Leadership Exam 1

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

a. "Tell me about a time you were involved in a conflict related to a project. What was your role in the conflict? In the resolution of the conflict?"

Which of the following are examples of application of the Leadership Rounding Tool? (Select all that apply.) a. "What is working well for you during bedside reporting?" b. "What has not worked for you today?" c. "Is there someone on your team who deserves special recognition for her efforts in the implementation?" d. "Did you have a good vacation?"

a. "What is working well for you during bedside reporting?" b. "What has not worked for you today?" c. "Is there someone on your team who deserves special recognition for her efforts in the implementation?" d. "Did you have a good vacation?"

The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are upset about the change and ask for a meeting to discuss the new model. After hearing their concerns related to reduction in professional autonomy, what is the initial response by the manager to address the concerns? a. Acknowledge the loss. b. Explain the reasons for change, emphasizing the need to reduce costs. c. Repeat the information several times, giving detailed budget overviews. d. Adjourn the meeting and provide explanation through e-mail.

a. Acknowledge the loss.

A new graduate nurse is working in an outpatient surgical center with the circulating nurse. The nurse is reviewing the patient's chart and orders. The patient has been in pre-op receiving eye drops in her right eye as preparation for cataract removal surgery. The pre-operative orders indicate a marking has been made above the right eyebrow by the pre-operative nurse for surgery. The pre-operative nurse has been instilling the medicated eye drops to dilate the right eye for surgery. Upon further review of surgical consent, the consent was for surgery on the left eye and the history and physical by the surgeon indicate the patient is supposed to have surgery on her left eye. What action by the new nurse is considered appropriate followership? (Select all that apply.) a. Alert the pre-operative nurse to the chart discrepancy. b. Ask the charge nurse to double check the chart together. c. Notify the surgeon to the issue for further orders. d. Complete a hospital incident report. e. Do nothing; assume the nurse was correct.

a. Alert the pre-operative nurse to the chart discrepancy. b. Ask the charge nurse to double check the chart together. c. Notify the surgeon to the issue for further orders. d. Complete a hospital incident report.

What would managers and staff review annually in order to ensure compliance with The Joint Commission (TJC) to improve patient safety? a. Appropriateness of charting terms and abbreviations b. Nursing hours per patient c. Acuity of patient admissions d. Wait times for care

a. Appropriateness of charting terms and abbreviations

A new graduate nurse wonders about the directions that her preceptor has given her regarding management of incontinent, confused patients. The new nurse brings the preceptor evidence-based information she located regarding incontinence interventions for confused patients and asks to talk about the guidance that given after the preceptor reviews the information in the article. What is the new nurse demonstrating in this situation? (Select all that apply.) a. Assertiveness b. Followership c. Management d. Insubordination

a. Assertiveness b. Followership

Based on data from the patient satisfaction survey, the nurse manager decides that a change should be made in communication with family members. What would be important for a nurse manager to consider when instituting a change to improve customer service? a. Assess the perceptions of the nursing staff regarding the specific service problem. b. Include community representatives on a planning committee to address the change. c. Involve physicians, other healthcare professionals, and ancillary staff. d. Review all patient complaints with the nursing staff.

a. Assess the perceptions of the nursing staff regarding the specific service problem.

The maintenance department wishes to have the nursing lounge renovated, so the lounge will be more "user-friendly." The department asks the nursing staff to make a wish list of everything that they would like to see in the new lounge. This process is an example of which part of the decision-making process? a. Assessment/Data collection b. Planning c. Data interpretation d. Generating hypotheses

a. Assessment/Data collection

As a nurse manager and the leader of the unit, you are aware of multiple avenues for learning leadership traits. Which avenues would you pursue for learning leadership traits? (Select all that apply.) a. Attending professional conferences b. Reading books on leadership c. Joining professional organizations d. Connecting with other leaders in the organization e. Experiences from new nurses

a. Attending professional conferences b. Reading books on leadership c. Joining professional organizations d. Connecting with other leaders in the organization

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

a. Authoritarian leadership

As a new nurse manager, you are aware of leadership, management, and followership principles. What is the first step to becoming an effective leader? a. Being an effective follower b. Taking a class on leadership c. Taking a class on management d. Getting an advanced degree

a. Being an effective follower

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

a. Both eustress and distress

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

a. Clinical decision support

What patients would be considered "at risk" consumers during a healthcare visit? (Select all that apply.) a. Clyde requires an anticoagulant. He tells the nurse about his medications. He does not include an herbal supplement. b. George is very shy and withdrawn. He asks the nurse to leave him alone. c. Sarah is a new parent who finds that nurses on the children's unit are very helpful. She is eager to accept all suggestions, including those that she does not yet understand. d. Claude is booked for bowel surgery. His doctor explains about the colostomy. Later, Claude tells his wife that he really doesn't know what the doctor meant by colostomy.

a. Clyde requires an anticoagulant. He tells the nurse about his medications. He does not include an herbal supplement. c. Sarah is a new parent who finds that nurses on the children's unit are very helpful. She is eager to accept all suggestions, including those that she does not yet understand. d. Claude is booked for bowel surgery. His doctor explains about the colostomy. Later, Claude tells his wife that he really doesn't know what the doctor meant by colostomy.

The nurse manager of an ICU wants to implement the revised policy and procedure on central line catheter care. What would be the most effective method of getting the staff nurses to incorporate a new evidence-based practice into their care? a. Conducting an interactive educational workshop b. Distributing educational materials on clinical units c. Sharing the results of a chart audit with staff d. Providing staff with a short DVD on the topic

a. Conducting an interactive educational workshop

What does the SBAR approach to patient safety encourage? a. Consistency in assessment and practices b. Continuing education c. Multidisciplinary approaches d. Patient feedback

a. Consistency in assessment and practices

The nurse manager wants to use evidence-based recommendations to prevent ventilator-associated pneumonia. What is the critical first step to effectively gather evidence for guiding practice? a. Develop the clinical question. b. Identify the databases to be used. c. Appraise the evidence. d. Integrate available evidence with unit expertise.

a. Develop the clinical question.

In nursing theory, one theorist developed the theory of self-care of patients. In the theory, the nursing action of providing care and educating the patients can be interpreted in the form of followership for the patient. Who was their theorist? a. Dorothea Orem b. Patricia Benner c. Ida Jean Orlando d. Robert E. Kelley

a. Dorothea Orem

The nurse manager is working with a group of new nurses. The new nurses ask questions about leadership and the role of a manager in leading nursing. The manager shares the desire to have engaged staff nurses who participate in a team environment. What is the manager describing? a. Effective follower b. Effective leader c. Ineffective follower d. Ineffective leader

a. Effective follower

At the end of a shift, the charge nurse shares with the new nurse she had done an excellent job with a difficult patient that day. The new nurse was upset by the way the family of the patient had treated her. She shared her feeling with the charge nurse. The charge nurse offered to change the assignment the following day. What is the charge nurse displaying? a. Emotional intelligence b. Comportment c. Compassion d. Management of conflict

a. Emotional intelligence

You notice that Sally, a student on your unit, is giving information to an anxious young teen who seems very uncertain about preparation for an upper GI series. After Sally leaves the room, you ask her how she thought her conversation with the patient. What is the appropriate response for you to give Sally? a. Encourage her to ask the patient if he has questions or concerns about the procedure. b. Advise her to consider providing the patient with more information. c. Suggest that she leave some brochures on the procedure with the patient. d. Suggest that she also provide teaching to the adolescent's parents.

a. Encourage her to ask the patient if he has questions or concerns about the procedure.

To achieve Nurse-Sensitive Care Standards developed by the NQF, you advocate for which of the following in your health facility? a. Evidence-based practice to reduce the prevalence of pressure sores b. Implementation of informatics at the bedside c. Staff-manager conferences to review reporting of adverse medical events d. Patient councils to review food, recreation, and nurse-patient relations

a. Evidence-based practice to reduce the prevalence of pressure sores

A dispute arises between an RN and an LPN over a patient issue. The tension continues between the two and begins to affect other staff members, who are drawn into the conflict. Over time, the team becomes polarized toward either the RN or the LPN. How might this situation be prevented? a. Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves b. Asking other staff members what the real issues were in the dispute between the RN and the LPN c. Reassigning one of the parties to another unit when it became apparent that the two individuals could not resolve the dispute themselves d. Calling a staff meeting at the onset of the dispute to allow the team and the RN and LPN to discuss the initial dispute

a. Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves

The manager of a surgical area has a vision for the future that requires the addition of RN assistants or unlicensed persons to feed, bathe, and ambulate patients. The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea. What would be the best initial strategy for implementation of this change? a. Exploring the values and feelings of the RN group in relationship to this change b. Leaving the RNs alone for a time so they can think about the change before it is implemented c. Dropping the idea and trying for the change in a year or so when some of the present RNs have retired d. Hiring the assistants and allowing the RNs to see what good additions they are

a. Exploring the values and feelings of the RN group in relationship to this change

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

a. Flowchart

The chief nursing officer (CNO) is appointed for the local hospital in a rural area. The nursing committee agreed with the appointment of the new CNO offered the position. What is this type of leadership position considered? a. Formal leadership b. Informal leadership c. Director leadership d. Personal leadership

a. Formal leadership

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

a. Histogram

In developing leadership skills, one should focus on authentic leadership. The theory of authentic leadership focuses on various factors. What is the top priority in development of authentic leadership? a. Honest relationships b. Organizational task c. Accomplishment of goals d. Exploring others

a. Honest relationships

As a manager in a new nursing home, where might you consult for guidance and evidence to support the development of safe patient practices? a. Hospitals b. Business c. Industry d. Outpatient clinics

a. Hospitals

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

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

A staff nurse is taking leadership classes in an advanced degree program with a goal to become a nurse manager. The nurse is studying the leader-follower relationship. What has the nurse discovered as accurate part of the leader-follower relationship? a. Leaders are also followers. b. Followers need to linear structures. c. Followers are submissive in nature. d. Leaders should dictate to the group.

a. Leaders are also followers.

The manager calls the staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions. Staff members are becoming distanced from the family. After inviting the concerns of staff, the manager explains that the organization values patient-centered care and that evidence supports that acting as an advocate and a listener is helpful to families. The manager asks the staff for ideas and strategies that are effectively patient-centered in dealing with families in similar situations. What is the role of the nurse manager in this situation? a. Leadership b. Management c. Follower d. Visionary

a. Leadership

To engage your staff in awareness of their current practice and how it is affirmed or not by evidence, you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency. You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice. This learning approach is an example of which change management approach? a. Linear b. First-order c. Facilitative d. Integrative

a. Linear

The adage "leaders are born and not made" reflects which of the following ideas around leadership? a. Management can be taught; leadership depends on abilities. b. Mentorship is important in developing innate skills of leaders. c. Leadership is a natural skill that cannot be refined or developed. d. Succession planning and formal education related to leadership are ineffective.

a. Management can be taught; leadership depends on abilities.

A family is keeping vigil at a critically ill patient's bedside. Distant family members call the unit continuously asking for updates and expressing concern. The nurse speaks with the distant family members and states she is referring them to the hospital social worker, whose role is to work with family in this situation. What role is the nurse assuming through this action? a. Manager b. Leader c. Follower d. Laissez-faire

a. Manager

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

a. NANDA.

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

a. NDNQI

The manager is using self-reflection to gain insight into improving the leadership skills. By using self-awareness what does a leader develop? a. New knowledge b. Personal growth c. Improved self esteem d. Management skills

a. New knowledge

A nurse manager is implementing strategies to support the steps in the AHRQ document "Five Steps to Safer Health Care." What does the manager include in the implementation? a. Patients are actively encouraged to make decisions related to care. b. Rules and decisions are made through centralized processes. c. You monitor the performance of each staff member closely. d. Preference is given to increasing staff numbers rather than staff credentials.

a. Patients are actively encouraged to make decisions related to care.

A new nurse leader wants to be the best leader she can. The nurse takes classes, finds and leadership mentor, seeks input from her unit, and employs other strategies for leadership development. What is another strategy for the leader to develop and improve leadership skills? a. Proactive learning b. Ignoring feedback c. Being in charge d. Authoritative position

a. Proactive learning

Sarah is a second-year nursing student. The clinical instructor overhears Sarah telling a patient that she "always" checks patients' bracelets before giving medication and she is not sure how the nurses on the unit "get away with" not making more errors than they do. The clinical instructor pulls Sarah aside and explores with her how her communication might affect the patient and what it reflects about her beliefs related to the team. What competency does this action outline? a. QSEN b. IHI c. DNV/NIAHO d. AHRQ

a. QSEN

The chief nursing officer is pleased with the nurse manager's strategy of improving patient satisfaction in the pediatric intensive care unit. She decides to implement these changes throughout the hospital. What would be important to consider in implementing a new program focused on improving relationships with consumers? a. Recognition of the nursing staff for excellence in promoting consumer relationships b. Holding the staff accountable for resolving patient complaints c. Selecting a staff nurse leader to implement the program d. Identifying key staff members who have already demonstrated excellence in consumer relationships

a. Recognition of the nursing staff for excellence in promoting consumer relationships

A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who begins to complain loudly about the quality of care his mother is receiving. His behavior is so disruptive that it is overheard by staff, physicians, and other visitors. The family member leaves the unit abruptly, and the nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner? a. Reflect to gain insight into how the situation could be handled differently in the future. b. Try to catch up with the angry family member to resolve the concern. c. Discuss the concern with the patient after the family member has left. d. Notify nursing administration of the situation.

a. Reflect to gain insight into how the situation could be handled differently in the future.

