will evaluate the outcomes of our strategies on a monthly basis
The nurse supervisor would like to delegate accreditation preparation activities to the nurse manager. The manager is unsure of what is expected and has no experience with accreditation. How should the manager respond? (SELECT ALL THAT APPLY)
2. I will need some education on the accrediation process before I can accept this task 4. Please tell me more about what this assignment entails
The nurse manager holds a staff meeting and announces, I want to aggressively manage the stress on this unit. Why would the manager have this goal? 1. Stress has a negative impact on the functioning of the unit. 2. If the stress level is too low, people become apathetic and bored. 3. Low stress levels will reduce turnover on the unit. 4. Coping mechanisms only work when stress is high.
2. If the stress level is too low, people become apathetic and bored
The following documentation was entered in the client's medical record: "The client was found lying on the floor. Dr. X was notified. Apparently the restraints were improperly applied." Which statement best describes this documentation?
2. Inappropriate because it places blame on an individual
The local hospital has recently been acquired by a larger hospital corporation. The nurse manager encourages staff to attend the next unit meeting by hanging a poster announcing that the new wage scale and benefits package will be discussed. This is an example of which type of power?
2. Information power
Leaders and managers often exercise power differently. Select the powers most frequently used by leaders. Select all that apply.
2. Information power 4. Expert power 5. Referent power
The staff is transitioning to a major change in the provision of nursing care in a large hospital. Which behaviors should the nurse manager watch for that would indicate possible problems?
2. Nurses are doing both the old work and the new work. 3. A nurse says, "I guess everything we've done for years is wrong." 5. Nurses are doing parts of the old procedure and parts of the new procedure.
A newly formed task force is addressing the preventing of violence in the health care organization. Which group(s) of employees is/are most likely to experience violence? Select all that apply. 1. Private practice physicians 2. Nurses working in a geriatric unit 3. Nurses working in a pediatric clinic 4. Nurses whose work space includes large waiting rooms 5. Technicians working in the medical laboratory
2. Nurses working in a geriatric unit 4. Nurses whose work space includes large waiting rooms
The nurse is talking to a client who has a history of aggressive outbursts. What strategies should this nurse use? Select all that apply. 1. When addressing the client, use powerful body language. 2. Remain calm and speak in a moderate tone. 3. Approach the client with an aggressive "I'm in charge" attitude. 4. Speak in simple terms. 5. Allow the client to speak.
2. Remain calm and speak in a moderate tone 4. Speak in simple terms, 5. Allow the client to speak
A hospital's safety committee has been asked to make recommendations to administration regarding methods to improve employee safety. Which suggestions should be made? Select all that apply. 1. Reserving parking spaces closest to the facility for staff 2. Security cameras throughout the facility 3. Curved mirrors in the corridors 4. Using restraints on all confused clients 5. Requiring all personnel to take physical self-defense training
2. Security cameras throughout the facility, 3. Curved mirrors in the corridors
The nurse manager has been assigned the task of developing and implementing a new staffing system for the emergency department. The nurse has reached the "directing" phase of this project. On which activities would the nurse focus at this point? Select all that apply.
2. Selling the new system to the current emergency department staff 5. Coaching the staff through the implementation of a new schedule
A nursing group cannot complete a task assignment because information from another group has not been provided. Because the nursing group cannot complete its task, a group from physical therapy will not be able to complete its task. This is an example of breakdown in which task format? 1. Pooled interdependence 2. Sequential interdependence 3. Reciprocal interdependence 4. Reverse interdependence
2. Sequential interdependence Rationale 2: In sequential interdependence, activities must be coordinated with others in a designated order.
While providing continuing education about group dynamics and team building, the nurse manager attempts to explain the difference between a group and a team. Which statement by the manager is most effective? 1. A team is bigger than a group. 2. Teams have authority; groups may be informal. 3. A group has similar goals, whereas a team's goals are dissimilar. 4. Groups are formally designated by the organization, while teams are generally informally organized.
2. Teams have authority; groups may be informal. Rationale 2: Teams have a designated task and line authority. Groups may be either formal or informal.
The ED has seen as increase in violent behavior over the past year. The manager has voiced concerns to the CNO regarding the safety of the ED staff. What should be done as a first step in addressing this issue? 1. The manager should consult with local law enforcement. 2. The CNO should review the management of violent incidents procedure policy. 3. The CNO should discuss the matter with hospital security. 4. The CNO should have the manager discuss the matter with the ED staff.
2. The CNO should review the management of violent incidents procedure policy
A medical-surgical nurse manager has received a complaint by a client regarding the noise level on the unit. The manager reviews the schedule and harshly reprimands the nursing staff who cared for the client. What is the evaluation of this managers action? 1. It is appropriate and timely. 2. The action is inappropriate and increases the nursing staffs level of stress. 3. The action is inappropriate and should be reported. 4. It is appropriate and should be a model for future disciplinary actions.
2. The action is inappropriate and increases the nursing staffs level of stress.
A nurse manager who is retiring is helping the new manager learn about the position. As part of this education, the current manager has the new manager make all decisions that can be made under certainty. What conditions will these decisions have in common? (SELECT ALL THAT APPLY)
2. The alternatives are known 3. The conditions of each alternative are clear
Which statement indicates that a nurse has the skills to be politically involved? Select all that apply.
2. The nurse knows a lot about what is going on in the organization. 3. People often say that the nurse has a way of dealing with difficult people and situations. 4. Staff members seek out this nurse's ideas on how unit problems should be solved. 5. The nurse has a "sixth sense" about when to present new ideas.
The nurse manager is conducting a nurse's annual performance review. Which events from the previous year would be evidence that this nurse is a successful follower? Select all that apply.
2. The nurse participated in testing a new charting system before it was installed on the unit. 3. In a private meeting with the nurse manager, the nurse critiqued the manager's decision to change the unit's method of client assignment. 4. After attending an in-service presentation on a new intravenous access catheter, the nurse used one of the devices the next time an IV was ordered.
Which nursing interventions would be in line with the chronic care model? Select all that apply.
2. The nurse provides the client with the URL for a new website dedicated to self-management of a chronic respiratory disease. 3. The nurse advocates for the client who has decided to forego further dialysis. 4. Client information is entered into an electronic medical record. 5. Information about the operating hours of a community recreation center is provided to the client with coronary artery disease.
A nurse manager and a staff nurse are in conflict. The nursing supervisor has decided to use mediation to arrive at a solution. The supervisor should be most concerned about which person's level of comfort when choosing a place for the mediation meeting? 1. The manager 2. The staff nurse 3. The supervisor 4. There should be equal concern for all participants.
2. The staff nurse
The nursing supervisor is assessing a unit that has received several written complaints. The nurse manager seems overwhelmed and stressed trying to address many client situations. The charge nurse is trying to help everyone at once. Based on this assessment, what might this supervisor conclude? (SELECT ALL THAT APPLY)
2. The unit culture may foster distrust and poor communication among staff 3. Client complaints are usually an indicator of a larger unit problem 4. Nurses on the unit are in need of additional training and skills
A nursing leader wishes to maintain an image of power on a multidisciplinary committee. In a meeting, a committee member makes a statement that the nurse believes is in error. How should the nurse respond?
3. "What evidence supports that statement as accurate?"
Hospital administration has elected to use TeamSTEPPS as a method of team building. What should the nurse manager tell staff about this training? 1. "This program was developed by a nurse to use specifically in small hospitals." 2. "Teams of nurses will be sent to national training seminars." 3. "You can expect additional efforts to help us keep on track." 4. "This is a simulation-based training similar to the old disaster drills we used to do."
3. "You can expect additional efforts to help us keep on track." Rationale 3: Sustainability is a part of this framework.
The hospital has elected to initiate a rotating 8-hour shift schedule. Which strategy, taken by the nurse manager, will help staff cope with the stress associated with this staffing pattern? 1. Rotate the shifts several times each month so no one is on one shift very long. 2. Rotate the nurses among all shifts so that they know the concerns of each shift. 3. Be certain that nurses are taking their meal and work breaks each shift to increase rest. 4. Schedule a double back at the end of each rotation to allow new rotations to start uniformly.
