Leadership Exam 1

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An example of a care activity that would likely not be delegated by an RN to a UNP is (select all that apply):

1.Teaching self-catheterization to a patient with paraplegia who has limited English. 2.Basic care for a patient with a head injury who is rapidly deteriorating. 3.Assessment of patients being admitted through the Emergency Department.

The nurse manager was upset with the staff nurse and said, "You did not understand what I said." Which element in the communication process was she referring to?

A set of barriers that may occur between sender and receiver

Which of the following indicates safe delegation?

A unit manager agrees to release a staff from her unit to Unit B. The staff member she agrees to release is experienced on Unit B and is agreeable to the change. The unit manager's unit is fully staffed and patients are stable.

What is not a key concept in a well-functioning team?

Absence of disagreement or conflict

The nurse on the 7-7 shift is assigning a component of care to an unlicensed nursing personnel employee. The night nurse should remain:

Accountable.

Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She is assigned David, a patient who has been admitted with a severe head injury. In communicating with Sally, you would:

Advise her that you are available if she needs you.

Which of the following would not be a characteristic of an effective team nurse leader?

An autocratic perspective

The nurse manager is setting up the room assignments for the unit. She has one critical patient on the unit, who is going to require more care than the others. Before delegating a task, a nurse manager should:

Assess the amount of guidance and support needed in a particular situation.

The day shift nurse asks an LPN/LVN to complete a component of care for a client. The day shift nurse is engaging in what function?

Assigning

In keeping with standards of The Joint Commission (TJC), the nurse manager organizes an orientation for new staff members. As part of the orientation, the nurse manager reviews the employee handbook. Employers may be bound to statements in the employee handbook: a. Under the doctrine of apparent agency. b. Under the doctrine of respondeat agency. c. Based on the employee's or the employer's expectations. d. Based on the theory that the handbook creates an explicit contract.

The principle that requires nurses to uphold a professional code of ethics, to practice within the code of ethics, and to remain competent is which of the following? a. Beneficence b. Autonomy c. Fidelity d. Honesty

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. Justin decides to hire new staff in the order that applications are received until all vacant positions are filled. 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

The manager in the coronary care unit believes that the most important ethical considerations in performance evaluations are that they include the employee's good qualities and that they give positive direction for professional growth. This belief is an example of: a. Justice. b. Fidelity. c. Beneficence. d. Nonmaleficence.

Which of the following decision-making solutions should Justin (Question 17) 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. Consider all the options listed.

The SBAR system of communications is one of the most used communication systems in health care because:

It focuses on a system in which information is provided and gleaned in an honorable way.

The mediator noticed that tension was still evident between the nurse manager and staff members. He informed the chief nursing officer that to begin team-building, it would be important that everyone:

Work together in a respectful, civil manner

Which of the following 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 The Joint Commission issues setting-specific patient goals annually, as well as a list of "do-not-use" terms, abbreviations, and symbols and sentinel events.

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. Management theory addresses how managers address employees' concerns and needs and the interactions of managers with employees. Expectations of the managerial role affects expectations of self as the manager and of others. McGregor's (1960) Theory X and Theory Y made two basic opposing assumptions about employees and how the manager should interact with them. Theory X suggests that people do not like their work and that lower-order needs are more important. Theory Y adopts an optimistic view in which people are seen as capable of self-direction and autonomy.

As a patient care advocate, you regularly coach patients on how to stay safe in health care by educating them about: 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. The Five Steps to Safer Health Care for patients include keeping a list of medications that patients are taking.

Budgeting and protection of revenues is a function of: a. Leadership. b. Management. c. Team leadership. d. Followers.

b. Management. Managers address complex issues such as planning, budgeting, and allocating resources, whereas leaders address change

The nurse manager in the emergency department needs to implement new staffing patterns. As a transformational leader, the nurse manager should: 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. Transformational leadership inspires and motivates others through influence and persuasion rather than through rewards (e.g., free time) and punishment (e.g., smaller raises). This type of leader listens to the views of others (such as those of the staff members), empowers others to lead (such as in generating solutions for staffing problems), finds ways to remove barriers, and serves as an advocate for those who care for patients.

As the nurse manager who wants to increase motivation by providing motivating factors, which action would you select? 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. Complexity theory suggests that systems interact and adapt and that decision making occurs throughout systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts, and therefore all levels of staff would be involved in decision making. This principle is the foundation of shared governance.

In orienting a 25-year-old nurse, the unit manager understands that this worker: a. Likes to attend to detail. b. Is highly proficient in math and reading skills. c. Enjoys being managed by superiors. d. Likes to solve problems without being given solutions.

d. Likes to solve problems without being given solutions.

After a newly hired director of nursing has reviewed the hospital's strategic plans, she develops a timeline for achieving those plans. The new leader is: a. Not expecting that novice leaders would have a vision. b. Inviting a seasoned leader to come and share a vision with the group. c. Getting to know staff members, so they can work together for a few months. d. Translating a global document into realistic plans for nursing.

d. Translating a global document into realistic plans for nursing. Followers need three things from leaders: direction, trust, and hope. Developing timelines for the strategic plan involves translating a vision into reality and being able to communicate a vision meaningfully, which is an example of a leader's influencing behavior.