What facilitate the development of decision-making skills related to safe patient care for a nurse manager? a. Regular reflection on decisions b. A culture of perfectionism c. Recognition of who should be held responsible for individual errors d. A culture of trust between the staff and you

a. Regular reflection on decisions

Which of the following is a meta-analysis? a. Review of 35 studies on nurse work satisfaction to determine the significance of the aggregated research findings b. Review of multiple chart audits to determine which errors are being reduced through implementation of evidence-based guidelines c. RCT comparing the effectiveness of a local anesthetic in reducing the pain of venipuncture in young children d. Analysis of factors contributing to nurse burnout and dissatisfaction at emergency room sites

a. Review of 35 studies on nurse work satisfaction to determine the significance of the aggregated research findings

Pleasant Valley Hospital has amended its safety practices and policies. What has the hospital elected to emphasize accordance with changes by The Joint Commission (TJC)? a. Safety goals specific to Pleasant Valley b. Decision-making processes c. Sufficient staffing for safe care d. Increased numbers of baccalaureate-prepared RNs

a. Safety goals specific to Pleasant Valley

Steady state styles would be most likely in which of the following situations? a. Small hospital, in an isolated rural setting, with limited hierarchy b. Large urban teaching hospital c. Health network with several organizations d. Travel nurse agency

a. Small hospital, in an isolated rural setting, with limited hierarchy

A client requires an appendectomy. The surgeon explains the procedure and asks the client to sign the consent. The patient speaks very little English and looks worried. What is the appropriate action by the nurse? a. Suggest that an interpreter explain the procedure to the client and answer any questions. b. Ask the client if he has any questions. c. Draw a picture to show the incision. d. Not intervene.

a. Suggest that an interpreter explain the procedure to the client and answer any questions.

A nurse executive is hired to restore a unit's productivity, which has decreased as the result of low staff morale. The nurse executive utilizes which of the following leadership principles? a. The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment. b. If staff members increase productivity, then they are given opportunity to engage in learning events such as workshops and conferences. If the staff members are not satisfied, they will insist on a different leader, who will get them what they want. c. Leaders at the national level who are seeking relief for nurses in the workplace are seen as the solution to the nursing shortage. d. Workplace satisfaction depends on staffing ratios, adequate pay, and tuition reimbursement, and these are things the leader can control.

a. The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment.

The nurse is educating older adult patients on staying safe in the healthcare system. What information does the nurse include in the teaching? a. The need to understand and record all medications being taken. b. Bringing their own linens and other personal items to the hospital. c. Washing hands frequently while in a healthcare environment and using a hand sanitizer. d. Following closely the directions and orders of healthcare providers.

a. The need to understand and record all medications being taken.

Knowing when to have the entire team participate in the decision-making process or when to have only the team leader make the decisions depends on the situation and the desired outcomes. The autocratic process is used in which of the following situations? a. The task and the outcome are relatively simple and defined. b. It is unlikely that the group will reach a consensus. c. A decision has to be discussed thoroughly. d. A number of options need to be considered.

a. The task and the outcome are relatively simple and defined.

While interviewing for a nurse manager position, Ann is asked to give an example of a situation in which she demonstrated leadership. Which of the following examples exemplifies leadership? a. Through research and investigation of best practice and practice-based evidence, she proposed a change in the management of incontinence in older adult patients. b. She ensures that new policies related to parenteral infusions are implemented consistently within her team. c. When asked by her students about institutional policies, she readily and patiently interprets policies to facilitate quality care. d. She organizes the team and delegates responsibilities effectively in providing nursing care.

a. Through research and investigation of best practice and practice-based evidence, she proposed a change in the management of incontinence in older adult patients.

As a new manager, you are shocked to learn that your unit is still using heparin in heparin locks. You are aware of evidence related to this practice and want to change this practice as quickly as possible on your unit. You are in which stage of Lewin's stages of change? a. Unfreezing b. Experiencing the change c. Moving d. Refreezing

a. Unfreezing

Which of the following activities would represent a customer-friendly approach in a healthcare setting? (Select all that apply.) a. Using a local anesthetic before inserting a needle into a child's arm b. Repeating patient history information to the admitting clerk, the admitting nurse, and the ultrasound technician c. Ensuring that birthing preferences are on file and available in a laboring mother's chart d. Providing support to families when a family member is brought into trauma

a. Using a local anesthetic before inserting a needle into a child's arm c. Ensuring that birthing preferences are on file and available in a laboring mother's chart d. Providing support to families when a family member is brought into trauma

In designing a program for young adults regarding safe sexual practices, which of the following might reach the greatest number in the target group? a. Web-based applications b. Print-based media such as newspapers c. Television advertisements d. Brochures in kiosks in malls

a. Web-based applications

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

a. a clinical database.

Mr. Cruiser has been surfing the Web. He is looking for healthcare information on low back pain. He shows the clinic nurse a webpage he thinks is great and tells her that he has been following the exercises recommended by the author. He wants to know what she thinks about the site. When the clinic nurse evaluates this site, she discovers that its author is a personal trainer. No credentials are listed. In several testimonials on the page, people (their pictures are included) say how wonderful they feel after having done these exercises. The exercises all have animated demos when you click on the pertinent highlighted text or icon. They seem easy to follow. The site was posted 5 years earlier and was last updated 3 years before. The clinic nurse advises Mr. Cruiser to: a. avoid this site. b. check with his primary healthcare provider. c. continue with the exercises. d. contact the author for additional exercise and feedback.

a. avoid this site.

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

a. biomedical technology.

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

a. both a positive stressor and a negative stressor.

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

a. clarity in roles and valuing of contributions.

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

a. commitment, control, and challenge.

A nurse manager introduces prompted voiding into nursing practice on a unit, which is supported by clinical guidelines based on evidence-based practice. The nurses on the unit resist implementation, indicating that the bathroom facilities are too far away for efficient implementation of the guidelines, and that resources are too few to accomplish the initial voiding observations. For the nurse manager in this situation, it is important to have further discussion with the staff regarding: (Select all that apply.) a. compatibility of this intervention with the values of staff on the unit. b. advantages of prompted voiding over incontinence products and catheterizations. c. usefulness of prompted voiding with the particular population of patients on the unit. d. feasibility of the program with respect to unit design.

a. compatibility of this intervention with the values of staff on the unit. b. advantages of prompted voiding over incontinence products and catheterizations. c. usefulness of prompted voiding with the particular population of patients on the unit. d. feasibility of the program with respect to unit design.

Complex change situations require that the change leader promote ongoing visioning among staff members. One strategy is to: a. consciously evaluate invisible mental models. b. allow for individual outcomes. c. encourage cooperative activities. d. operate between order and disorder.

a. consciously evaluate invisible mental models.

Once evidence related to the use of prompted voiding in patients with cognitive impairment has been appraised and integrated with practice, it is important to: a. consider whether patients' families see this as necessary for the well-being of family members. b. search large databases such as CINAHL to amass further evidence. c. clarify the clinical practice question. d. solicit input regarding integration with practice.

a. consider whether patients' families see this as necessary for the well-being of family members.

As a nurse manager, you see an opportunity for patients to be well serviced through the medical home concept. You recognize that the concept of medical homes: a. currently does not include nurses in its vision of multifaceted primary care. b. includes nurses as part of an interdisciplinary and multidisciplinary team. c. restricts nurses to services related to direct care and procedures. d. cannot encompass nurses within this framework.

a. currently does not include nurses in its vision of multifaceted primary care.

The nurse manager frequently interacts with staff and other hospice facility employees. Communication is purposeful because the manager assesses current issues, such as specific satisfactions and dissatisfactions with the newly implemented computerized documentation system. Informally, the manager gathers available staff members to address similar learning needs. Many times, staff members are found coaching other staff about improving use of the new system. According to Senge (1990), the activities demonstrated in this example are: a. dialogue, team learning. b. resilience, personal mastery. c. shared vision, systems thinking. d. mental models, teachable moments.

a. dialogue, team learning.

Nurses on Unit 17 complain that their manager frequently "checks up on them" and encourages little involvement in decision making and yet, during performance reviews, praises them for their outstanding performance. Nurses on Unit 18 indicate that their experience is different from that of nurses on Unit 17. The manager on Unit 18 encourages active involvement in decision making and provides authentic, growth-promoting feedback. The practices on Units 17 and 18 reflect. a. differences in the managers' expectations of their role. b. shaping of the workplace behavior of employees. c. different approaches to cooperation and collaboration. d. recognition of institutional priorities.

a. differences in the managers' expectations of their role.

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

a. distancing oneself from work.

A nurse manager is discussing with unit staff the repeated lack of staff compliance in documenting exercise activity for post-cardiac surgery clients. The unit's licensed practical/vocational nurses are responsible for ensuring that clients carry out the prescribed exercise regimen and that the activity is documented. Using Drucker's five basic functions of a manager, identify appropriate functions for the nurse manager to use when addressing this situation: (Select all that apply.) a. divide the necessary activities into manageable tasks, so clients adhere to the exercise regimen. b. establish objectives and goals for each area and decide who is accountable for them. c. allow clients to organize the activities. d. engage in activities that motivate the team and communicate effectively with the responsible staff members. e. analyze, appraise, and interpret the performance of responsible staff, and communicate these findings to staff management. f. allow clients to establish objectives and goals.

a. divide the necessary activities into manageable tasks, so clients adhere to the exercise regimen. b. establish objectives and goals for each area and decide who is accountable for them. d. engage in activities that motivate the team and communicate effectively with the responsible staff members. e. analyze, appraise, and interpret the performance of responsible staff, and communicate these findings to staff management.

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

a. eighty percent of all patients admitted to the Emergency Department will be seen by a nurse practitioner within 3 hours of presentation in the Emergency Department.

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

a. enable detection of variations in clinical outcomes from well-researched standards that are supported by confirmatory evidence.

A functional résumé focuses on: a. experience and skills gained in positions. b. positions held and specific roles in the positions. c. academic qualifications and achievements. d. relating skills and experience to qualifications in a specific position.

a. experience and skills gained in positions.

Hospital ABCD is a Magnet® hospital. One reason this designation has been applied to Hospital ABCD because it: a. facilitates active staff participation in decision making related to quality nursing care. b. has implemented a graduate nurse orientation program. c. espouses commitment to excellence in patient care. d. is establishing career ladders for nurses.

a. facilitates active staff participation in decision making related to quality nursing care.

Knowing your professional strengths is important to: a. find your fit in positions and a career path. b. maintain a professional status. c. act in a manner that is legal and ethical. d. understand the role expectations of a position.

a. find your fit in positions and a career path.

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

a. finding well-qualified candidates who can function well within your particular work culture.

Examples of sentinel events include: (Select all that apply.) a. forceps left in an abdominal cavity. b. patient fall, with injury. c. short staffing. d. administration of morphine overdose. e. death of patient related to postpartum hemorrhage.

a. forceps left in an abdominal cavity. b. patient fall, with injury. d. administration of morphine overdose. e. death of patient related to postpartum hemorrhage.

The nurse manager is anticipating changes on the unit because of managed care. It is up to the manager to "sell" the staff on this care concept. A goal of managed care that the staff must understand is that managed care is: a. grounded in business theory. b. useful for long-term patients only. c. designed to reduce unit resources and staff. d. not concerned with the best interests of clients.

a. grounded in business theory.

The implementation of saline flushes for capped angiocatheters across all areas of practice in the facility is an example of: a. how multilevel and interprofessional application of a procedure can slow adoption of EBP. b. how competition among disciplines can lead to negative patient outcomes. c. the reluctance of hospital administrators to act on recommendations from EBP. d. how a safe, well-known practice outweighs the benefits of adopting a newer practice.

a. how multilevel and interprofessional application of a procedure can slow adoption of EBP.

In a busy rehabilitation unit, the team manager decided that the best way to reward the staff was to give them a monetary bonus rather than time off. The staff was very concerned about the decision and went to the administration with a number of complaints. Critical thinking is a process that entails a number of steps. What steps did the manager omit? She should have: (Select all that apply.) a. identified what assumptions were underpinning the issues. b. considered why it was important to make this change or the context for the change. c. considered how this change might affect staff relationships. d. attained a majority consensus of all staff.

a. identified what assumptions were underpinning the issues. b. considered why it was important to make this change or the context for the change. c. considered how this change might affect staff relationships.