3. Be certain that nurses are taking their meal and work breaks each shift to increase rest.
As a result of retirements, resignations, and reorganization, a nurse became nurse manager of a high-acuity unit 3 months after being licensed. The manager struggles with the responsibilities of the position and is often unable to make decisions. Which component of the AONE management competencies does this nurse probably lack?
3. Clinical practice knowledge
What is the most common skill shared by effective nurse leaders in leadership theories or models?
3. Communication
A night shift supervisor has been called to the ED to assist in managing a violent situation with a visitor. Once the violence has been contained and security and police have responded. What should be the supervisor's next action? 1. Notify staff on other nursing units. 2. Notify the violent person's physician. 3. Complete an incident report. 4. No action is necessary; the situation has been managed.
3. Complete an incident report
A newly promoted nurse manager would like staff to solve problems without relying on preconceived ideas. How should the manager role-model this ability?
3. Demonstrate a genuine desire to find our why there is dissention
During a discussion of how to proceed on a project, a team member says, "I don't care how we do it. Just tell me what to do and I will get it done." What kind of followership is this nurse exhibiting?
3. Dependent
A nurse manager has been appointed leader of a large task force charged with a complex assignment. What strategies should the manager use? 1. Limit full task force meetings to an initial meeting, a middle meeting, and a final meeting. 2. Lead one of the subgroups established at the first full task force meeting. 3. Develop a work plan with interim deadlines. 4. Set deadlines that are at least 1 week earlier than necessary to give subgroups time to be late.
3. Develop a work plan with interim deadlines. Rationale 3: This work plan will be necessary to keep all subgroups on task
A nurse has a longstanding conflict with another nurse working the same shift. Over the last few days the first nurse has made an effort to smooth over the conflict. Which statement would the nurse manager evaluate as an example of a "smoothing" comment? 1. "We are never going to agree because I am from Generation X and you are a baby boomer." 2. "I'm tired of this fight and I'm not going to argue with you anymore." 3. "Even though we don't agree on much, I do think you are correct about enforcing the length of lunch breaks." 4. "I think everything is fine and that we can get along."
3. Even though we don't agree on much, I do think you are correct about enforcing the length of lunch breaks
Immediately following a barium swallow, a client noticed hives and a feeling of shortness of breath. Although there were no known allergies to food or drugs prior to this incident, the diagnosis was allergic reaction to the preservatives in the barium. Which is the correct risk category for this incident?
3. Procedure complication
An experienced nurse manager is serving as mentor to a newly appointed manager. The experienced manager says, "always try to keep your staff as well informed as possible about what is going on at the administrative level." What rationale should the manager offer for this advice? 1. Nursing involvement at the administrative level is required by accrediting agencies. 2. Involvement of all departments in the agency supports the organizations management style. 3. Staff members who are kept informed are less likely to be suspicious and spread rumors. 4. Sharing both the positive and negative information from administration helps to reduce the managers stress.
3. Staff members who are kept informed are less likely to be suspicious and spread rumors.
The RN receives reports on eight clients in the morning. Client assignments are then delegated to an LPN and two nursing assistants. The morning is busy, with physician visits and new client orders, and the RN communicates these new orders to the LPN and nursing assistants. The RN also meets with the case manager to discuss nursing home placement for a client. What type of nursing care delivery system is in place in this hospital?
3. Team nursing
The staff nurse has been appointed to a task force. What can the nurse expect regarding this group? 1. There will be no official leader for the group. 2. The nurse will be working with people from several different departments within the hospital. 3. The assignment will be time limited. 4. The group members will compete for resources for their own units.
3. The assignment will be time limited. Rationale 3: A task group is charged with accomplishing a specific time-limited assignment.
The ICU staff has been dealing with several distractions over the last week. There was a scheduling error caused by a change in the staffing matrix and miscommunication between management and administration. The staff is also caring for a client whose family has been verbally abusive and threatening. The manager notes an increase in absenteeism with the staff over the past 2 days. To which of these distractions is the absenteeism most likely related? 1. The staffing dilemma caused by the scheduler 2. The change in the staffing matrix 3. The decline in staff morale due to a hostile environment 4. The miscommunication between management and nursing administration
3. The decline in staff morale due to a hostile environment
Which leadership activities exemplify a quantum leadership style? Select all that apply.
3. The leader is accepting of change. 4. The leader encourages staff nurses to help clients access Internet sites about their disease process.
The nurse leader wishes to develop a culture of shared visioning for the health care organization. How should the nurse proceed with this plan? Select all that apply.
3. The leader should survey employees regarding what is important to them for the organization's future. 4. The leader should encourage innovative ideas.
A staff nurse tells the nurse manager, "I don't know how you do it. You manage the unit, work extra shifts, and have so many people depending on you and yet you seem so calm and in control." What explains this nurses perception? 1. Nurse managers don't do much direct client care, so their work is predicable. 2. The staff nurse is trying to manipulate the manager. 3. The manager has excellent coping skills and high stress tolerance. 4. Some people do a very good job of hiding their stress.
3. The manager has excellent coping skills and high stress tolerance.
A nurse manager praises a staff nurse by saying, "you are such a perfectionist and it clearly shows in your work." The supervisor who hears this praise is concerned for which reason? 1. Giving such high praise to a staff nurse may result in the nurse asking for a raise. 2. The manager should not praise a staff nurse so highly in front of other nurses. 3. The manager may be promoting a trait that often leads to constant stress. 4. This type of praise often leads to the nurse behaving in a superior manner when around the other nurses.
3. The manager may be promoting a trait that often leads to constant stress.
Which action by the nurse manager is a demonstration of satisficing?
3. The nurse manager agrees with a proposed budget that does not provide badly needed new client beds
A staff nurse asks the nurse manager, "What assignment are you delegating to me today? I would like to begin to organize my day before shift report begins." What is the error inherent in this statement?
3. The nurse manager is not delegating but rather making daily assignments
A rural hospital has been at capacity for the past 3 months. The chief nursing officer (CNO) has heard numerous complaints from the nursing staff. Most of the complaints are issues related to other nursing departments and are minor. How should the CNO interpret these complaints? 1. The nursing staff members are inefficient in managing the client load. 2. This is a typical reaction among nursing departments. 3. The nursing staff is stressed due to a sustained increased workload. 4. The nurses are ready to unionize
3. The nursing staff is stressed due to a sustained increased workload.
For the nurse to effectively and legally delegate, which document must be consulted and followed to reduce the likelihood of liability?
3. The regulations of the state nurse practice acts
An OB nurse is caring for an unmarried woman who is in labor. The nurse learns the client is unwilling to name the baby's father. A male visitor who comes to visit the client raises the nurse's concern that he might be violent. Which behavior would raise this concern? 1. The visitor states, "I am the baby's father." 2. The client is very anxious with the visitor present. 3. The visitor moves into the nurse's personal space when asking about the client's status. 4. The visitor sits in a chair in the corner of the client's room, rocking and smiling constantly.
3. The visitor moves into the nurse's personal space when asking about the client's status
A group of nurses is developing a poster presentation titled "Nursing Care Delivery Through the Ages" for the hospital's annual Nurses' Day celebration. What form of nursing care delivery should they depict as occurring prior to 1930?
3. Total patient care
The hospital is opening its first intensive care unit. The nurse executive should plan to staff this unit according to which model of care?
3. Total patient care
A newly promoted nurse manager is fearful that previous coworkers will undermine her efforts to succeed in this new position. The new manager does not share information with these coworkers even though they may need the information to understand changes that are going to occur in the organization. Which emotional intelligence self-management competency is this nurse most clearly violating?