The risk manager wants to evaluate the reasons for an increased number of falls on the rehab unit. The risk manager devises a fishbone diagram. A fishbone diagram is a useful tool to: a. identify the root causes of problems. b. list possible solutions to problems. c. help leaders select the best options. d. evaluate the outcomes of decisions made.

a. identify the root causes of problems.

The nurse manager of a rehab unit wants to purchase a new antiembolic stocking for use with patients. To make a high-quality decision, the nurse manager would: a. involve the rehab staff in the decision. b. involve the sales representative. c. make the decision alone. d. involve administration in the decision.

a. involve the rehab staff in the decision.

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

a. involves screen displays that are best configured for nonclinical users.

During a discussion of concern about approaches used with aggressive patients in the Emergency Department, several staff members express concern for their safety. As a leader, the nurse manager should: a. look directly at speakers and acknowledge their comments. b. promise to implement each suggestion that is made. c. implement the idea that receives the most discussion. d. listen but implement the plan that she had in mind before the discussion began.

a. look directly at speakers and acknowledge their comments.

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

a. maintain a relaxed and professional manner. c. allow the employee to express opinions orally and in writing.

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

a. maintenance of anecdotal notes over the entire evaluation period.

During review of back injuries, it is determined that a large number of injuries are occurring in spite of mechanical lifts being used. Furthermore, it is determined that some lifts are outdated. In addressing this concern, the unit manager: a. meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure. b. after consultation with the staff about the review, orders new lifts to replace older ones that are malfunctioning. c. blames the system for inadequate funding for resources. d. reviews the system of reporting incidents to ensure that appropriate reporting is occurring.

a. meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure.

When assessing the appropriateness of adopting WL COWs for a nursing unit, you need to consider the advantages, which include: a. mobility of the carts. b. small display screen. c. font size. d. speed of operation.

a. mobility of the carts.

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

a. organizational mission, philosophy, and position requirements.

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

a. participating in organizational information technology committees.

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

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

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

a. reduction in incidents of medication error. b. immediate documentation of care. c. comparison of patient data with previous data.

The primary difference between a résumé and a CV is that a résumé: a. reflects your skills, knowledge, and background in relation to a specific position. b. offers a detailed listing of positions held and where positions were held. c. includes a long and detailed explanation of academic and work experience. d. provides contact information and focuses on your background, in general.

a. reflects your skills, knowledge, and background in relation to a specific position.

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

a. review the position description and performance expectations for the opening.

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

a. role acquisition.

Becky graduated 5 years ago and is keenly interested in pursuing leadership opportunities. She has been active in learning about leadership through workshops and Internet research and recently began a graduate degree program with a focus on nursing administration. She has excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and sometimes aggressive behavior tends to alienate other staff members on the unit. In coaching Becky, you: a. suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation. b. suggest that she not consider leadership roles because her interaction skills are more suited to roles in which she has limited opportunities to work with others. c. ask staff members on the unit with whom she works to provide her feedback about ways in which her behavior irritates or turns them away. d. encourage her to continue her graduate courses, as information about strategies and technical aspects of the role will compensate for negative interactions.

a. suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation.

Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." After speaking with Elizabeth, a few days later you discover that she is now fine with the change but is concerned that other areas of the organization might resist the change because of perceptions related to patient safety and cost. She suggests that it is important to bring pharmacy on board as they have had previous concerns about the use of heparin. In relation to change theory, this is indicative of: a. systems level thinking. b. linear thinking. c. interprofessional collaboration. d. first-order change.

a. systems level thinking.

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

a. total organizational involvement is critical to QI.

A good nursing decision maker is one who: a. uses various models to guide the process based on the circumstances of the situation. b. adopts one model and uses it to guide all decision making. c. decides not to use any models because they are all useless. d. develops a new model each time a decision has to be made.

a. uses various models to guide the process based on the circumstances of the situation.

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

b. "At a staff meeting last year, two of our staff commented on the number of recent falls and asked, 'What can we do about it?'"

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

b. A combination of tools

As the RN charge nurse on the night shift in a small long-term care facility, you've found that there is little turnover among your LPN and nursing assistant (NA) staff members, but they are not very motivated to go beyond their job descriptions in their work. Which of the following strategies might motivate the staff and lead to greater job satisfaction? a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night LPNs and NAs. b. Allow the LPNs and NAs greater decision-making power within the scope of their positions in the institution. c. Hire additional staff so that there are more staff available for enhanced care, and individual workloads are lessened. d. Ask the director of nursing to increase job security for night staff by having them sign contracts that guarantee work.

b. Allow the LPNs and NAs greater decision-making power within the scope of their positions in the institution.

In orienting new staff nurses to a pediatric intensive care unit, the nurse manager asks the staff nurses to answer the following question: "What is an important consideration in providing information to parents of a critically ill child?" a. Making sure that they receive complete information during each encounter with a member of the nursing staff b. Assessing parents' preferences regarding the amount of information provided c. Allowing parents to observe key aspects of their child's nursing care d. Making sure that patient education brochures explaining ICU protocols are readily available

b. Assessing parents' preferences regarding the amount of information provided

You are excited by evidence supporting the use of workstations on wheels (WOWs) at the bedside to improve documentation and patient outcomes. You have disseminated the information through discussions and e-mails and are now ready to begin the process of considering implementation on the unit. To develop positive attitudes toward the use and implementation of the technology, you would discuss your ideas with (Rogers' diffusion of innovations theory): a. Harvey, RN, a technology guru, who enthusiastically tries on all new software. b. Berta, RN, who thoughtfully considers evidence and regularly uses it to try new approaches in her practice. c. Carol, LPN, who is positive about new ideas but looks to her friends for their ideas about whether or not to try something new. d. Ben, a 10-year veteran of the unit, who wonders why technology should be used at all. He says that he will use it when there is no chance of security breaks.

b. Berta, RN, who thoughtfully considers evidence and regularly uses it to try new approaches in her practice.

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

b. Call a meeting of all staff to discuss this issue.

As a leader on a rehab unit, the manager encourages all staff members to see themselves as having a role in decision making and quality care. The manager sees their role as involving particular responsibilities in decision making but not as a hierarchal role. What is this view of the role consistent with in this situation? a. Trait theories b. Complexity theory c. Situated theory d. Emotional intelligence

b. Complexity theory

As a head nurse, you are concerned about the service orientation on your unit. Which of the following findings and approaches might provide useful information for you? a. Patients find nurses friendly and accessible; data are aggregated for the institution as a whole. b. Data indicate that nurses are responsive to requests for assistance; data are available for the unit and the institution. c. Specific questions related to management of comfort are included for the institution as a whole. d. The survey asks for a range of responses for the unit and the organization, with a focus on facilities, such as cleanliness and responsiveness of administrative services.

b. Data indicate that nurses are responsive to requests for assistance; data are available for the unit and the institution.

The manager of a unit is finding it difficult to work with a new graduate nurse. The new nurse has many ideas; however, his manner of presenting them irritates the manager. After reflection and discussion with others, the manager recognizes that she feels threatened by his behavior. She comes to understand that the new nurse is trying to establish his own role on the unit; is not trying to challenge her; and needs guidance, coaching, and affirmation. What is the nurse manager demonstrating in this situation? a. A positive self-concept b. Deepening self-awareness c. Leadership d. Acquiescence

b. Deepening self-awareness

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

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

At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. What is the appropriate next step? a. Arrange another meeting in a week's time so as to allow a cooling-off period. b. Elevate the next negation session to the next manager, one level above. c. Insist that participants continue to talk until a resolution has been reached. d. Back the unit manager's actions and end the dispute.

b. Elevate the next negation session to the next manager, one level above.

A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of the older adult patient. Using complexity principles, what would be the best approach to take for implementation of this change? a. Leverage the hierarchical management position to get unit staff involved in assessment and planning. b. Engage involved staff at all levels in the decision-making process. c. Focus the assessment on the unit and omit the hospital and community environment. d. Hire a geriatric specialist to oversee and control the project.

b. Engage involved staff at all levels in the decision-making process.

A young male nurse began in nursing as a staff nurse at a hospital. After 3 years, he moved to a home healthcare agency for increase in pay and taking a position as a manager in the agency. What type of motivation does this exemplify in career success? a. Internal b. External c. Spiral d. Entrepreneurial

b. External

John is an older adult patient who comes regularly to the multigroup practice in which you are a nurse practitioner. He says that he doesn't understand what he is supposed to be doing about his medications, because every time he comes to the clinic, he sees a different provider. John's experience represents what aspect of the current consumer experience? a. Nurses are well-trusted members of the healthcare team. b. Fragmentation of care results in lack of respect and trust. c. Care providers often have conflicting ideas about care. d. The public does not trust care providers other than nurses.

b. Fragmentation of care results in lack of respect and trust.

The nurse manager must develop a patient satisfaction survey. What is one of the critical elements in selecting a patient satisfaction instrument? a. Being able to use the same instrument for all clinical units b. Including items that are important from the patient's perspective c. Being able to administer the instrument before a patient's discharge from the hospital d. Being sure that the reading level is no higher than third grade

b. Including items that are important from the patient's perspective

A staff nurse is the person on the unit everyone seeks for input and asks questions. What type of leadership position is the staff nurse displaying? a. Position leadership b. Informal leadership c. Personal leadership d. Formal leadership

b. Informal leadership

A nurse manager when in the formal leadership position attempts to translate the picture or vision of her facility across for the staff nurses. The manager is faced with a staff who is resistant to the vision of the facility. What is the theory the manager needs to incorporate to be effective? a. Model the Way b. Inspire a Shared Vision c. Challenge the Process d. The Four Agreements

b. Inspire a Shared Vision

A staff nurse wants to become a charge nurse. What is one of the most effective methods for the staff nurse to incorporate to effectively transition to charge nurse? a. Read a book on charge position. b. Integrate prior experience to new role. c. Do things the way always done. d. Change units to be a charge on different unit.

b. Integrate prior experience to new role.

The nurse manager analyzes the data from the patient satisfaction surveys. What can a nurse manager do to strengthen service recovery and improve consumer relationships? a. Post comparisons of patient satisfaction scores with those of other units monthly. b. Involve the staff in resolving consumer issues quickly and effectively. c. Ensure that staff members apologize to patients when they complain about services. d. Ask that patients with complaints about services place them in a written format.

b. Involve the staff in resolving consumer issues quickly and effectively.

Which of the following nurses is MOST likely to inspire others to do their best? a. Nancy, RN, is an individual who enjoys details and organization. She regularly leaves notes for the next shift about what has been done incorrectly or omitted. b. Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious. c. Clara has been the head nurse on Unit 3Y for years. She is quiet but enjoys patients and their families. She has not been to a conference in years because the unit is her entire life. d. Karen is a team leader. She is extraordinarily vigilant about ensuring that everyone is treated fairly in assignments. She is also very conscientious about care and regularly checks up on what everyone is doing to ensure that it is done correctly.

b. Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious.

To engage your staff in awareness of their current practice and how it is affirmed or not by evidence, you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency. You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice. Staff nurses who gain information on current IV therapy practices are engaging in which phase of Rogers' decision-making process? a. Persuasion b. Knowledge c. Confirmation d. Decision

b. Knowledge

Chart audits have revealed significant omissions of data that could have legal and financial guideline ramifications. The unit manager meets with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. What is the manager demonstrating? a. Leadership b. Management c. Decision making d. Vision

b. Management

Before implementation of the new policy and procedure on central line catheter care, the nurse manager uses an appraisal system to evaluate the evidence. What is important in using an appraisal system to evaluate the evidence gathered in preparation for development of a new protocol? a. Limiting the search to randomized clinical trials b. Matching the appraisal tool to the type of evidence c. Eliminating qualitative research studies d. Using only preprocessed evidence

b. Matching the appraisal tool to the type of evidence

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

b. Monthly staff meetings during which a portion of the agenda is devoted to sharing

What is a strategy that can be used by a small community hospital with limited resources to develop an evidence-based nursing practice program? a. Hiring a nurse researcher b. Partnering with nurse researchers at a local university c. Subscribing to journals devoted to evidence-based nursing d. Including research competencies in managers' job descriptions

b. Partnering with nurse researchers at a local university

In nursing theory, one theorist developed the idea of new nurses progressing to experienced nurses and playing an important role in patient care in all stages. The new nurses follow their role and progress through stages to advanced nurse. Who was this theorist? a. Dorothea Orem b. Patricia Benner c. Ida Jean Orlando d. Robert E. Kelley

b. Patricia Benner

The nurse manager is working with a group of new nurses. The new nurses ask questions about leadership and the role of a manager in leading nursing. The manager shares she has incorporated her core values and beliefs into her role and responsibilities as a nurse manager. What type of leadership has she described? a. Positional leadership b. Personal leadership c. Formal leadership d. Information leadership

b. Personal leadership

Volunteers in a study are assigned randomly to groups. Some of the volunteers receive an herbal supplement that is reputed to control nausea, and some of the volunteers are assigned to a control group where a placebo is administered. This is an example of a(n): a. longitudinal study. b. RCT. c. meta-analysis. d. appraisal tool.

b. RCT.

The manager of a nursing unit is having difficulty working with a new graduate nurse. The new graduate nurse is excited and full of ideas she wants to try. The manager decides to journal her feelings regarding the new nurse and her feelings. What is the nurse manager practicing in this situation? a. Leadership b. Reflection c. Knowledge d. Action

b. Reflection

A staff nurse is taking leadership classes in an advanced degree program as the nurse wants to become a manager. The instructor requires the students to create a journal and make notes of their feelings when they experience conflicts at work over the next few weeks. The assignment calls for the use of reflection. What is the purpose of this assignment? a. Log of conflicts which occur b. Reflection for self-awareness in conflict situations c. Assess the students conflict management skills d. Analysis of student lead conflicts

b. Reflection for self-awareness in conflict situations

A strategic goal for nursing in the facility developed by the chief nursing officer is to implement an evidence-based practice program. What is an appropriate strategy that can be used by a nurse manager who is beginning to implement an evidence-based practice program on the unit? a. Conducting a review of adverse events and incident reports b. Soliciting input from staff members c. Reviewing specialty organization guidelines d. Identifying patients with extended lengths of stay

b. Soliciting input from staff members

The core of leadership is awareness. The text by Don Miguel, The Four Agreements, presents a set of agreements to enhance personal growth and awareness. What is not one of the four agreements? a. Be impeccable with your word. b. Take things personally. c. Do not make assumptions. d. Always do your best.

b. Take things personally.

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

b. The effectiveness of appraisal is enhanced by a combination of methods and effective communication skills.

You overhear a new graduate RN telling a nurse colleague that leadership and management belong to the unit manager, not to her. As a nursing colleague, what do you know to be true in regard to the statement? a. The statement is correct. Leadership is not the role of the staff nurse. b. The new graduate would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals. c. The new graduate has been influenced by nurse leaders and managers who leave for other positions. d. The general perception is that nurse leaders and managers are not satisfied in their jobs.

b. The new graduate would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals.

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

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

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

b. The type of speech required for voice recognition is unlikely to occur in a pressured situation.

Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style? a. Transformational b. Transactional c. Trusting d. Truthful

b. Transactional

Which of the following would be most effective in implementing the findings of a new clinical treatment for problems associated with bowel motility for the staff nurses? a. Lecture by a nurse practitioner b. Workshop for surgical nurses that involves discussion of case studies and application of evidence c. Discussion of the findings on the bulletin boards at the workstation d. Education of unit opinion leaders regarding the evidence presented in the studies

b. Workshop for surgical nurses that involves discussion of case studies and application of evidence

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

b. a bias related to recent events.

Tara, the unit manager, is explain to her colleague her recent project, which involves seeking the most effective approaches to incontinence care, with the intention of adopting evidence-supported approaches on her dementia care unit. Her colleague suggests that translation of research into practice is: a. less important than knowledge-generating research, which is required to advance the nursing profession. b. a priority of all healthcare practitioners to improve patient care. c. characterized by lack of knowledge about how to use evidence to guide practice. d. so difficult that it is useless to begin the query in the first place.

b. a priority of all healthcare practitioners to improve patient care.

The clinical guidelines for management of incontinence developed by the Registered Nurses Association of Ontario (RNAO): a. reflect practice that is fiscally directed and sound. b. articulate practice recommendations developed from synthesis and review of evidence. c. are intended to increase awareness of issues in incontinence management. d. reflect a compilation of information from a variety and range of sources related to incontinence.

b. articulate practice recommendations developed from synthesis and review of evidence.

A 27-year-old woman is admitted to your ICU in a coma, following an accident. The family of the patient, who is a Native American, places a medicine pouch in the bed with the young woman. As the nurse in this situation, it is important to: a. explain to the family that the medicine pouch may contain herbs that may bother other patients. b. ask the family about the significance of the medicine pouch for them. c. remove the pouch when the family is not present. d. put the medicine pouch on the shelf beside the bed.

b. ask the family about the significance of the medicine pouch for them.

The new head nurse on G Unit has been the subject of a great deal of discussion and complaining during breaks. She is a competent nurse of tremendous integrity with approximately 30 years' experience. Her predominant method of problem solving and communication is through meetings, which can go over the allotted time. The staff may: a. be represented by a high number of Baby Boomers. b. be presenting different generational values and attitudes than the head nurse. c. be unresponsive to her transactional leadership style. d. want a leader rather than a manager.

b. be presenting different generational values and attitudes than the head nurse.

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

b. can be used to support and justify fairness in termination discussions.

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

b. central data repository.

Decision making is described by the nursing educator as the process one uses to: a. solve a problem. b. choose between alternatives. c. reflect on a certain situation. d. generate ideas.

b. choose between alternatives.

To enhance team leadership skills for your team leaders, you arrange opportunities for: a. certification. b. continuing education. c. graduate courses. d. volunteerism.

b. continuing education.

The hospital administrator approves a case management position for a new rehabilitation unit to help reduce costs. In developing the job description, the nurse manager understands that a key element of case management is: a. managing of care by nurse managers. b. coordination of resources for effective outcomes. c. rapid discharge of clients to decrease costs. d. managing of care for outpatient clients only.

b. coordination of resources for effective outcomes.

During a fire drill, several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This autocratic decision style is most appropriate for: a. routine problems. b. crisis situations. c. managers who prefer a "telling" style. d. followers who cannot agree on a solution.

b. crisis situations.

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

b. data, information, and knowledge.

A manager who is concerned with ensuring that patients on her surgical unit have the necessary information to make informed choices is: a. practicing legal nursing care. b. demonstrating respect for patient rights. c. avoiding risks. d. likely experiencing staff issues with informed consent.

b. demonstrating respect for patient rights.

As a senior executive, you are keen to develop your hospital as a learning organization. Part of your purpose in translating this vision into practice is to: (Select all that apply.) a. retain funding from third-party payers. b. develop leaders. c. maintain and/or improve quality of care. d. stay abreast of new knowledge and evidence.

b. develop leaders. c. maintain and/or improve quality of care. d. stay abreast of new knowledge and evidence.

As a nurse manager, you trial a new pain scale on your unit that is supported by numerous research studies. You compare the patient outcomes with the new scale against the existing scale. Feedback from staff suggests that the new scale is too difficult for patients who have limited language skills and who are already under duress to understand. The difficulty in implementing the new scale refers to testing: a. efficacy. b. effectiveness. c. practice failure. d. comparative error.

b. effectiveness.

To develop a curriculum vitae, or résumé, a nurse must develop a personal data file. The goal of a personal data file is to: a. create an opportunity to be interviewed. b. have a listing of facts about your professional life. c. have a tool in place for marketing yourself. d. create a document that lists your skills.

b. have a listing of facts about your professional life.

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

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

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

b. hold staff accountable for safe practices.

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

b. learning goals, or management by objectives.

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

b. measurable and nursing-sensitive.

The nurse manager plays a unique role in institutional management in that the nurse manager: a. encourages shared decision making. b. models professional nursing behavior. c. interprets healthcare trends and their impact on revenues. d. coordinates care and allocates resources.

b. models professional nursing behavior.

A group of managers is meeting to discuss ideas related to the successful implementation of evidence-based practice on their units. Susan has been asked by the director of care to assume leadership of these discussion groups. After two such sessions, Susan expresses disappointment to her mentor that the group seems disinterested in her ideas and that they are listening to Ken, who has much less experience with leadership. In discussing this with Susan, the mentor understands that leadership: a. is a designated role. b. must be earned. c. is more likely to be taken by someone who is more talkative. d. rarely is taken over by someone with less experience.

b. must be earned.

Based on Elizabeth's insights and suggestions, you involve pharmacy, only to discover that the change in practice involves practice committees, a medical practice committee, and concerns from administration about potential costs and safety of the proposed change to the IV protocols. The change process at this point is: a. linear. b. nonlinear. c. sabotaged. d. neutralized.

b. nonlinear.

When goals/outcomes are somewhat unclear in early preparation for a complex change, the manager and the change management team develop several acceptable goals/outcomes. This change in management approach is termed: a. unfreezing. b. nonlinear. c. cybernetic. d. linear.

b. nonlinear.

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

b. nursing care standards.

The Sunny long-term care facility has experienced numerous difficulties with staff relationships, despite its success in maintaining financial viability and judicious use of resources. Staff members complain that the primary concerns of the facility include applying policy, saving money, and ensuring that lawsuits are avoided. There is little trust in, and involvement of, staff members. This facility may be: a. well managed and well led. b. overly managed and not well led. c. poorly managed and well led. d. overly led and overly managed.

b. overly managed and not well led.

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

b. perfectionism.

A nurse is applying for a new position. This position is one in which she will serve as a liaison between a hospital and a school of nursing. The nurse must update her résumé to include her teaching experience. The goal of creating a curriculum vitae is to: a. have a listing of facts about your professional life. b. provide potential employers with information about where you are in your career. c. respond quickly whenever a position becomes available. d. be certain you can recall facts for a prospective position.

b. provide potential employers with information about where you are in your career.

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

b. recommending that a multidisciplinary team should assess the root cause of errors in medication.

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

b. reduced wait times to see specialists.

The nurse manager in the Emergency Department needs to implement new staffing patterns. As a transformational leader, the nurse manager would: a. explain in detail how well the new idea will work. b. reinforce how this change will respond to the ideas and solutions generated by staff members. c. reason with staff members that the new idea will save money and allow more free time. d. imply that raises will be smaller than anticipated if the new idea is not accepted.

b. reinforce how this change will respond to the ideas and solutions generated by staff members.

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

b. reviewing vacation requests.

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

b. role ambiguity.

An example of one strategy used to improve participation in the change process by staff fitting the behavioral description of innovators and early adopters is to: a. repeat the benefits of the change. b. share change experiences early in the process. c. initiate frequent interactions among staff. d. provide select information to the staff.

b. share change experiences early in the process.

The nurse manager, as the leader of the unit's "customer (client) first" initiative, has asked the staff nurses to develop and administer a survey to every client before discharge. In asking the staff nurses to accomplish this task, the nurse manager is demonstrating: a. accountability. b. shared leadership. c. a common purpose. d. independence in the nursing manager's role.

b. shared leadership.

The style of leadership that Kari is exhibiting is likely to: a. ensure that the organization is financially stable. b. stifle innovative thinking about ways to move out of financial jeopardy. c. lead to apathy and disinterest in the organizational goals. d. lead to decreased attrition of staff on her unit.

b. stifle innovative thinking about ways to move out of financial jeopardy.

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

b. that structure influences nurse burnout and participation in quality improvement initiatives.

John Smith, one of three managers at BSG Labs, drafted a policy that would allow his department to do more testing in his lab. This policy included the times for regular collection as well as a new process for emergency laboratory testing. The policy and procedures were never followed. The reason was that: a. the policy was too lengthy and inundated readers with too much detail. b. the policy made decisions for other departments in the company. c. the staff did not believe that the new policy would be effective. d. testing should not be done in the lab.

b. the policy made decisions for other departments in the company.

A nurse executive who considers herself a Baby Boomer will have the challenge of convincing the emerging work force of the necessity of committee meetings. One of the primary reasons that the Baby Boom generation appears to have so many meetings in the work environment is that: a. they feel more comfortable in a group. b. they find that the journey to the solution is as important as the solution itself. c. they were deprived of collective action opportunities in the past and now feel that solutions are better when many people have input. d. Baby Boomers are aging and need the respite from work that meetings offer, so they can recuperate from the physical demands of the work environment.

b. they find that the journey to the solution is as important as the solution itself.

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

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

Nurses in the CCU are unhappy and frustrated with their nurse manager. They complain that "nothing is ever good enough for him." These statements suggest that the nurse manager's goals may be: a. measurable. b. unrealistic. c. attainable. d. too low.

b. unrealistic.

An outpatient surgery manager is evaluating new infusion pumps for purchase to use in the operating room. The manager should: a. select the least expensive brand. b. use a decision-making tool to evaluate brands. c. ask the nursing staff which brand they prefer. d. select the vendor the institution usually buys from.

b. use a decision-making tool to evaluate brands.

Technology is integral to a cardiac ICU. Sue, the nurse manager, implements a patient-centered approach that focuses on the meaning of the experience for the patient and family, primary nursing, and a health literacy approach. Sue is: a. using high-tech-low-touch approaches. b. using high-tech-high-touch approaches. c. providing products. d. providing tangible products of satisfaction.

b. using high-tech-high-touch approaches.

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

b. whether mentoring is included in the position description.

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

c. "I will be in contact with all candidates by telephone by next Friday. It has been a pleasure to meet you."

Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." Which of the following would be the most effective response to Elizabeth? a. "I understand how you feel, but you are going to have to change." b. "It is unfortunate that you feel this way. Others seem quite excited about the new information." c. "It is difficult sometimes to change what we know very well. Sometimes it can be frightening." d. "Perhaps I can arrange some more information sessions for you, so you can see just how important this change is to patient safety."

c. "It is difficult sometimes to change what we know very well. Sometimes it can be frightening."