3. Transparency
The nurse has made several "near errors" in client care in the last 2 months. The nurse manager says, "These are simple errors. You just aren't listening." How could the nurse improve listening skills in this situation? (SELECT ALL THAT APPLY)
3. While listening to instructions, the nurse should ask anyone who interrupts to wait a moment 4. The nurse should get sufficient time away from work to rest 5. The nurse should be careful not to prejudge what the speaker is going to say
The nurse manager has been asked to assemble several groups to work on tasks to improve the unit's performance and client satisfaction scores. This manager would put the fewest people in a group working on which type of task? 1. Additive 2. Disjunctive 3. Divisible 4. Conjunctive
4. Conjunctive Rationale 4: In a conjunctive task, the group succeeds only if all of the members succeed, so it makes more sense to have fewer members on the team. However, the members should be highly qualified for the work.
The nurse manager presents an issue to the nursing staff for a decision. The group assesses the problem, and a decision is made meeting the needs of both the nurse manager and the nursing staff. This is an example of which conflict management strategy? 1. Integrative decision making 2. Win-lose strategy 3. Accommodation 4. Consensus
4. Consensus
A hospital is concerned about low customer satisfaction ratings and poor evaluation on quality indicators. The nurse managers are asked to implement a nursing delivery system that is cost-effective and improves both customer satisfaction and quality of care. Which nursing delivery system should the managers implement?
4. Patient-centered nursing
The nurse has determined that in order to provide the highest quality care it is important to become more creative. What is the most effective way for the nurse to increase creativity?
4. Practice the steps of the process as often as possible
A busy ICU unit has a high noise level. This frustrates the charge nurse in part because it is difficult to focus when entering physicians orders into the electronic medical record. Which would be the most appropriate action by the ICU nurse manager? 1. Decrease the noise level on the unit. 2. Tell the staff members that they need to be quiet when sitting at the nurses station. 3. Close the doors to the clients rooms. 4. Rearrange the space so that an area that is quieter is available for order entry.
4. Rearrange the space so that an area that is quieter is available for order entry.
The nurse manager realizes that power must be used to influence a change that is needed on the unit. What should this nurse remember when exerting this power?
4. The best strategy is to undertake all power interactions in a polite manner.
In which situation should the nurse be most concerned that communication was distorted?
4. The emergency nurse receives a client who was transferred via ambulance for confusion
A nurse who had advanced to assistant nurse manager was demoted back to staff nurse last month. The manager gives the nurse low-acuity client assignments. The nurse is efficient, unhappy, and bored. The nurses response is most likely related to which phenomena? 1. Low self-esteem 2. Low morale 3. Mismanagement 4. Underutilization
4. Underutilization
In order to come to a solution for an ongoing conflict among several nursing units, the nursing supervisor says, "Your managers will meet to create a voting form representing both sides of this issue. Each of you will vote and the majority will rule." What kind of a solution is the supervisor seeking? 1. Consensus 2. Win-win 3. Forcing 4. Win-lose
4. Win-lose
The nursing supervisor states, "I really don't have the time to delegate this task to a nurse manager. I can do it faster!" What is the most likely basis for this statement?
4.The nursing supervisor is concerned that staff is ill-prepared to assume additional responsibilities
A nurse manager is competing a critical incident form regarding a nurse who has missed two 12 hours shifts, three 8 hour shifts, was 2 and 1/2 hours late to one shift and left 3 hours early from another shift. The manager should document the total time lost as ____ hours
53 1/2 hours
An outbreak of smallpox has followed a national sporting event. Terrorist activity is suspected. How would this event be categorized?
A man-made, biologic disaster
A nurse is working with a hospital team to create an emergency response plan that will meet Joint Commission requirements. Which sections should be included in this plan?
A method to recognize that a disaster is imminent or occurring with plans to reduce the disaster's impact, A plan whereby policies and procedures as well as equipment and personnel are in place to handle disasters, Policies and procedures that operationalize actual activities during the disaster, Policies and procedures describing what will occur immediately after the disaster
A critical care nurse has reported off because of an illness. Which choice of replacement for this nurse would provide the best continuity of quality nursing care?
A nurse from a decentralized internal float pool
Which action will have the greatest impact on the successful implementation of a planned change?
A supportive work environment for those experiencing the change is the strategy most likely to result in an easier transition.
An emergency department (ED) manager is disciplining a nurse with a history of multiple client and staff complaints. The last disciplinary action was a verbal warning. If the institution follows the progressive method of addressing disciplinary issues, the manager would prepare for which action? A. A written warning B. A counseling session C. Another verbal warning D. Termination
A written warning
8. Florence Nightingale is attributed with being intelligent (she developed statistical methods to evaluate health care), dependable (she often worked long hours to care for the injured), and ambitious (she fought against society's perception of nursing). Those who depict her as a leader on the basis of these qualities are practicing which leadership theory? A.Trait B. Chaos C. Bureaucracy D. Organizational
ANS: A Correct: Leadership trait theory describes intrinsic traits of leaders and is based on the assumption that leaders were born with particular leadership characteristics. Other traits found to be associated with this leadership theory include intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery.
16. A staff nurse provides care based on intuition and always seems to be in control of her personal and professional life—serving on the board of the state nurses association, serving as the nursing unit's representative on the ethics committee, and coaching her daughter's soft ball team. Many of the staff observes how she manages time and provides care. This nurse's power comes from which type of power? A. Referent B.Legitimate C. Information D. Connection
ANS: A Correct: Referent power comes from the followers' identification with the leader Referent leaders are admired and respected and able to influence other nurses because of their desire to emulate her.
9. A nurse manager is concerned with restocking the emergency cart, creating the staff schedule, requesting floor stock from pharmacy, and checking the orders on patient charts. Which type of leader accurately describes this nurse? A.Transactional B. Situational C. Transformational D. Contemporary
ANS: A Correct: The transactional leader is concerned with the day-to-day operations of the facility.
1. In an attempt to persuade employees to bargain for another type of health insurance, a handout is circulated that describes the present employees' health care insurance as being insensitive, limiting choices of care providers, and providing inferior care. This reflects which aspect of Lewin's planned change? a. Unfreeze b. Move c. Refreeze d. Acceptance
ANS: A Correct: Unfreeze is correct because the change agent promotes problem identification and encourages awareness of the need for change. In alignment with Lewin's stages of change (unfreezing, moving, and refreezing), education and involvement are keys to successful change. People must believe that improvement is possible before they will be willing to consider chang
10. According to the unit's policy for call-ins, a nurse is suspended for 3 days because of excessive call-ins that occur within 15 minutes of shift change. The nurse states, "You are unfair to me." Which theory would disprove the nurse's statement? A. Bureaucracy B. Closed systems C. Open systems D. Trait
ANS: A Correct: Weber's concept of bureaucracy revolves around the assumption that authority confers the right to issue commands within an organization on the basis of impersonal rules and rights, by virtue of the management position rather than any trait ascribed to the person who occupies that position. Other characteristics include the following: Impersonal rules govern the actions of superiors over subordinates, all personnel are chosen for their competence and are subject to strict rules that are applied impersonally and uniformly, and a system of procedures for dealing with work situations is in place. Represents the systems theory of the organization.
7. The illustration below identifies which type of chart? A. Productivity B. Organizational C.Resource D. Staffing
ANS: B Correct: An organizational chart is a visual picture of an organization that identifies lines of communication and authority. Incorrect: a. Productivity is the amount of output or work that is produced with a specific quantity of input or resources. c. Resources include personnel, time, and supplies needed to accomplish the goals of an organization. d. Staffing is the manpower needed to complete the work.
3. The first step in the nursing process and in the problem-solving process is to: a. identify the problem. b. gather information. c. consider the consequences. d. implement interventions.
ANS: B Correct: The nursing process, which is familiar to nurses who address patient care needs, can be applied to all management activities that require decision-making and problem-solving. As in the nursing process and the problem-solving process, one must first gather information about the problem or situation.
19. A hospital recently learned that their scorecard did not meet the national benchmark for patient satisfaction and brought in a professional change agent to determine what their issues were and how they could improve their score. The agent collected data and recommended that nurses participate in interdisciplinary walking rounds and allow the patient and family to be participants. Nurses now round every shift and perform "huddles to update the team" as needed throughout the shift as part of best practices. Random visits are made to nursing units to ensure all nurses are participating and patients are interviewed for their involvement. This stage of Lewin's change is: A. unfreeze. B. moving. C. refreeze. D. resistance.