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

c. "We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?"

During performance appraisal interviews, Joanne's nurse manager notices Joanne's excitement when she talks about how she has helped patients on a rehab unit understand the complexities of their regimens. When Joanne's nurse manager asks her about her career path plans, Joanne says that she wants to become a nurse administrator. The best response to Joanne would be: a. "Nursing administration is rewarding. What experiences would help you along this path?" b. "You do not appear excited about nursing administration. Unless you are excited by that career path, I wouldn't advise going in that direction." c. "You seem to find teaching others very rewarding. Have you considered that as a possible career path?" d. "You are too inexperienced to consider administration. Work for a few years, and then consider administration."

c. "You seem to find teaching others very rewarding. Have you considered that as a possible career path?"

On your curriculum vitae, which of the following is the recommended approach for listing employment and educational history information? a. 1979 RN Diploma 1985 BScN 2002 MN b. 2002 Mount Rush Health Center Staff Nurse 1997 Cedar Falls Clinic Staff Nurse 2007 Kilkarney Rehab Center Case Manager c. 2007 MN 2005 BScN d. 1997 Sturgeon County Hospital Head Nurse 2002 Sturgeon County Supervisor 2007 Sturgeon County Director

c. 2007 MN 2005 BScN

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

c. 3, 1, 4, 5, 2

The hospital administration is discussing the possibility of closing hospital beds in your unit because of a nursing shortage and the increased amount of overtime required to care for patients. As the leader on the unit, which of the following examples best demonstrates your transformational leadership style? a. Your entire staff walks out on strike. b. Your staff sends an ultimatum to the clinic director demanding higher pay. c. A group of your staff members goes to the administration to propose closing of a different unit. d. A group of your staff members goes to the administration to request that they be allowed to work the overtime hours.

c. A group of your staff members goes to the administration to propose closing of a different unit.

Which of the following actions best exemplifies advocacy? a. Developing a list of agencies that will provide free services for the homeless b. Working in a needle exchange program for individuals in an inner-city environment c. Acting on behalf of a patient to promote end-of-life wishes to an ethics committee d. Working in a free clinic for immigrant workers

c. Acting on behalf of a patient to promote end-of-life wishes to an ethics committee

As part of performance appraisal, the nurse manager designs strategies to acknowledge staff members. What practices by the nurse manager best acknowledge staff accountability and contribution? a. Providing new and varied learning experiences for staff members b. Fostering group cohesiveness through standardization of unit activities c. Allowing professionals greater influence over their practices d. Giving recognition for success and support for failure to staff members

c. Allowing professionals greater influence over their practices

A grievance brought by a staff nurse against the unit manager requires mediation. At the first mediation session, the staff nurse repeatedly calls the unit manager's actions unfair, and the unit manager continues to reiterate the reasons for the actions. What would be the best course of action at this time? a. Send the two disputants away to reach their own resolution. b. Involve another staff nurse in the discussion for clarity issues. c. Ask each party to examine their own motives and issues in the conflict. d. Continue to listen as the parties repeat their thoughts and feelings about the conflict.

c. Ask each party to examine their own motives and issues in the conflict.

As a leader in nursing, one must seek new insights and establish personal tools to improve their lifelong learning. Which behavior by manager would be a concern for a chief nursing executive? a. Journaling for self-reflection b. Authentic relationships c. Complacent behavior d. Improved knowledge of staff

c. Complacent behavior

A nurse manager has worked to bring the staff to participate in and then accept changes in the unit's mission, so that downsizing can be avoided. How is the nurse manager using change theory for this situation? a. Focusing on past concerns related to the mission b. Teaching staff members how to self-manage themselves c. Determining accurately the direction of change in the institution d. Requiring all staff members to review and reinforce their technological skills

c. Determining accurately the direction of change in the institution

A staff nurse has been recently promoted to unit manager. During the time on the unit, the nurse formed a strong social network among staff, has promoted the development of relationships between staff and workers in other areas of the organization, and has formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, what principle is being engaged? a. Empowerment b. Systematic thinking c. Development of networks d. Bottom-up interactions

c. Development of networks

In planning a new wing, the nurse manager complies with the workplace safety requirements of the Occupational Safety & Health Administration (OSHA). Which of the following groups is considered to be at high risk for violence in the workplace? a. Pediatric staff b. Postsurgical unit staff c. Emergency Department staff d. Medical oncology unit staff

c. Emergency Department staff

Excellent leaders need to have or develop the skills of empathy and expressiveness when dealing with others in the workplace. This is also known as understanding and managing own feelings and emotions as well as discerning the emotions of others. What is this an example of required by good leaders? a. Social awareness b. Self-awareness c. Emotional intelligence d. Intellectual ability

c. Emotional intelligence

The Rehabilitation Unit at Pleasant Valley Hospital has a high number of falls. What interventions might assist to reduce the number of falls on the unit? a. Determining who is responsible for the falls b. Strengthening unit policies to avoid inappropriate admissions c. Encouraging involvement of nurses in education related to falls and safety d. Ensuring that patients are appropriately restrained if they are at risk for falls

c. Encouraging involvement of nurses in education related to falls and safety

As a nurse manager, you are a leader in health care and on the unit you manage. Looking at the larger picture of health care and patient environment on the unit, what is your primary role when evaluating the care provided on your nursing unit? a. Focus on cost outcomes. b. Assess staff for contentment on unit. c. Ensure quality patient care on unit. d. Provide education to the staff of the unit

c. Ensure quality patient care on unit.

How would the nurse executive begin to increase safety in patient care areas of the Valley Hospital? a. Asking the community what the safety issues are b. Consulting with a management expert about staffing schedules c. Ensuring that the senior nursing officer attends the board meetings d. Instituting improved practices to reduce needlestick injuries

c. Ensuring that the senior nursing officer attends the board meetings

To help staff nurses adjust to using research in practice, what strategy would the nurse manager use? a. Attendance at a regional research conference b. Formal classes in electronic search techniques c. Establishing a journal club d. Issuing reports on the adverse consequences of outdated practices

c. Establishing a journal club

After searching the literature, Tara, the unit manager develops a table that outlines the findings of studies on management of incontinence. She then examines the studies in terms of risk and whether the findings fit within her practice context and for her population of moderately to severely cognitively impaired patients. This is which phase of a research utilization model? a. Preparatory b. Validation c. Evaluation d. Application

c. Evaluation

A family is keeping vigil at a critically ill patient's bedside. The nurse approaches the unit manager with concern over the family dynamics for the patient concerned there are patient-family conflicts based on patient's wishes. The nurse suggests that the patient's provider may need to discuss the treatment plan with the family. The unit manager states he will arrange a discussion with the patient's provider and ask the nurse to support the provider's decisions. What is the role of the nurse in this situation? a. Leadership b. Management c. Follower d. Evidence-based

c. Follower

At an organizational level, which of the following strategies would assist in ensuring that EBP is incorporated into nursing care? a. Formation of nursing-only implementation teams b. Restriction of evidence to RCTs c. Formation of a network of individuals doing research and/or interested in research utilization d. Avoidance of partnership with experienced researchers

c. Formation of a network of individuals doing research and/or interested in research utilization

The nurse manager wants to increase motivation by providing motivating factors for the nurse on the unit. What action would be appropriate to motivate the staff? a. Collaborate with the human resource/personnel department to develop on-site daycare services. b. Provide a hierarchical organizational structure. c. Implement a model of shared governance. d. Promote the development of a flexible benefits package.

c. Implement a model of shared governance.

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

c. Improvement in patient outcomes

Mary, an 85-year-old patient with cognitive impairment and gross instability, wanders continuously. Lately, she has fallen twice, and the family demands that she be restrained. As the unit manager, you have initiated a least restraint practice. What is an appropriate action in this situation? a. Setting up a nursing team meeting to review practices b. Calling the family to inform them of the practice c. Initiating a multidisciplinary and family meeting to focus on Mary's needs d. Restraining Mary to satisfy the family's wishes

c. Initiating a multidisciplinary and family meeting to focus on Mary's needs

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

c. Lack of staff understanding and support for BCMA has led to overrides or failures to scan bar codes during busy times.

The charge nurse walks into Mr. Smith's room and finds him yelling at the LPN. He is obviously very upset. The charge nurse determines that he has not slept for three nights because of unrelieved pain levels. The LPN is very upset and calls Mr. Smith an "ugly, old man." The charge nurse acknowledges the LPN's feelings and concerns and then suggests that Mr. Smith's behavior was aggressive but was related to lack of sleep and to pain. The charge nurse asks, "Can you, together with Mr. Smith, determine triggers for the pain and effective approaches to controlling his pain?" This situation is an example of what? a. Lack of empathy and understanding for Miss Jones b. Concern with placating Mr. Smith c. Leadership behavior d. Management behavior

c. Leadership behavior

Which of the following situations is most likely to result in a productive, whole work situation? a. Amy, RN, 5 years of experience in the Emergency Department. Amy accepts a position working with older clients in a home health agency because she has relocated, and this is the only full-time position available. b. Adam, RN, 8 years of experience in various nursing positions, including that of a nurse manager. Adam accepts a new nurse manager position because he has a family and wants more regular hours. He is most comfortable working in direct client care. c. Louise, RN, 10 years of experience in an Emergency Department. She accepts a position as a case manager in home health care, working with older clients. She especially enjoys working with older adults and wants to take on leadership and management challenges. d. Courtney, RN, a new graduate. Courtney is getting comfortable with delivering nursing care as an RN. She is offered a position on surgery as a permanent team leader. The unit has had a great deal of turnover recently, and only limited mentorship is available.

c. Louise, RN, 10 years of experience in an Emergency Department. She accepts a position as a case manager in home health care, working with older clients. She especially enjoys working with older adults and wants to take on leadership and management challenges.

In writing the patient satisfaction survey, the nurse manager is aware of the education levels of the families. What is the most critical element in the concept of health literacy? a. Providing instructional materials at appropriate reading levels b. Facilitating access to translators for persons with language barriers c. Obtaining, processing, and understanding basic health information so appropriate decisions can be made d. Knowing that most people have limited health literacy skills

c. Obtaining, processing, and understanding basic health information so appropriate decisions can be made

Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high turnover rate among rehab-assistants because of the heavy work assignments. Despite his need for staff, Justin decides to review each application thoroughly and interview candidates carefully because he recognizes that it is important to hire staff who can best provide high-quality care and who will fit well with the team. Which of the following decision-making models did Justin use in making his decision? a. Subjective model b. Objective model c. Optimizing model d. Satisficing model

c. Optimizing model

As a new nurse manager, you are aware of leadership, management, and followership principles. The concept of followership is rather new as relating to leadership. What is the role of the follower in followership? a. Leading the group in task b. Submission position in organization c. Person who may influence team d. Negative meaning for worker

c. Person who may influence team

An experienced staff nurse applies for a distinct position of patient advocate at a new clinic. Based on the various tools available to her, which of the following should she bring to her interview to best present her skills? a. Résumé b. Annual evaluations c. Portfolio d. Patient advocacy project

c. Portfolio

Which of the following is an example of a formal leadership position on a nursing unit? a. Staff nurse b. Unit secretary c. Unit manager d. Nursing assistant

c. Unit manager

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

c. WL pager

During an interview for a manager's position, you find the supervisor and staff unfriendly. Responses to questions are met with vague responses. After the interview, you decide not to pursue the position. What follow-up, if any, is most appropriate? a. There is no need for you to do anything further. You likely will not be offered the position anyway. b. You should file a complaint with human resources about the supervisor's lack of interviewing skills. c. You should send a thank-you note to the interviewer, indicating appreciation for her time. d. You should call and leave a voicemail, indicating your disinterest in the position.

c. You should send a thank-you note to the interviewer, indicating appreciation for her time.

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

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

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

c. a database.

To solve a problem, the nurse manager understands that the most important problem-solving step is: a. the implementation phase. b. identification of numerous solutions. c. accurate identification of the problem. d. evaluation of the effectiveness of problem resolution.

c. accurate identification of the problem.

During review of a patient's progress, the healthcare team determines that a patient requires treatment that is generally accepted at that time in the usual illness trajectory of a patient. The patient is unable to pay. As the head nurse, you persist in ensuring that this patient receives the treatment. You are: a. empowering the patient. b. avoiding litigation. c. advocating for the patient. d. supporting the clinical pathway.

c. advocating for the patient.

The clinical coordinator expects the position description of the new wound care specialist to change nurses' responsibilities in caring for clients with skin integrity problems. The best approach to address this need for change, yet to have the best outcomes for clients, staff nurses, and the organization, is to: a. select one of the change models. b. use Lewin's model and principles of change. c. apply both planned and complexity theory approaches. d. form a task force of nursing staff and wound care specialists.

c. apply both planned and complexity theory approaches.

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

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

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

c. benchmarking.

The complexity of the healthcare environment for consumers is increased by: a. falling levels of education among the public. b. increased levels of poverty. c. complex compensatory systems and a variety of delivery systems. d. increased numbers of uninsured or underinsured.

c. complex compensatory systems and a variety of delivery systems.

1. An example of a career is: (Select all that apply.) a. employment in short-term contract jobs in business, nursing, and whatever is available. b. involvement in an area of practice that is regulated. c. continuous employment in the same position and the same arrangement for 20 years. d. moving into and out of nursing positions in various cities while pursuing travel and education that develop understanding of global health.

c. continuous employment in the same position and the same arrangement for 20 years. d. moving into and out of nursing positions in various cities while pursuing travel and education that develop understanding of global health.

The home health agency hired an expert in financial management to evaluate and propose a plan for reversing growing expenses and decreasing revenues. The expert is well respected, both personally and professionally, by members living in this small community. To be effective, staff will need to perceive this change agent as: a. trusted, quiet. b. flexible, informal. c. credible, enthusiastic d. communicative, personable.

c. credible, enthusiastic

Select the statement that best defines the difference between problem solving and decision making: a. decision-making skills require critical thinking; problem-solving skills do not. b. problem-solving skills require critical thinking; decision-making skills do not. c. decision making is a goal-directed effort; problem solving is focused on solving an immediate problem. d. problem solving is a goal-directed effort; decision making is focused on solving an immediate problem.

c. decision making is a goal-directed effort; problem solving is focused on solving an immediate problem.

You anticipate that your region will soon move toward an e-health record system. You begin to discuss this with your staff and are disappointed that you receive little positive response from the staff about this possibility. One staff member, in particular, seems to sum it up by saying "e-health? Won't happen in my working life! There are too many problems with it, like privacy issues." This response is most likely motivated by: a. lack of urgency regarding the need to change. b. lack of evidence to support importance of technology. c. deficits in education and experience. d. lack of organizational support for change.

c. deficits in education and experience.

A nurse manager is experiencing considerable conflict among staff members because of weekend staffing coverage. During a called staff meeting, the nurse manager asks the disgruntled staff to meet as a group and determine the best staffing practices. In doing this, the nurse manager is using the concept of collaboration to: a. demonstrate interdependence. b. depict flexibility and broadmindedness. c. focus all energies of staff members on a best possible strategy. d. defuse the possibility that staff members will escalate their discontent when staffing the unit on weekends.

c. focus all energies of staff members on a best possible strategy.

Several nurses on an adolescent psychiatric unit complain that the teens are becoming unmanageable on the 0700-1900 shift. To resolve this problem, the nurse manager decides that the staff should have a brainstorming session. The goal of brainstorming is to: a. evaluate problem solutions. b. critique the ideas of others. c. generate as many solutions as possible. d. identify only practical and realistic ideas.

c. generate as many solutions as possible.

High-quality decisions are most likely to be made in nursing situations when: a. team leaders make the crucial decisions. b. individuals are advised of the problems. c. group size is neither too small nor too large. d. members are passively involved.

c. group size is neither too small nor too large.

From the information supplied in this chapter, which statement best defines critical thinking? Critical thinking is a: a. high-level cognitive process. b. process that helps to develop reflective criticism for the purpose of reaching a conclusion. c. high-level cognitive process that includes creativity, problem solving, and decision making. d. discussion that guides the nursing process.

c. high-level cognitive process that includes creativity, problem solving, and decision making.

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

c. identify a clinical activity for review.

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

c. identify the standard.

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

c. improves patient outcomes.

As the unit manager on the unit that is leading changes to heparin locks, you find that Elizabeth is very valuable in terms of her observations about other units and her knowledge of organizational processes, and now in discussing the new procedure with others. Elizabeth might be considered an: a. engager. b. innovator. c. informal change agent. d. informant.

c. informal change agent.

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

c. informatics competencies.

The oncology clinical manager and the educational coordinator asked nursing staff to complete a brief written survey to assess their attitudes and knowledge related to having used the new infusion equipment for 6 weeks. The stage of change in this situation is: a. developing awareness. b. experiencing the change. c. integrating the change. d. perceiving awareness.

c. integrating the change.

A nurse is admitted to a psychiatric unit. The staff expresses frustration with her because they have explained her medication regimen several times, and yet, when she leaves the unit with a pass, she fails to follow it. The staff believe that, as a nurse, she should be able to understand what is expected. The nurse's failure to follow the regimen indicates: a. early cognitive impairment. b. lack of motivation. c. lack of health literacy. d. worsening health state.

c. lack of health literacy.

Elizabeth is an example of a(n): a. early adopter. b. late majority. c. laggard. d. resister.

c. laggard.

To retain supervisory staff members, the director of nursing develops a mentoring program. The best person to be a mentor for a new supervisor in a leadership position is someone who has: a. been in the same position and can relate to the new supervisor's problems. b. had vast leadership opportunities and likes to talk about his or her past experiences. c. leadership experience and time to spend communicating with the new supervisor about his or her experiences. d. people who can help the new supervisor get what he or she needs to make the organization grow quickly and prosper in the process.

c. leadership experience and time to spend communicating with the new supervisor about his or her experiences.

A well-written letter of resignation is critical to: a. first announce your intent to resign. b. formally signal discontent in your current position. c. maintain a positive relationship with your former organization and colleagues. d. fulfill your legal obligations as a departing employee.

c. maintain a positive relationship with your former organization and colleagues.

As the clinical director of 24 employees, you have been asked to explain to staff members why they are not getting a raise this year, even though they have been working short-handed for many months and patient satisfaction scores have never been higher. Because you believe yourself to be a transformational leader, you will approach this problem by: a. telling the assistant clinical director and asking her to share the bad news with the other staff members. b. posting a note on the bulletin board that includes the phone number of the chief nursing officer, so anyone who has complaints may express them. c. showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future. d. meeting with a small group of seasoned staff members and asking them how to break the news.

c. showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future.

A nurse manager has been employed in the same facility for 20 years and has held the same position. This career style is known as: a. linear. b. spiral. c. steady state. d. entrepreneurial/transient.

c. steady state.

A home health nurse has been assigned to cover a 300-square-mile area of remote Montana. Mrs. Baker has just been discharged home following bowel surgery and has a new colostomy. She will need daily contacts for at least 2 weeks and then regular weekly contact following that week. Because it is not possible to visit Mrs. Baker in person every day and see all of the other clients, the nurse gives her a laptop computer with net meeting software installed. Each morning, both dial in at an agreed-upon time and discuss her progress. The home health nurse assesses whether or not the client needs to be seen that day and is able to view the colostomy site. This type of technology is called: a. distance learning. b. knowledge software. c. telecommunications. d. biomedical technology.

c. telecommunications.

In working with Cheryl, her mentor suggests that it is really important for Cheryl to engage in self-appraisal and to know her strengths. This observation is based on an understanding that: a. self-confidence comes automatically out of leading. b. self-confidence requires constant self-affirmation of strengths. c. there is little external motivation and affirmation in leadership. d. supervisors of leaders rarely provide feedback.

c. there is little external motivation and affirmation in leadership.

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

d. "I'm sorry, but you will have to enter the information using your own password."

Sarah, RN, is one of your most enthusiastic staff members and has been to a workshop on preparing educational materials for patients. On the basis of this workshop, she would like to develop an information website for patients who are being admitted to the ward. An appropriate response to Sarah's suggestion would be: a. "That is a great suggestion, but we have no resources for such an expensive undertaking right now." b. "Perhaps you can keep that in mind as we redesign our charting system." c. "We have too many seniors as patients, and you know that they don't use technology." d. "There is a great group here that meets to look at technology pilots. Let's see if you can join them and discuss your idea further."

d. "There is a great group here that meets to look at technology pilots. Let's see if you can join them and discuss your idea further."

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

d. 6

Which of the following exemplifies a service orientation for a facility? a. Staff members on the unit are encouraged to chart details about family support networks. b. Chart audit reveals that details related to assessment of family history are missing. c. The palliative care unit organizes a "tree of light" fundraiser each year to highlight the importance of palliative care. d. A children's preoperative holding area is implemented in response to requests from families and staff nurses for development of an area.

d. A children's preoperative holding area is implemented in response to requests from families and staff nurses for development of an area.

You are offered an opportunity to take a temporary leave from your position as a nurse manager to lead a technology implementation project. Which of the following reasons for accepting the opportunity is most consistent with developing a solid career path? a. You are pressured to do so by your supervisor. b. The organization has no other suitable candidate for the position. c. You have limited knowledge of information technology and no real interest, but this will increase your knowledge. d. Accepting a position outside of your established skill set may establish you organizationally as an innovative, adaptable leader.

d. Accepting a position outside of your established skill set may establish you organizationally as an innovative, adaptable leader.

Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high turnover rate among rehab-assistants because of the heavy work assignments. Despite his need for staff, Justin decides to review each application thoroughly and interview candidates carefully because he recognizes that it is important to hire staff who can best provide high-quality care and who will fit well with the team. Which of the following decision-making solutions should Justin consider to have a more efficient department? a. Replace staff only with qualified applicants. b. Determine what the problem or problems are before hiring new staff. c. Consult with the human resources department and develop a plan for hiring new staff. d. All listed are appropriate to consider.

d. All listed are appropriate to consider.

The manager of a nursing unit is having difficulty working with a new graduate nurse. The new graduate nurse is excited and full of ideas she wants to try keeps pushing the manager to make changes. The manager decides to provide the new nurse with an opportunity to present an idea to the staff at the next meeting. What is the manager providing the new nurse? a. Leadership opportunity b. Working to improve patient care c. Input to the unit d. All of the above

d. All of the above

The nurse manager has been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperatively. The program is to be implemented across the entire facility. What illustrates effective leadership in this situation? a. The training modules are left in the staff room for times when staff are available. b. The current approach is continued because it is also evidence-based and is more familiar to staff. c. You decide to implement the approach at a later date because of feedback from the RNs that the new approach takes too much time. d. An RN who is already familiar with the new approach of volunteers to take the lead in mentoring and teaching others how to implement it.

d. An RN who is already familiar with the new approach of volunteers to take the lead in mentoring and teaching others how to implement it.

A new graduate nurse has accepted a position in an intensive care unit. The nurse is assigned a preceptor with several years of experience. The new nurse also notices the other staff seek this nurse out for answers to questions and as a resource to the unit. What does the new nurse consider the role of the mentor nurse? a. A formal leader b. A positional leader c. An official leader d. An informal leader

d. An informal leader

After consulting with practice environments about quality and safety concerns in health care, a dean in a health care program implements what to improve quality and safety in health care? a. A nursing program that emphasizes the development of a strong disciplinary identity. b. Programming that stresses discipline-based research. c. Partnerships with health care to develop software for the reporting of adverse events. d. An interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizes collaborative learning teams.

d. An interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizes collaborative learning teams.

The chief nursing officer at a local hospital seeking Magnet® status creates staff development classes concerning translation of research into practice (TRIP). What best describes TRIP? a. Conducting an integrative review of the literature b. Searching the literature for a systematic review c. Providing the results of research studies to practitioners d. Applying strategies that aid in adoption of research in practice

d. Applying strategies that aid in adoption of research in practice

Nancy is a staff nurse who works on a rehabilitation unit. Nancy tells you that the assistants are experiencing difficulty with the new lift and wonders what your thoughts are on organizing an in-service training. Nancy is exhibiting which trait of a follower? a. Provides a vision for safety that is communicated. b. Thrives on taking risks in identifying the problem with safety. c. Coordinates the development of knowledge and skills necessary to use the lift. d. Assumes responsibility for identifying a safety concern and concedes authority for solution to you.

d. Assumes responsibility for identifying a safety concern and concedes authority for solution to you.

Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." According to Havelock (1973), this comment may originate from failure in which phase of the six phases of planned change? a. Generating self-renewal b. Choosing the solution c. Diagnosing the problem d. Building a relationship

d. Building a relationship

Which of the following is not important in a positive work environment, as defined by the AONE? a. Clear, open, trustful communication b. Accountability and clarity of roles and responsibilities c. Participatory decision making d. Challenge and striving for excellence

d. Challenge and striving for excellence

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

d. Coaching

Which of the following is most accurate regarding evidence-based practice? a. Evidence-based practice replaces continuous quality improvement. b. Evidence-based practice began with medicine and assists in determining which medical models can be applied in nursing practice. c. Effective and efficient care can already be demonstrated, which means that EBP will soon become redundant. d. EBP is generally recognized across disciplines and by policymakers as state-of-the-art clinical practice.

d. EBP is generally recognized across disciplines and by policymakers as state-of-the-art clinical practice.

Electronic health records (EHRs) are being instituted at Pleasant Valley Hospital. Some of the staff on Unit 4 complain to the manager that acquiring the technologic skills required is too time consuming. They question its value in patient care. The manager responds that: a. the use of technology is inevitable in our technologically oriented society. b. the hospital is no longer able to find the space to accommodate paper record-keeping. c. the initiative is being driven by decision makers higher up in the hierarchy and there is no choice. d. EHRs will increase effectiveness of care by enhancing coordination and improving patient outcomes.

d. EHRs will increase effectiveness of care by enhancing coordination and improving patient outcomes.