ANS: C Correct: In the refreezing stage, change becomes status quo and the agent reinforces until the change is part of the daily process as in the above situation.
6. Managers who exhibit an authoritative behavioral style are most likely to use which source of power? a.Informal b.Expert c.Coercive d.Reward
ANS: C Correct: Seven primary sources of power are known. Coercive power is based on fear of punishment or failure to comply. Coercive power fits well into the authoritative behavioral style because authoritative managers dictate the work with much control, usually ignore the ideas or suggestions of subordinates, and provide little feedback or recognition for work accomplished.
15. A director of nursing (DON) asks the staff to list how their nursing unit can help the organization meet its goal to "provide quality patient care with attention to compassion and excellence." An ad hoc committee is formed to develop a timeline of identified actions. The DON coaches the committee to reach desired outcomes. This DON is demonstrating which other role of leadership and management? A. Transactional B. Clinical consultant C. Corporate supporter D. Autocratic
ANS: C Correct: The manager is embracing the mission of the organization by supporting achievement of goals noted in the mission statement.
2. One difference between a leader and a manager is that a: A. Leader has legitimate authority B. Manager motivates and inspires others C. Manager focuses on coordinating resources D. Leader focuses on accomplishing goals of the organization
ANS: C Correct: The terms leadership and management are often used interchangeably, and it is difficult to discuss one without discussing the other. However, these roles have specific traits unique to themselves. The manager is the coordinator of resources (time, people, and supplies) needed to achieve outcomes.
13. A hospital's policy requires that all nurse managers must have a minimum of a bachelor's degree in nursing. A BSN nurse new to the hospital has recently been hired as nurse manager for the oncology unit. An RN who has worked on this unit for many years is unable to be promoted to a nurse manager position because of his educational status and has been commenting to physicians and staff, "The new nurse manager has book sense but no leadership abilities." What is the best approach that can be used by the new nurse manager who is attempting to gain the trust and respect of the nursing staff on the unit? A. Send memos to all staff except the upset nurse to invite them to a luncheon. B. Ask management to transfer the upset nurse to another unit. C. Assign the upset nurse to committees that do not directly affect that nursing unit. D. Acknowledge the clinical expertise of the upset nurse and clearly explain the expectations for teamwork and open, honest communication.
ANS: D Correct: The best way for the new nurse manager to communicate with this employee, who may be an informal leader, is to show respect for the individual's clinical expertise and experience through clear and direct communication. The new nurse manager should attempt to identify the staff nurse's power as an informal leader, should involve him and other staff members in decision-making and change-implementation processes, and should clearly communicate goals and work expectations to all staff members.
11. A nurse is reading about positive reinforcement with the goal of increasing staff motivation. Which action would demonstrate positive reinforcement? A. Every morning at shift change, thank each employee for an excellent job. B. Rotate a monthly "employee recognition award" among all employees on the unit. C. Wait until the annual performance review to recognize accomplishments. D. Give spur-of-the-moment recognition to an employee who has accomplished a goal.
ANS: D Correct: To be effective, positive reinforcement should (1) be specific, with praise given for a particular task done well or a goal accomplished; (2) occur as close as possible to the time of the achievement; (3) be spontaneous and unpredictable (praise given routinely tends to lose value); and (4) be given for a genuine accomplishment.
Leader competencies are a necessary aspect of a leader's role. As a leader, you are aware that the following is needed for this role: A. A clear vision and owned purpose B. A pessimistic attitude with colleagues C. A negative approach with families D. A membership with more than three committees
Ans: A Leaders need to "do the right thing," be future oriented, be visionary, focus on purposes, and empower others to set and achieve organizational goals.
You are mentoring a new nurse. You know that which of the following is NOT a mentor's responsibility? A. Discuss means to correct chronic tardiness B. Offer criticism on nursing skills C. Perfom a nurse's probation period review D. Evaluate the nurse's exact break and lunch times
Ans: A Page 4 and 7 Leaders focus on effectiveness, and managers deal with efficiencies. Discussing means to correct chronic tardiness is the job of a first-level manager since it is the task for first-level-managers to submit time schedules for nursing shifts as well as conducting employment reviews, including counseling reports and termination.
The vice president of nursing is responsible for: A. Establishing organizational goals and strategic plans for nursing B. Developing and maintaining daily assignments C. Prioritizing events during disaster plan implementation D. Overseeing the mission and vision of the organization
Ans: A Page 9 Vice president of nursing is an upper-level manager. "A nurse executive is a registered nurse who is part of the executive management team and as such is responsible for the management of the nursing organization and clinical staff or nursing throughout the organization." Upper-level manage is responsible for establishing organizational goals.
The middle-level manager: A. Makes hospital-wide decisions B. Supervises a number of upper-level managers C. Is responsible for the people and activities on a 24-hours-a-day/7-days-a-week- basis D. Is responsible for their specific shift only
Ans: C The middle-level manager, also know as supervisor, director, assistant director or associate director of nursing. They supervise a number of first-level managers. They may spend more time planning, evaluating, and coordinating and less time with direct patient care. They are responsible for the people and activities within the departments they supervise on a 24-hours-a-day/7-days-a-week basis.
The nurse manager on the labor and delivery unit evaluates that one of the staff nurses has leadership qualities. Which of the following is a basis for this judgment? A. The nurse works overtime every week B. The nurse stays long after her shift is over to chart C. The nurse uses a monthly forum to review current knowledge content D. The nurse uses a negative approach when evaluating staff skills
Ans: C Leadership can be defined as the use of individual traits and personal power to influence and guide strategy development. Leaders need to "do the right thing," be future oriented, be visionary, focus on purpose, and empower others to set and achieve organizational goals.
A nurse who is obtaining a bachelor's degree in nursing is formulating a project regarding nurse's job satisfaction. The nurse is aware that research has shown job satisfaction is related to which factors in the working environment?
Appropriate staffing, involvement in organizational decision making, being recognized for a job well done, good relationships among staff
Every month the chief financial officer (CFO) reviews the budget with the hospital's board of directors. The CFO requests a million dollars to purchase a new MRI (magnetic response imaging) unit for the radiology department. Which category best describes this request? A. Non-revenue expense B. Capital expense C. Variable cost D. Allocation of funds
Capital expense
The pharmacy reports that medication records of a unit have begun to show frequent corrections. What other signs of diversion would the manager look for on the unit?
Chart review on effectiveness of pain control, Increase in use of doses of as-needed narcotics that results in wastage, Chart review that reveals that clients require much more narcotic pain medication on one shift than on others, Narcotic containers that look as if they have been altered
a nurse comes to a mandatory education session wearing a picture and slogan that is degrading to nursing. what should the manager do first?
Check the human resources policies regarding appropriate dress
The nurse manager is planning to initiate new policies in the department and is reviewing several change theories. Which step of Havelock's model will the nurse find most closely resembles Lewin's moving stage?
Choosing a solution and gaining acceptance are most like Lewin's moving stage. Previous to this stage in both models, the work is to convince participants that change is necessary and to secure resources for the change. After solutions are identified and implemented, the final stage begins.
An experience nurse often answers less experienced nurses' questions about client care and teaches hemodynamics during orientation to the unit. The nurse has also participated in research into hemodynamic monitoring of ICU clients. Which clinical ladder designation does this nurse best exemplify?
Clinical expert
A nurse comes to the unit manager to report a coworker's behavioral changes. The nurse has noticed that the coworker's handwriting has become shaky and illegible, that the coworker has mood swings and that the coworker has increased tardiness. Which should be the manager's first action?
Collect additional information regarding behaviors, absenteeism and/or tardiness
A nursing unit is extremely short staffed. The manager calls a nurse who is on Family and Medical Leave to ask the nurse to return to work 2 days prior to schedule. When the nurse declines, the manager becomes insistent. What should be the nurse's first action?
Contact the HR director
A nurse manager is struggling with two marginal nurses and goes to the supervisor for advice. How should the supervisor advise the manager?