How would a nurse manager and the staff prepare for redesignation as a Magnet® Hospital? a. Commit staff resources over a 6-month period to updating procedure manuals. b. Educate staff through meetings and training sessions regarding appropriate answers to questions. c. Prepare a manual that outlines orientation procedures and ensure that all safety issues are addressed. d. Ensure that there are empirical data to support review of patient outcomes, actions taken, and results of actions.

d. Ensure that there are empirical data to support review of patient outcomes, actions taken, and results of actions.

Which of the following is an effective approach in the appraisal of research studies? a. Accept only studies that use a RCT design. b. When ranking research studies, choose RCTs over qualitative studies. c. Select only studies with a large sample size. d. Evaluate the quality of the research against the standards for that type of research.

d. Evaluate the quality of the research against the standards for that type of research.

After assessing an older adult patient in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. What is the most likely basis for the nurse manager's request? a. An established clinical pathway b. Confirmatory scientific evidence c. Unit protocol d. Experience

d. Experience

The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility. While making rounds on the units, the staff development coordinator overhears RN staff complaining that they feel it is insulting to be required to participate in a competency program. What behavior by the staff development coordinator is most appropriate in this situation? a. Disregard staff concerns and continue with development of the program. b. Inform the nurses that this program is a requirement for JCAHO accreditation. c. Schedule a meeting with the chief nurse executive to apprise her of the situation. d. Facilitate a meeting so nurses can articulate their values and concerns about a competency program.

d. Facilitate a meeting so nurses can articulate their values and concerns about a competency program.

In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital reduced the number of its managers and increased the number of units for which each manager was responsible. Within a year, the number of adverse events on the units had doubled. How do the increase in adverse events relate to decreased managers? a. The overload of staff nurse duties b. Resistance to change by staff c. A change in reporting system for everyone d. Fewer clinical leaders facilitate best practice

d. Fewer clinical leaders facilitate best practice

When confronted with the controversy and the apparent poor morale of the evening staff, the unit manager decided the staff needed to take some time off. He scheduled holidays for the staff without consulting them. A couple of the staff nurses approached the manager and indicated that the problem was not scheduling, but rather the team leader and her patient assignments. What was the unit manager's first missed step in problem solving? a. Not using a problem-solving model b. Not considering a number of alternatives c. Poor evaluation of outcomes d. Incorrect problem identification

d. Incorrect problem identification

As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety and reducing morbidity and mortality on your unit. What recommendations would be consistent with the IOM The Future of Nursing report? a. Careful screening of nursing staff for substance use and abuse b. Increased RN staffing on the unit c. Salary and benefits that reflect nursing accountabilities d. Increase in the percentage of baccalaureate-prepared nurses to 80%

d. Increase in the percentage of baccalaureate-prepared nurses to 80%

As the manager on an acute care medical unit, you note that the incidence of medication errors has increased since the implementation of staffing changes. What is an important stratagem to reduce errors? a. Revisit reporting standards for medication errors in your organization. b. Ensure that medication errors are consistently reported. c. Provide staff with additional education related to safe practice in medication administration. d. Involve RN staff in determining reasons for errors and practice solutions to increase the safety of medication administration.

d. Involve RN staff in determining reasons for errors and practice solutions to increase the safety of medication administration.

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

d. Never Events.

The definition of follower has historically referred to a person who is subservient and submissive. The new principles of followership offer a different perspective. What is NOT considered an attribute of followership in nursing? a. Independent decision making b. Critical thinking c. Patient advocate d. No influence over leaders

d. No influence over leaders

In developing an orientation program, the hospital educator breaks essential organizational information down into chunks, which she develops as online modules. This is an application of which of Drucker's functions of management? a. Establishment of goals and objectives b. Motivation and communication c. Analysis and interpretation of performance d. Organization of activities into manageable tasks

d. Organization of activities into manageable tasks

Role theory has its underpinnings in management theory. Management theories influence managers' leadership styles. Which of the following styles would a nurse manager be most likely to follow when redesigning the staffing schedule? a. Humanistic b. Authoritarian c. Flexibility d. Participative

d. Participative

The core of nursing leadership incorporates integration of unique qualities to include us as individuals. Which is not considered part of leadership integration? a. Person b. Leader c. Nurse d. Position

d. Position

Jane, an experienced head nurse, is given the task of completing the summer vacation schedule for the pediatric unit. She is fully aware of the hospital's restrictions on time off and the number of staff on vacation at any given time, as well as its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative? a. Ask for requests for vacation time in advance, and post the times. b. Post the completed vacation schedule. c. Post a tentative schedule, and request feedback. d. Post a blank schedule, and ask staff members to fill in their times by a given date.

d. Post a blank schedule, and ask staff members to fill in their times by a given date.

As a nurse manager on a urology unit, you note that there has been a marked increase in medication errors on the unit. Which of the following actions would be consistent with the National Database of Nursing Quality Indicators (NDNQI) measures? a. Staff are consulted regarding improvements in interprofessional approaches to patient care. b. Nursing staff are asked for input regarding the purchase of new medication carts. c. A recognition program is developed to acknowledge nurses who have provided safe and exemplary care utilizing skills in the staffing mix to optimize the delivery of patient care. d. Recent changes in staffing mixes are examined to determine if the timing of changes coincides with the increase in errors.

d. Recent changes in staffing mixes are examined to determine if the timing of changes coincides with the increase in errors.

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

d. Stress triggers such as self-criticism and overanalyzing

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

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

Which of the following needs revision on a résumé or CV? a. John Jones 87 Highway Drive City, MI 79110 [email protected] b. M. Howes Anyway Highway City, MO 77700 (H) 777-777-0000 e-mail: [email protected] c. Dr. L. Jones 99 Carway Drive City, NY 84003 (H) 999-999-0000 (Cell) 999-000-9999 d. Tanya Jones 67 Honeywell Drive City, MO 66907 [email protected]

d. Tanya Jones 67 Honeywell Drive City, MO 66907 [email protected]

What would be the primary emphasis in designing and implementing a quality, safe healthcare environment? a. Evidence-based practice b. Informatics c. Staffing d. The patient

d. The patient

The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader? a. The unit secretary who knows everyone's business b. The chief nursing officer who is in charge and is responsible for nursing services c. The chief cardiologist who admits the largest number of patients and brings in more revenue than any other physician d. The staff nurse who persuades other staff members to practice by making evidence-based decisions

d. The staff nurse who persuades other staff members to practice by making evidence-based decisions

The definition of leader refers to a person who has ability to guide people. In nursing, the leader does more. What is NOT a role of a leader in nursing? a. Active listening b. Open communication c. Accountability in decisions d. Tight control of decisions

d. Tight control of decisions

As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas. What is the leadership you are employing? a. Situational b. Trait-based c. Contingency-based d. Transformational

d. Transformational

On the West Surgery unit, you want to institute a new system for checking armbands that evidence suggests may increase safety in medication administration. The system involvestechnology. What strategy may assist with rapid adoption of the technology and system? a. Employ a centralized decision-making approach. b. Use simulators for initial practice to build confidence. c. Bring in a nurse consultant who is familiar with the technology. d. Use early adopters among the staff as leaders and role models in implementation.

d. Use early adopters among the staff as leaders and role models in implementation.

A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled but must often care for his wife, who is undergoing treatment for breast cancer. According to Maslow's need hierarchy theory, what would be the best approach to satisfying the needs of this nurse, other staff, and patients? a. Line up agency nurses who can be called in to work on short notice. b. Place the nurse on unpaid leave for the remainder of his wife's treatment. c. Sympathize with the nurse's dilemma and let the charge nurse know that this nurse may be calling in frequently in the future. d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife's treatments.

d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife's treatments.

As the unit manager, you are interested in determining whether patient autonomy is preserved through informed consent in surgical settings. You determine that participatory action research is the best method to address this question. Which of the following is consistent with a participatory action research design? a. You interview 125 patients who have recently undergone surgery and transcribe the interviews to determine themes. Themes are validated with an expert in informed consent. b. You circulate a questionnaire to patients who recently underwent surgery and ask for their opinions regarding consent. Data is analyzed and the findings distributed to administration and other groups. c. An audit is undertaken of signed consents for treatment, to determine if the consent is properly witnessed and signed. Findings are used to inform changes in policies. d. You meet with a patient group to determine which questions should be asked about patient informed consent and what issues might be encountered and addressed during the research.

d. You meet with a patient group to determine which questions should be asked about patient informed consent and what issues might be encountered and addressed during the research.

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

d. a behaviorally anchored rating scale.

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

d. a committed orientation and training program.

A clinic nurse has observed another nurse deviating from agency policy in performing wound care. The best approach for the clinic nurse to take is to: a. stay out of it. b. inform the nursing supervisor. c. fill out a notification form (incident report). d. assess the risk to the client and the agency before proceeding.

d. assess the risk to the client and the agency before proceeding.

A nurse manager's responsibility for financial management involves making budgetary decisions. Budgets that allow the nurse manager to allocate resources at the unit level allow: a. minimal nurse manager input. b. limited rationale for budgetary requests. c. budgetary allocations at the executive nurse level. d. budgetary decision making at the point-of-service (POS).

d. budgetary decision making at the point-of-service (POS).

Elizabeth, an RN with approximately 15 years of service on your unit, walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." Your response to her indicates that: a. Elizabeth will never adopt the change. b. Elizabeth is insecure in her practice. c. Elizabeth requires more information about the practice. d. change involves emotions.

d. change involves emotions.

A method commonly used in quality assurance to monitor adherence to established standards is: a. a Pareto chart. b. brainstorming. c. patient interviews. d. chart audit.

d. chart audit.

As the unit manager, you spend a day performing direct patient care and work with a new system that is designed to capture patient documentation at the bedside. During discussions with staff while giving care, you discover that the number of screens that need to be opened during documentation makes charting more complex and time consuming than traditional manual charting approaches. On the basis of this feedback, you: a. assume that the system is doing what it needs to do. b. provide reassurance to staff that the unit has achieved its goals in implementation of the system. c. ask some of the staff if they have had similar experiences with the system. d. consult chart audit data and end user consultation reports to determine if errors and problems are occurring.

d. consult chart audit data and end user consultation reports to determine if errors and problems are occurring.

Corrine, a student nurse, often hears that nurses are gatekeepers and wonders what that term means. As a nurse leader, you explain that this is a reference to the: a. assessment and admission of patients into care. b. orientation of patients to services once they are admitted. c. function of controlling which patients see the physician and which do not. d. coordination of care, services, advocacy, and access for patients within the healthcare system.

d. coordination of care, services, advocacy, and access for patients within the healthcare system.

An example of one strategy to improve participation in the change process by staff fitting the behavioral descriptions of laggards, early majority, late majority, and rejecters is to: a. encourage teamwork. b. transfer to a different unit. c. require attendance at staff meetings. d. delegate the roles and tasks of change.

d. delegate the roles and tasks of change.

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

d. determine her personal and professional goals.

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

d. developing rules that support inferences.

You are involved in designing a clinic for women in an inner-city neighborhood. A goal of this clinic might be: a. development of services that are identified in various studies as important for this target group. b. partnership with area city councilors and health professionals to provide services that are consistent with their vision and funding sources. c. provision of immunization and addictions services and health screening services for women in the area. d. development of services that have been identified by the women and neighborhood advocates as necessary for their health care.

d. development of services that have been identified by the women and neighborhood advocates as necessary for their health care.

A nurse makes a medication error that is not serious and does not cause harm to the patient. As the charge nurse, your best action would be to: a. call attention to it by posting the critical incidents report at the nursing station. b. include the mistake on the nurse's performance appraisal. c. apologize to the patient for the error and indicate that discipline has occurred. d. educate the nurse on how to provide an apology to the patient.

d. educate the nurse on how to provide an apology to the patient.

The chief nursing officer decides to establish a client advocacy position in an oncology unit. Advocacy is best represented by: a. establishing private and professional networking systems. b. asking social services to handle clients' concerns. c. identifying community support groups. d. empowering others by promoting self-determination.

d. empowering others by promoting self-determination.

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

d. enables individualization of learning to the learner's needs.

John is interested in leadership positions within his nursing organization. Although he has been on the same unit for 10 years, he has attended two workshops during that time and has steadfastly refused opportunities to engage in leadership development opportunities or other learning offered as part of the hospital's succession planning strategy. He says that he is interested in a leadership role primarily because it will give him a more stable work schedule and will enable him to spend more time with his family. In coaching John, it would be important to: a. affirm that his years of service and stability on the unit are the most important attributes for assumption of a leadership role. b. reinforce that his concern with maintaining balance outside work would be a key factor in selecting him for a leadership position. c. encourage him to consider the financial rewards of the position, as well as the positive effect on his work schedule. d. encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in work-life balance.

d. encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in work-life balance.