Continue to be persistent in you work with these nurses, Be fair and consistent with them, You must continuously assess the rest of your staff as you work with these two nurses, You must continue to address the issues with these nurses as they arise
The nurse manager is explaining the organizational staffing policy to a newly hired nurse. The nurse will be scheduled on an as needed basis. The manager explains this policy is a supplemental scheduling policy. Which staffing strategies would be included in this policy?
Contracting with outside agency nurses, A decentralized float pool, Establishing an internal float pool, Establishing an internal float pool of nurses who are cross trained, Developing a float pool of nurses shared with another hospital in the system
A nurse who has just returned from two weeks of time off following minor surgery says, Im so glad to be back to work. Im sick of watching television. I cant believe I missed the stress here. What are possible explanations for this statement? Select all that apply. 1. Lack of stress can cause boredom. 2. Stress can be motivational. 3. Apathy can occur if stress is absent. 4. Eustress occurs when stress is decreased too much. 5. A balance between stress and coping is essential.
Correct Answer: 1, 2, 3, 5 Rationale 1: A certain amount of stress is stimulating. Without stress boredom can occur. Rationale 2: A moderate amount of stress can motivate a person to perform. Rationale 3: A person who is accustomed to stress may become apathetic if stress is removed. Rationale 4: Eustress is positive stress. Rationale 5: If there is not enough stress, the person feels out of balance.
A staff nurse is late for work for the second time this week. When the manager mentions the tardiness, the nurse says, Im so sorry. Ive just got so much going on with my impending wedding. I am so stressed. Which responses by the manager would help this nurse cope?Select all that apply. 1. Good stress can be just as bad as negative stress. 2. We need to get you back in balance. 3. Your personal issues should not interfere with work. 4. Weddings are fun, but they can be stressful as well. 5. If you are late again, I am going to write you up.
Correct Answer: 1, 2, 4 Rationale 1: Good stress can be just as hard on the body as negative stress. Rationale 2: A balance should exist between stress and the ability to handle it. Rationale 3: The nurse realizes this fact, apologized, and offered an explanation for the tardiness. Rationale 4: Acknowledging the nurses situation may help with coping. Rationale 5: A threatening response will not decrease the nurses stress.
A newly hired registered nurse is having difficulty focusing and performing nursing tasks. The nurse manager has noted a decrease in the nurses performance. When meeting with the nurse, the manager learns the nurse has recently gotten married and moved into a new home. The client load in the unit has returned to normal levels from very high levels and another newly hired nurse was terminated for disruptive behavior. The nurse reports that everyone has been so nice and they try to help me. Which situations are most likely causing this nurses stress?Select all that apply. 1. Marriage 2. Purchasing a new home 3. Decreased workload 4. Assistance from other nursing staff 5. The coworker who was terminated
Correct Answer: 1, 2, 5 Rationale 1: Even though getting married is a happy time, the wedding can be very stressful to plan. Adapting to married life can also be stressful. Rationale 2: Purchasing a new home is very stressful. Rationale 3: Typically, a reduced workload is not stressful. Rationale 4: Assistance from other nursing staff should not be stress inducing. Rationale 5: Working alongside a noncompliant coworker who is terminated can be very stressful.
A nurse supervisor is aware that nurses in the facility have been under a great deal of stress while working through a major change in the ownership of the hospital. Which nurses would the supervisor be most concerned might develop compassion fatigue? Select all that apply. 1. Emergency department nurses 2. Outpatient diagnostic procedure nurses 3. Nurses working in the trauma surgery unit 4. Nurses working in geriatrics 5. Nurses working in obstetrics
Correct Answer: 1, 3 Rationale 1: Compassion fatigue is more likely to occur when the nurse is providing care to people who are traumatized. Emergency department nurses fall in this category. Rationale 2: Outpatient nurses may be somewhat sheltered from caring for trauma patients, which is a major cause of compassion fatigue. Rationale 3: Compassion fatigue is more likely to occur when the nurse is providing care to people who are traumatized. Trauma surgery nurses fall into this category. Rationale 4: Nurses working in geriatrics are not at as great a risk for compassion fatigue as other nurses. Rationale 5: Generally, the risk for compassion fatigue is not as high in nurses working in obstetrics.
A staff nurse on a busy outpatient surgery unit comes to the manager and says, "I don't know what is going on. I just feel unsettled and anxious." How should the manager interpret this statement? Select all that apply. 1. The nurse is trying to establish a problem for which days off will be necessary. 2. The nurse may be suffering from free-floating anxiety. 3. The nurse may be overstressed. 4. The nurse has compassion fatigue. 5. The nurse is about to experience post-traumatic stress disorder.
Correct Answer: 2, 3 Rationale 1: There is no indication that the nurse is trying to make up an illness to get time away from work. Rationale 2: Free-floating anxiety is anxiety that seems to have many alternating causes. Rationale 3: Stress can cause these feelings of anxiety or fear. Rationale 4: Compassion fatigue has much more serious symptoms than anxiety. Rationale 5: There is no evidence of post-traumatic stress disorder.
The nurse manager of an intensive care unit has several open shifts that require an RN to fill. Several nurses have taken overtime shifts but there are still several uncovered shifts. The CNO decides to fill these vacancies with agency nurses. The CNO realizes that agency personnel must have which requirements prior to working in the facility?
Current licensure to practice within the state, orientation to the facility and the unit, documentation of malpractice insurance
Hospital administration is aware that staff may be reluctant to be called back to work in a disaster. How can the hospital be proactive in encouraging staff to make the decision to serve?
Develop a caring relationship with staff during normal times
The manager is contemplating terminating a nurse. What should the manager consider regarding the expectations of the job prior to proceeding with termination? A. Did the nurse receive and sign for a copy of the appropriate job description when hired? B. Was the nurse apprised of the criteria on which evaluation would be based? C. Have any changes to policy and procedure been discussed with the nurse and made available in writing? D. Was the nurse hired using the same documentation as others hired at the same time? E. Have others hired during the same time period been successful?
Did the nurse receive and sign for a copy of the appropriate job description when hired, Was the nurse apprised of the criteria on which evaluation would be based, Have any changes to policy and procedure been discussed with the nurse and nade available in writing? A, B, C
A director must discipline an ICU manager. The director and manager have become friends. When disciplining the manager, what is the best approach by the director? A. Notify the human resources director that the meeting will occur. B. Include the chief nurse officer (CNO) in the session. C. Ask a manager from another department to sit in on the meeting. D. Discuss the issue, concentrate on the issue, and do not make it personal.
Discuss the issue, concentrate on the issue, and do not make it personal
A nurse who receives frequent phone calls informs the manager the phone calls are related to a health crisis concerning a family member. Other nurses also receive personal calls, but not as many as the first nurse. Which action by the manager is appropriate? A. Tell the nurse to have family call the manager's office if there is a crisis. B. Discuss with the nurse how personal phone calls may affect client care and should be limited. C. Inform the nurse the phone calls are causing morale issues among the staff. D. Lift the policy against staff carrying personal cell phones for this nurse while the crisis continues.
Discuss with the nurse how personal phone calls may affect client care and should be limited
A nurse makes a medication error and notifies the client's physician. The physician berates the nurse over the phone and states - you are an idiot. How should the manager deal with this situation?
Document the facts of the encounter, Privately tell the physician that the behavior was bullying, Confront the physician during rounds and demand an explanation
A nurse manager overhears a conversation in which staff nurses complain about the evaluation process. One nurse says,"It really is just a waste of time. I get the same raise no matter what I'm rated" Which is the best way for the manager to address this concern?
Emphasize the practice development aspects of evaluation
The nurse manager is facilitating change to a new documentation system in the unit. If the manager wants to use the most common method to overcome resistance to the change, which strategy would be chosen?
Giving information is the most common method of changing individuals' perceptions, attitudes, and values.
The hiring process to fill a nursing position has been slowed because the human resources department is involved in a recruitment effort for laboratory positions. A staff nurse says, Why do we have to wait on HR? Why cant we just hire a nurse? What rationale does the nurse manager provide for waiting until HR can be involved in filing the nursing position?