After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of unmanageable teenage patients. To maximize group effectiveness in decision making and problem solving, the nurse manager has: a. prevented conflict. b. formed highly cohesive groups. c. used majority rule to arrive at decisions. d. encouraged equal participation among members.

d. encouraged equal participation among members.

Thomas has been a nurse in your ICU for 10 years. In facilitating Thomas' professional development, the nurse manager would focus on: a. certification for the ICU environment. b. discussions about how Thomas can fit with role expectations and relationships. c. possible changes to other ICU environments. d. encouraging him to lead changes that leave long-term impacts after his retirement.

d. encouraging him to lead changes that leave long-term impacts after his retirement.

Within a multisite healthcare system, the most appropriate strategy for translation of research would be: a. widespread development of protocols using EBP at unit levels. b. dissemination of EBP and recommendations to individuals, units, and the organization. c. development of the skills of individual managers on how to build guidelines based on EBP. d. establishment of an interdisciplinary center to guide and lead the translation of research findings into practice.

d. establishment of an interdisciplinary center to guide and lead the translation of research findings into practice.

The nursing manager of a surgical unit has been asked by administration to evaluate client outcomes post cardiac catheterization. Using data about client outcomes post cardiac catheterization for the past 6 months in order to modify practice is an example of: a. information. b. cost-effective care. c. meeting standards. d. evidence-based practice.

d. evidence-based practice.

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

d. external

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

d. have good information literacy skills.

As a nurse manager, you identify that a shift in nursing care models might increase patient and staff satisfaction and avoid downsizing. Administration is reluctant to adopt this approach because downsizing is seen as critical to reduction of costs. To leverage your ideas, you: a. ask staff to send e-mails to administration encouraging consideration of your option. b. invite a senior member of administration to your staff meeting, so you can tell him what you are planning. c. write a letter of complaint to a member of the institutional board about the lack of openness of the administration. d. identify influential members of your nurse manager group with similar ideas and request an opportunity to meet with administration to discuss options.

d. identify influential members of your nurse manager group with similar ideas and request an opportunity to meet with administration to discuss options.

The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports related to patients falling during the 11-7 shift. The nurse manager knows that the best way to resolve the problem is to: a. use creativity. b. obtain support from the 7-3 shift. c. use institutional research. d. identify the problem.

d. identify the problem.

The agency in which you are a nursing leader makes a decision to reduce the number of RN positions in favor of PN positions because agency data suggest that the clients in the agency can receive appropriate care from PN staff. Furthermore, the agency is facing a decline in funding and without restructuring, some clients might not receive services at all. You provide this information on this decision to the staff and ask them to advise you if they have any feedback, concerns, or alternative solutions. This decision-making style is known as: a. paternalistic. b. shared. c. reasoned d. informative.

d. informative.

Susan, a new graduate on the dialysis unit, appears to take Kari's remarks very seriously and works even harder, often volunteering for extra assignments. She also is often in Kari's office, advising of successes with her patients and of the extra effort that she is committing. This behavior suggests that Susan: a. is fearful of losing her job. b. lacks understanding of Kari's leadership style. c. is not intimidated by Kari's leadership style. d. knows how to "play the game."

d. knows how to "play the game."

A nurse manager in a hospital is deeply concerned that senior administration makes decisions about budgetary directions that affect staffing and other resources without sharing the rationale for changes or demonstrating concern as to how these changes may affect patients or staff. She says she does not feel respected and is emotionally tired as a result. This situation represents: a. bureaucratic organization. b. realities of current health care. c. negative organizational culture. d. lack of engagement by administration.

d. lack of engagement by administration.

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

d. linking policies and procedures to the network for access when required at the point-of-care.

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

d. more powerless and devalued.

The nurse manager on a pediatric intensive care unit wants to evaluate patient satisfaction. The nurse manager understands that ultimately, positive relationships with consumers of care are evaluated by the: a. cultural sensitivity of staff. b. cost-effectiveness of care delivery. c. economic value of service. d. outcomes for clients and their perceptions of care.

d. outcomes for clients and their perceptions of care.

The wound care nurse decided to involve those to be affected by change early in the change management process. This can positively result in: a. coordination. b. resistance. c. anticipation. d. participation.

d. participation.

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

d. patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff.

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

d. physiologic monitoring systems enable detection of early changes before an adverse event occurs.

The senior executive praises John for the positive patient evaluations that his unit has received. As an effective leader, John: a. thanks the senior executive for having confidence in him and celebrates by going out to a special restaurant. b. points out the impact that the changes he has initiated have had on the unit. c. advises the senior executive that the mission statement and goals are important to him. d. points out the contributions of his staff to the outcomes and shares the praise with his staff.

d. points out the contributions of his staff to the outcomes and shares the praise with his staff.

In preparing for a fair interview process as a hiring manager, you should: a. put water out for the candidates. b. ensure that you know the names of all candidates. c. dress comfortably and professionally. d. prepare a schedule of questions to be asked of all candidates.

d. prepare a schedule of questions to be asked of all candidates.

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

d. risk management programs are not designed to assign blame.

In a rural hospital, the unit for which you are charge nurse has a particularly busy morning. A 52-year-old patient is complaining of left-sided chest pain and a multiparous patient is about to deliver. A child with asthma is experiencing early signs of an attack. The other RN on the unit is a recent graduate who has not yet been orientated to the labor room and has limited cardiac nursing experience. An unlicensed assistant is available to assist. You must decide which patient situation you will take and where the new graduate RN's skills can best be used. Given the limitations in skills and experience, number of staff available, and time constraints, you must make a decision that involves: a. a higher order thinking process. b. selecting the best option for reaching a predefined goal. c. optimizing. d. satisficing.

d. satisficing.

Marie is a long-term staff nurse on the rehab floor. Her unit manager has been eager to adopt evidence-based recommendations related to family-centered care on the unit. Marie's response has been that she rarely has time to provide care to patients, let alone families, and that there is no good reason to do anything different than what she is already doing. An approach that may gain Marie's support of the idea is to: a. invite Marie to review the studies for herself. b. suggest that she does not need to provide family-centered care. c. avoid discussion of the idea with her until she initiates it. d. secure the support of her closest colleagues on the unit.

d. secure the support of her closest colleagues on the unit.

To effectively achieve a change goal/outcome in a change situation, the wound care specialist will: a. preserve the status quo. b. diminish facilitators and reinforce barriers. c. weigh the strength of forces. d. strengthen facilitating forces.

d. strengthen facilitating forces.

A necessary, basic condition for successful integration of clinical information systems is: a. software. b. standard medical nomenclature. c. confirmatory evidence from nursing-led studies. d. strong interdisciplinary cultures.

d. strong interdisciplinary cultures.

Resistance is most likely when change: a. is not well understood. b. involves many layers in an organization. c. involves nonprofessional workers. d. threatens personal security.

d. threatens personal security.

A cover letter and a résumé together should be no longer than ________ page(s). a. two b. one c. four d. three

d. three

After a newly hired director of nursing has reviewed the hospital's strategic plans, she develops a time line for achieving those plans. The new leader is: a. not expecting that novice leaders will have a vision. b. demonstrating mistrust of the abilities of her staff to implement the plans. c. instituting deadlines against which the performance of staff will be evaluated. d. translating a global document into realistic plans for nursing.

d. translating a global document into realistic plans for nursing.

The successful integration of informatics into healthcare settings is key to: a. quality decision making related to management of resources and patient care. b. accessing current information about business practices. c. meeting the modern-day expectations of staff regarding technology use. d. speeding up calculations and decisions in budget development.

a. quality decision making related to management of resources and patient care.

Professional associations: a. set regulatory requirements and establish entry requirements for nursing. b. offer graduate programs for clinical and career advancement. c. provide opportunities for career networking and support. d. are open to all individuals who meet the criteria for membership.

c. provide opportunities for career networking and support.

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

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

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

d. Depersonalization

Sue, a nurse manager, has a staff nurse that has been absent a great deal for the past 3 months. A whistleblower gives some information to Sue indicating that the staff nurse will be resigning and returning to school. Because of this, Sue decides to do which of the following? a. Immediately fire the staff nurse. b. Speak to the whistleblower and elicit more information. c. Speak to the staff nurse and ask her to resign. d. Do nothing.

d. Do nothing.

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

a. start taking yoga lessons.

During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is discussed. What is considered when the suggestion by the manager is for the unit mission to be derived from the organization mission? a. Empowering b. A leadership tag c. A symbol d. A management task

b. A leadership tag

Recruiting among the emerging work force (18 to 35 year olds) is a challenge for healthcare agencies. Marketing brochures should address the leadership and vision of the healthcare agency. Which of the following workplace environments will attract applicants in the emerging work force? a. A highly professional environment b. A nurturing and receptive environment c. An environment highlighted by lots of meetings, so staff members can have lots of input d. A totally online environment, so staff members will not have to interface with uncaring colleagues

b. A nurturing and receptive environment

What did the IOM Health Professions Education report highlight as a concern for patient safety? a. A normal risk in professional practice b. A result of disciplinary silos c. A reflection of frontline staff d. Related to systems errors

b. A result of disciplinary silos

The charge nurse of a unit is asking the staff what patients they had the day before to make assignments for the day. A new nurse complains about having the same patients every day. The charge nurse considers the new nurse request at an assigned to different patient for today. What type of leadership is the charge nurse displaying? a. Informal leadership b. Formal leadership c. Favoritism d. No leadership displayed

b. Formal leadership

The NQF provides a model for advancement of healthcare quality that could be used in healthcare organizations. What does the use of this model by the Centers for Medicare and Medicaid Services specificity link with adverse patient events for healthcare facilities? a. Staffing b. Funding c. Composition of executive councils d. Composition of consumer-based councils

b. Funding

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

b. shared values, flexibility, and a human-capital focus.

John notes that the next section is specific to the organizational philosophy and has a 4-point ordinal scale that describes performance from "always meets expectations" to "does not meet expectations." This type of evaluation is most commonly known as: a. a behavior-anchored rating scale. b. management by objectives/learning goals. c. the forced distribution scale. d. a graphic rating scale.

d. a graphic rating scale.

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

d. behaviorally anchored rating scale.

A new graduate is seeking a new position in nursing and wants to "sell" herself effectively. The best strategy is to: a. create a résumé. b. practice interviewing. c. call the personnel offices. d. create a curriculum vitae.

a. create a résumé.

Budgeting and protection of revenues is a function of: a. leadership. b. management. c. team leadership. d. followers.

b. management.

A unit manager recently graduated as a clinical nurse specialist with a focus in gerontology. She applied to take a certification exam. Certification is designed to recognize: a. basic knowledge in a specified area. b. advanced practice in functional roles. c. special knowledge beyond basic licensure. d. continued competence as a registered nurse.

c. special knowledge beyond basic licensure.

While explaining the importance of developing leadership skills among nurses to a group of first-year nursing students, Natalie, a nursing unit manager, emphasizes that: a. most nurses are not expected to assume leadership roles. b. the role of nurse leadership is only at the bedside, ensuring that patient care is performed according to established standards. c. only individuals in formal leadership roles are expected to be leaders. d. the public depends on nurses to assume leadership in moving consumer advocacy concerns forward.

d. the public depends on nurses to assume leadership in moving consumer advocacy concerns forward.

The chief nursing officer at a local hospital seeking Magnet® status creates staff development classes about incorporating evidence-based practice in nursing. What best describes evidence-based practice? a. Applying best research evidence to care of patients b. Using research-based information to develop practice guidelines c. Conducting a randomized control trial to determine effectiveness of handwashing techniques d. Developing standards for practice

a. Applying best research evidence to care of patients

As a nurse manager, you are a leader and a follower in health care and on the unit you manage. Looking at the larger picture of health care and patient environment on the unit, what is the primary role of the followers on the unit, as defined in nursing? a. Direct care provider b. Implements leader's policy unquestioned c. Passive role on unit d. Devalued staff member

a. Direct care provider

After being interviewed for the unit manager position, the staff nurse reflects on the interview process. The staff nurse is aware that leadership begins: a. within. b. through a relationship with a mentor. c. with the job description. d. with the chief nursing officer of the organization.

a. within.

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

c. providing one source of data for QI initiatives.

Before beginning her own nursing agency, a nurse worked with other temporary nursing agencies in nine states and multiple agencies. She had set a personal goal to start her own agency. What type of motivation does this exemplify in career success? a. Linear b. Spiral c. External d. Internal

d. Internal

According to the complexity theory, what would be the focus of measurement? a. Cost per hospital day b. Bed utilization c. Infection rates d. Staff morale and budgets

d. Staff morale and budgets

As a nurse manager, you embrace the usefulness of resources such as Smart Bed. This behavior is important to: a. budget development. b. a manager's role. c. succession planning. d. encouragement of staff utilization of technology.

d. encouragement of staff utilization of technology.

An example of a factor that would impede a patient's learning is: a. poverty. b. limited health insurance. c. being an older adult. d. heavy sedation.

d. heavy sedation.