HR will screen the applicants for us so we dont waste time interviewing people who are not qualified, HR makes certain that we are not doing anything illegal as we interview for this position, We cant hire a nurse until HR has done a criminal background check, HR has to check to be certain that the applicant has a valid license before we can offer the job
The manager has just terminated a nurse. What statement by the manager is appropriate? A. "You may go back to the unit to say good-bye to your coworkers." B. "We have cleaned out your locker and have your personal belongings ready for you." C. "I have notified security to escort you as you leave the building." D. "As of this time, you are no longer an employee of this institution." E. "Please do not discuss your termination with any other nurses."
I have notified security to escort you as you leave the building, as of this time, you are no longer an employee of this institution
A nurse writes some scathing remarks about another nurse's professionalism on a social media site. A complaint of bullying lodged with the nurse manager. Which statement by the manager is appropriate?
I will follow up on this complaint and take action as needed
A valued long time nursing employee says to the manager, I am so tired of all the policies on this unit. I am thinking about retiring. What should the manager's response be?
I'd hate to lose you but have you thought about transferring to a different unit?
A hospital has used capital funds to purchase a new piece of diagnostic equipment. The hospital's chief financial officer (CFO) says, "The cost of this equipment will be expensed out across all units that use it." How should the nurse manager interpret this statement? A. The equipment is jointly owned by all units that use it. B. If clients on the manager's unit require the use of this equipment, a portion of the cost will be charged to the unit. C. The equipment will be rented to the units for use. D. The nurse manager will ask physicians to refrain from using the equipment.
If clients on the manager's unit require the use of this equipment, a portion of the cost will be charged to the unit
The nurse manager of a post surgical unit is preparing the next month's schedule. The manager has reviewed the surgery schedule for the corresponding month and notes there are several high acuity surgeries. Which staffing adjustment would the manager ,ake to best provide the care needed by these postoperative clients?
Increase the number of registered nurses
The manager has disciplined a nurse with a written warning. At the end of the session, the manager asks the nurse to sign the warning and the nurse refuses. What should the manager do? A. Tell the nurse that signing the form in mandatory. B. Indicate on the form that the nurse declined to sign. C. Sign the nurse's name to the form and include the manager's initials. D. Complete a second warning for the nurse's failure to follow procedure.
Indicate on the form that the nurse declined to sign
A charge nurse on the night shift did not notify the anesthesiologist regarding an emergency case. The manager investigated the matter and learned the charge nurse thought the primary care nurse would call the anesthesiologist. Which response by the manager would be most appropriate? A. "It is in your job description and your duty." B. "It is your responsibility. In the future, call anesthesia and transfer the call to the primary nurse." C. "It's not the surgery nurse's responsibility to call anesthesia!" D. "Why was this considered an emergency case?"
It is your responsibility. In the future, call anesthesia and transfer the call to the primary nurse
A baccalaureate nurse has been invited to join Sigma Theta Tau International (STTI). While trying to decide about taking the offer, the nurse asks a member about the organization. Which option reflects the best reason to join a group such as this?
It offers the ability to network and learn while serving the organization
An experienced ICU nurse manager is orienting a newly hired nurse manager to the organization. The ICU manager makes occasional notes in a small notebook. The new manager asks why the ICU manager is taking notes. What are the most likely rationales for this behavior?
It saves me time in the long run, Taking notes helps me to address issues immediately so they do not escalate, It helps me to remember what to address in staff meetings, Having notes helps protect me when evaluations are written
A staff nurse is not meeting job expectations. The manager has followed some standard strategies such as counseling to try to motivate the nurse, but they have not been successful. When discussing the situation with the supervisor, the manager says, I Think I will try shaping strategies. What can the supervisor expect of the staff nurse's performance?
It should gradually move toward the expected behaviors
A nurse manager writes the following note: "Over personnel budget by $1,250 in April due to late snowstorm. Nurses unable to get to work. Overtime wages paid." Why is this note important? A. It will help the manager create the budget for the next year. B. It is required by The Joint Commission. C. All variances must be documented and forwarded to the hospital attorney. D. It ensures that there is no question of diversion of hospital funds.
It will help the manager create the budget for the next year
A nurse manager is trying to educate the staff regarding efficiency and how it affects the unit's costs. Strategies to increase efficiency could include which of the following? A. Increasing the number of unlicensed assistants providing direct nursing care B. Limiting dressing supplies on the nursing unit C. Labeling the cost of each item in the clean supply closet D. Eliminating staff education sessions
Labeling the cost of each item in the clean supply closet
A nurse who has an interview with the HR director enters the office, doesn't make eye contact, and is very timid. Toward the end of the interview the HR director asks the nurse if there are any questions. The nurse states, "no, I think I've learned all that I need to know." What impression has this nurse given the HR director?
Lack of interest in the position
Which statement by the nurse manager is the best example of day-to-day coaching? A. "Can we meet this afternoon for about 30 minutes to discuss your progress?" B. "I think you need to get different day care that would allow you to be on time." C. "Over the past 6 months the narcotics count has been off on several days that you have worked." D. "Let me show you a method I have found to be effective in making patient assignments."
Let me show you a method I have found to be effective in making patient assignments
The nurse was reported for not following unit policy in relaying a client's complaint regarding another staff member. During a meeting, the nurse insists he managed the situation appropriately. How should the manager respond? A. "Let's schedule another meeting for later in the week after you have had time to reflect on the situation a little more." B. "Let's explore some alternative solutions to what happened." C. "I am going to request a meeting for both of us and the human resources director." D. "As I see it, the problem is your inability to follow the simplest of unit policies and to take direction."
Let's explore some alternative solutions to what happened
Hospital management is brainstorming ways to reduce absenteeism. Which suggestions from this session deserve further investigation?
Lets offer a salary increase for those with good attendance, Why not include attendance as part of the employee performance appraisal, I don't think we are enforcing the absence policies we have now. That is the logical part to start, We need to start at the top and be certain all of our management employees maintain good attendance
An employee has consistently violated policy and has not responded to coaching. The manager has decided that discipline is required. What should the manager do first?A. Plan a private meeting for the disciplining. B. Wait for one more infraction to occur and discipline immediately afterward. C. Make certain that the information regarding policy violations is correct. D. Keep the human resources department informed.
Make certain that the information regarding policy violations is correct
A client's spouse is concerned about the cost of hospitalization. The nurse says, "Since your spouse is on Medicare, the hospital will be paid according to the DRG." What does the nurse mean by this statement? A. Medicare will pay the total cost for the care provided. B. Medicare will pay an average of the total costs. C. Medicare will pay based on the usual cost of the treatments provided. D. Medicare will pay based on a set amount for the specific condition for which the client was hospitalized.
Medicare will pay based on a set amount for the specific condition for which the client was hospitalized
A nurse who has a baccalaureate degree in nursing is interested in going to graduate school. The nurse is talking to a peer who is in a nurse practitioner program. Which advice would be beneficial for this nurse in choosing a graduate program?
Meet with faculty and students of various graduate programs
A nurse has been pulled from the surgical unit to the ICU unit and is asked by an ICU nurse to administer a medication that requires monitoring the cardiac rhythm. When asked about the client's cardiac rhythm after the medication was administered, the surgical nurse states, "I don't know." What actions should be taken by the unit's nurse manager? A. Meet with the ICU nurse to discuss the situation. B. Meet with the surgical nurse to discuss the situation. C. Give a written warning to the surgical nurse for not following policy. D. Give a written warning to the ICU nurse for not following policy. E. Meet with the nurses together and issue an informal verbal warning to both.
Meet with the ICU nurse to discuss the situation, Meet with the surgical nurse to discuss the situation A, B
A nursing assistant has taken long lunch breaks for the last 2 days and today is 15 minutes late returning from the cafeteria. What should the manager do? A. Go to the cafeteria and confront the assistant. B. Send a message with a nurse going to lunch for the assistant to return to the unit immediately. C. Call the cafeteria and ask that they send the assistant back to the unit. D. Meet with the assistant and calmly say, "You have been late back from lunch for 3 days this week." E. Anticipate that the assistant will give an explanation for the lateness.
Meet with the assistant and calmly say, "You have been late back from lunch for 3 days this week,", Anticipate that the assistant will give an explanation for the lateness D, E
The staff has complained that a nurse receives frequent personal phone calls, which is a violation of policy. In what manner should the manager address this nurse? A. Meet with the nurse privately and inquire as to the necessity of personal phone calls. B. Meet with the nurse and give a verbal warning. C. The manager should inform the nurse the other nurses are complaining about the phone calls. D. Tell the complaining nurses to handle the situation with peer pressure.
Meet with the nurse privately and inquire as to the necessity of personal phone calls
A hospital administrator receives a call that mass casualty shootings have occurred at several different locations within the city. Early information indicates that up to 50 victims may be arriving at the hospital starting within minutes. What action should the administrator take?
Mobilize the hospital incident command system, Notify other administrators and order a rapid needs assessments in all critical areas, Authorize the implementation of the hospital's disaster plan
A proposed change in a health care organization is controversial and will require cooperation from all parties involved. Which change strategy should the change agent use?
Normative-reeducative strategy uses collaboration as its primary decision-making technique. It is most likely to result in the greatest number of people being happy with the decisions made.
The manager overhears a nurse say to a client, I am having trouble getting your IV started because you are so fat. The manager determines that a critical incident form should be completed. Which entry is appropriate to document on the form?
Nurse ______ attempted to start an IV on this client and state, "I am having trouble getting your IV started because you are so fat."
The CEO of the hospital approaches the chief nurse with a request that the nurse act as the primary change agent in the implementation of a new hospital-wide policy. Why would the nurse be a good choice for this assignment?
Nurses are client advocates who routinely interact with multiple disciplines in the provision of quality care.
A nurse manager strongly believes that nurses should seek advanced educational degrees. The manager encourages this attitude in staff nurses. What are the dangers of this practice?
Nurses who achieve an advanced degree are more mobile, Staff members may need time off to attend school, Staff members may need to resign to attend school full time
A nurse is unsure in which graduate nursing program to enroll. A colleague recommends the nurse consider a degree program for which it appears there will be growing demand. Which role is expected to continue to be in great demand in the future?
Nursing education
The nurse manager is explaining her staffing budget to the hospital administration. the manager has developed a flexible staffing pattern. The administration questions the manager as to why this pattern was developed. Which answer is most correct?
Nursing shortages and salary constraints have affected staffing patterns
A nurse manager has a strong belief in the value of certification for staff nurses. Unfortunately, only two staff members are certified. How could the manager encourage the remaining staff to seek certification?
Obtain grant monies to fund purchase of materials for certification Support those who are seeking certification with study sessions and helpful study hints Work with administration to obtain a salary adjustment for those who become certified Role model the behavior by becoming certified
The staff development nurse has elected to use coaching as a staff development technique. Which situation is an example of this technique?
Pairing a nurse with conflict management experience with an employee who has expressed dissatisfaction with the job
A nurse constantly complains about employee policies and procedures and frequently mentions how they are out to get us. The nurse is surprised when referred to by the manager as disgruntled during a discussion of this behavior. What information should the manager provide this nurse?
People who are constantly complaining decrease the morale of the rest of the unit
The nurse manager identifies a minor problem with the way a staff nurse documents client care. The manager meets with the nurse and discusses the issue, but does not issue a warning. What is the manager's next action? A. Report the meeting to human resources. B. Enlist the aid of a more experienced nurse to help monitor the documentation. C. Record the specific behavioral steps discussed for future reference. D. Tell the nurse that failure to comply with steps discussed will result in a written warning.
Record the specific behavioral steps discussed for future reference
An OB nurse has violated a unit policy. The OB manager is discussing the incident with the nurse. During the discussion the nurse informs the OB manager of the actions of other staff and the physician's attitude leading up to the event. How should the manager address these issues? A. Tell the nurse that physician's attitude is none of the nurse's business. B. Inform the nurse of the policy violation. C. Inquire about the physician's attitude and the staff actions during the incident. D. Redirect the nurse to focus on the issue.
Redirect the nurse to focus on the issue
The nurse manager becomes aware of frequent incorrect narcotics counts on the night shift. This is verified by the pharmacy. What should be the first action taken by the manager?
Review the staffing pattern and absentee list for the night shift
The nurse manager is updating the position control sheet for the fiscal year prior to beginning a new budgetary cycle. What would the manager include in this sheet? Select all that apply. A. The FTE factor for an LPN hired this month B. The current wage range for RNs working on the units C. The names of all unit clerks working in the unit D. The level of licensure of a nurse working on the unit E. The fact that two RNs have retired this year
The FTE factor for an LPN hired this month; The names of all unit clerks working in the unit; The level of licensure of a nurse working on the unit; The fact that two RNs have retired this year; A, C, D, E
A manager has been informed by a reliable registered nurse that an assistant lied about bathing a client. The manager calls the assistant into the office with a written warning. Why is this action inappropriate? A. The registered nurse should issue the warning. B. The first warning should be verbal. C. The assistant should be allowed to discuss the matter. D. This type of action should be conducted by the human resources department.
The assistant should be allowed to discuss the matter
The nurse manager tells the staff that this year's budget numbers will not change, even if census drops over the rest of the year. How should the staff interpret this information? A. The budget is a fixed one. B. The hospital uses incremental budgets. C. The hospital uses a variable budget. D. The hospital starts the budgeting process with a zero-based budge
The budget is a fixed one
When faced with the prospect of change, the nurse states, "We have always done it this way and never had any problems." A few weeks later, the same nurse remarks, "This new way seems to work better than the old way did." This statement is characteristic of which type of change response?
The early majority prefers the status quo but eventually accepts change.
a nurse manager often uses negative reinforcers as part of operant conditioning in order to inhibit undesirable behaviors. What often results from this action?
The employee ducks into a client room each time the manager is seen, no improvement in the frequency of the undesired behavior is seen, the employee calls in sick more often, the manager must constantly monitor the situation
Which findings associated with an employee are likely to be considered when discussing performance?
The employee has been tardy on one occasion when an unexpected snow feel just before shift change, The employee found a purse containing $200 in the cafeteria and turned it into security, The employee made two work errors requiring incident reports in the last year.
Unrest and employee turnover have resulted in a unit being critically understaffed. The human resourcces department and nurse manager are attempting to recruit new nurses for the unit. How should the history of this unit be presented?
The facts of the history should be presented while maintaining the confidentiality of those involved, Steps being taken to correct problems on the unit should be outlined and explained
A hospital's budget is incremental. Which statement by the nurse manager reflects use of this type of budget? Select all that apply. A. "The finance department sent me the budget worksheet with last year's expenses." B. "We have $1,000 left in our education account that we need to spend before the year is over. Who has an idea for a class to attend?" C. "I have to justify all our activities as if we have never done them before." D. "I like this type of budget preparation because it is fairly simple and straightforward." E. "In order to create next year's budget, I am to start at 80 percent of what we budgeted last year."
The finance department sent me the budget worksheet with last year's expenses; We have 1,000 left in our education account that we need to spend before the year is over. Who has an idea for a class to attend?; I like this type of budget preparation because it is fairly simple and straightforward A, B, C
The new chairperson of the nursing department has determined that the faculty's teaching is stagnant and outmoded. The chairperson would like to encourage the faculty to adopt more innovative teaching strategies. According to Lewin, what is the first step in initiating this plan?
The first step is to unfreeze the existing equilibrium by asking staff to become part of the process of change, particularly in the first phase.
A nurse manager has recently been transferred from OB to Pediatrics. The manager consistently stays in the office, does not relieve staff for lunches and rarely assists staff when the unit is to busy. Lately, the manager has noticed an increased in staff absences. Which options may contribute to the situation on the unit?
The manager has a lack of confidence in personal ability to provide care to pediatric clients, The manager is unable to confront staff regarding absences, The manager is not supervising the work of the unit, The manager has a lax attitude toward absenteeism
An emergency department nurse manager is preparing for a night-shift nurse's annual appraisal. The manager is apprehensive because there are issues to address regarding rudeness and unprofessional behavior. How should the manager prepare for conducting this appraisal?
The manager should arrange a 20-30 minute meeting with the nurse to discuss the evaluation privately
A nurse manager has planned orientation activities for a new registered nurse. The new nurse is required to observe shift report and UAP delegation for a week. Then the new nurse is required to take shift report and delegate UAP assignments for a week. What is the rationale for making this orientation assignment?
The manager should focus on those skills specific to the new nurse's role
An organization has begun using critical incidents as part of the evaluation process. The supervisor is meeting with a manager to review the managers use of critical incidents since training last week/ Which finding would concern the supervisor?
The manager's notes are all written at the same time on the same day, There is no indication that the critical incidents recorded have shared with staff, One note states, "This nurse has an abrasive personality"
During an interview with a potential employee, the nurse manager tells the individual that an additional 10 percent of the hourly rate will be paid for working the 7:00 pm-7:00 am shift. What is another way the manager could have described this difference in pay? A. "You will receive an additional 10 percent for overtime." B. "The night shift differential is 10 percent." C. "Your evening premium is 10 percent." D. You will get a 10 percent cost-of-living raise for working the night shift."
The night shift differential is 10 percent
A nurse manager elects to ignore a nurse's performance problem, hoping it will go away. What does this strategy indicate about the nurse's management ability?
The nurse is using a valid strategy.
Which statements would the nurse manager interpret as indicating a nurse understands the critical thinking skills necessary for disaster management?
The nurse's prioritization will be different in a disaster, Clinical judgment skills will be an essential part of nursing's contribution to disaster management, The nurse's abilities will make the difference in successful management of a disaster
Multiple casualties have arrived at the emergency department following a tornado. Which instructions from the manager to staff is incorrect?
There is no time to worry about using personal protective equipment, just try to be safe
A nurse manager tells the human resources director, "I would really like to hire somebody of another race to balance out the team" The HR director tells the manager recruiting and hiring based on race is in violation of which statute?
Title VII of the civil rights act
Why is post disaster follow-up an essential part of disaster planning?
To evaluate the performance of those involved, To initiate any improvements needed, To evaluate the overall effectiveness of the plan
A nurse is considering graduate school. The nurse is interested in becoming a nurse practitioner. This nurse has worked as a medical-surgical nurse for the past 10 years. Which opportunity would benefit this nurse's career?
Transferring to the ICU unit
The management staff is investigating ways to decrease absenteeism that will also help to promote greater job satisfaction over the long term. Which suggestions should they consider?
We could convert a specified number of unused sick days to vacation days, Is there a way we could convert unused sick time to retirement credit, I think we should stop putting a limit on how many sick days an employee can accumulate
A nurse manager is working on a task force to develop policy for man-made disasters. There is some discussion in the committee about whether fire should be included in the policy. Which suggestion by a task force member would be most useful?
We should only focus on arson fires
An unfavorable rate variance has occurred in the salary budget of a unit. When investigating this variance, the nurse manager should look for which situations? Select all that apply. A. Were any unexpected bonuses awarded? B. Did agency personnel hours exceed the number predicted in the budget? C. Were new employees hired at lower wages? D. Did the number of client days exceed the predicted budgeted amount? E. Were fewer nursing hours worked than were predicted?
Were any unexpected bonuses awarded?; Did agency personnel hours exceed the number predicted in the budget; A, B
An organization has changed its performance appraisal process and is conducting training for managers. what topics should the trainer include in the agenda for this session?
What a reasonable job performance should look like, how to complete the evaluation form, how to give the employee feedback on evaluation, use of anecdontal notes
A hospital's disaster management team is reviewing the disaster plan after reading about a hospital that was destroyed by tornado's direct hit. What questions should team members ask themselves?
What are our current capabilities for evacuation?, Do we have sufficient resources in any other areas to continue operations if this happens to us?, Are there physical training needs that we have not filled?, What education should we provide to the staff and community?
The nurse manager is coaching an employee who has been late for work three mornings this week. What statements and questions should the manager include in this coaching session? A. "What is causing you to be late?" B. "When you are late it throws the pace of the entire unit off and client care suffers." C. "Does it not bother you that your lateness makes everyone else's job more difficult?" D. "You have been late three times this week and that is not acceptable." E. "What are you going to do to avoid being tardy again?"
What is causing you to be late, When you are late it throws the pace of the entire unit off and client care suffers, You have been late three times this week and that is not acceptable What are you going to do to avoid being tardy again? 1, 2, 4, 5
A nurse is being terminated due to continued violation of hospital policy. What statements by the manager are appropriate? A. "Your actions have been degrading to the profession." B. "You may wish to resign rather than being terminated." C. "Human resources will answer any questions you may have about benefits." D. "I'm sorry you could not be happy here." E. "You are being terminated for the policy violations I have just outlined."
You may wish to resign rather than being terminated, Human resources will answer any questions you may have about benefits, You are being terminated for the policy violations I have just outlined. B, C, E
A candidate is concerned that some answers she gave during her interview were vague and lengthy. She relates some of the answers to a peer, saying "I don't know what happened, I was just so nervous." What is an appropriate response by the peer?
You should have given short and to the point answers
A nurse manager is leading an education session regarding disaster triage for emergency department nurses. Which statement should the manager include in this instruction?
Your triage system will be revered during a disaster
The nurse executive works hard to create a civil workplace that does not tolerate harassing behaviors. How would this nurse best explain the reason for this emphasis on civility?
bullying and incivility are dangerous to client care
A nurse manager has been terminated for failing to follow institutional policy and procedures. Upon reviewing the manager's files, the supervisor discovers multiple unfinished employee evaluations from the last two years. The supervisor is faced with which concerns?
finding someone with enough knowledge of the employee's work to complete the evaluation processes, how to share evaluation information with employees, whether the care provided on the unit has been safe and effective, how long it has been since employees have had a valid evaluation
The nurse manager is completing employee evaluations. Which practices should the manager use when doing these appraisals? Select all that apply. 1. Appraising staff nurses every 18 to 24 months 2. Sharing the appraisal with staff nurses verbally and in writing 3. Requiring the staff nurse to sign the appraisal 4. Allowing the nurse to make written comments on the appraisal 5. Advising the nurse of the right to appeal the appraisal
sharing the appraisal with staff nurses verbally and in writing, requiring the staff nurse to sign the appraisal, allowing the nurse to make written comments on the appraisal, advising the nurse of the right to appeal the appraisal 2, 3, 4, 5
During discussion about the hospital's disaster plan, the administrator says I am concerned about our current surge capacity. How should the members of the group interpret this concern?
the administrator is worried about the hospital's ability to respond to a large influx of clients from a disaster
An ICU nurse manager prefers to use a results-oriented system when evaluating employees. Why should the manager prefer this system?
the employee knows in advance what is expected
Which job behaviors would the nurse executive consider troublesome no matter which unit employed the nurse?
the nurse made two medication errors today the resulted in poor client outcomes, a manager reports that a nurse used a piece of equipment that had been taken out of service for malfunction, a nurse did not report to work for 2 days and did not call in the absence
a nurse executive says I would really like to develop our current nurses so they can take a greater leadership role in the future. why is this a good management plan?
this method of developing leaders has proved to be cost-effective, the leadership development can be varied according to the needs of the nurse, when leaders are developed from within, management is already aware of their strengths and weaknesses, the specific needs of the organization can be served
A health care facility has adopted automated scheduling across all client care areas. When presenting this decision to nursing staff, the nurse executive should include which information?
this system will allow nurses to spend more time with those clients who need us the most, We expect that using this system will help us improve client outcomes
A nurse manager is selecting nurses to serve as teachers in on the job instruction. What qualification should these nurses hold?
willingness to teach new nurses, ability to explain procedures accurately and clearly
A new nurse manager asks to see the Joint Commission manual in order to determine adequate staffing for the next shift. How should the supervisor respond to this request?
you need to look at the policy and procedure manual for the organization, not in the Joint Commission