An RN colleague, who is a long-standing and collaborative member of your team, is performing a complex and novel dressing for the first time for the patient to whom she has been assigned. Which of the following would be the most appropriate communication with her?

"Here is what you need for the dressing, and I will show you what needs to be done."

In delegating to a UNP in a home health setting, which of the following represents the most appropriate delegation communication?

"Mrs. S. needs help to get into and out of her bathtub. Her bath will need to be completed by 10:00. When you are helping her to dry, please check between her toes and toenails, and phone me by 10:30 if you notice nail discoloration or redness."

A colleague asks you to give her your password access so that she can view her partner's healthcare record. This request violates the patient's right to: a. Privacy. b. Confidentiality. c. Undue authorization of treatment. d. Protection against slander.

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 nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks toward a patient with a previous history of sexual abuse. The patient sues, claiming malpractice. Which of the following conditions would likely not apply in this situation? a. Injury b. Causation c. Breach of duty d. Breach of duty of care owed

A staff nurse who was fired for reporting client abuse to the appropriate state agency files a whistleblower lawsuit against the former employer. Reasons that the court would use in upholding a valid whistleblower suit claiming retaliation include that the nurse: a. Had previously reported the complaint, in writing, to hospital administration. b. Had threatened to give full details of the client abuse to local media sources. c. Was discharged after three unsuccessful attempts at progressive discipline had failed. d. Had organized, before filing the complaint, a work stoppage action by fellow employees.

An applicant in a wheelchair is applying for the position of receptionist in an outpatient clinic. The nurse manager understands that the Americans with Disabilities Act of 1990 requires that employers: a. Make reasonable accommodations for persons who are disabled. b. Allow modified job expectations for persons recovering from alcoholism. c. Hire disabled individuals before hiring other qualified, non-disabled persons. d. Treat, for purposes of employment, homosexuals and bisexuals as disabled.

As a charge nurse, you counsel your RN staff member that he has satisfied his duty of care by notifying a child's physician of his concerns about deterioration in the child's status at 0330 hours. The physician does not come in. The child dies at 0630 hours. As the charge nurse, you could be held liable for: a. Professional negligence. b. Assault. c. Avoidance. d. Murder.

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 upon 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. 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.

Mr. M. complains to you that one of your staff asked him details about his sexual relationships and financial affairs. He says that these questions were probing and unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry with him and would not provide him with good care. Mr. M.'s statements reflect concern with: a. Privacy. b. Confidentiality. c. Veracity. d. Informed consent.

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

The nurse manager of a rehab unit wants to purchase a new anti-embolic stocking. 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.

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.

Three gravely ill patients are candidates for the only available bed in the ICU. As the supervisor, you assign the bed to the patient with the best chance of recovery. This decision reflects which of the following ethical principles? a. Beneficence b. Autonomy c. Veracity d. Nonmaleficence

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 the assumptions that were underpinning the issues. b. Considered the context of the present problem or situation. c. Gathered data before making her decision and evaluated all possible outcomes. d. Attained a majority consensus of all staff.

ABC

One of your staff nurses asks for your advice because a patient refuses to sign a consent for surgery. The patient says that he won't sign because he doesn't understand the nature of the surgery. You advise that (select all that apply): a. Consent must not be coerced. b. The patient has a right to choose not to consent. c. The patient must sign the consent because the doctor wants him to sign. d. Witnessing a consent is related only to the voluntary nature of the signature.

ABD

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.

ABDE

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.

ABDE Drucker's five basic functions include division of work into tasks, development and communication of goals and outcomes, motivation and communication, and analysis, approval, and interpretation of staff performance.

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

Active delegation.

The nurse educator was giving a workshop on team building. She noted that effective communication is essential for team building. One of the key questions in the workshop was, "What is the best way to check to see if what you have communicated to a team member is understood the way you meant it to be understood?" The correct response is which of the following options?

Active listening and feedback

By following a shared leadership model, the nurse manager believes that staff members will learn to function synergistically. Some teams function synergistically because members:

Actively listen to each other

Marcy, a new staff nurse, is very concerned about "fitting in" on the rehabilitation unit. She addresses her concerns and speaks with the head nurse. The head nurse speaks with the rest of the staff and reminds them how important it is for a staff member to feel that he or she is part of the group. Which of the following statements would she not include in her talk? "Staff members who feel included:

Are part of the 50% who feel their strengths are used."

A nurse manager is experiencing conflicts between herself and staff members. She had tried to develop a team by using a shared leadership model to empower the staff. Staff members are functioning:

As a group

You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Before assigning Evelyn to Mrs. N.'s care, the most appropriate action of the care coordinator would have been to:

Ask Evelyn if she has worked with inhalers before and to describe what she knows about them.

Assignment.

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.

Assisting to establish priorities among possible changes to care identified in QI

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

Attitude.

You ask Evelyn, a new UNP, to check what is left in Mrs. N.'s inhaler when Evelyn makes visits to Mrs. N. and also to check whether Mrs. N. is receiving any positive effect from the medication. Evelyn reports for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left in the device. The day of her last visit to Mrs. N., Mrs. N. is admitted to the hospital in severe respiratory distress. When she is admitted, she tells the physician that she has not been using the inhaler for 4 weeks. Determination of Evelyn's educational preparation and certification is related to the concept of:

Authority.

An outpatient surgery manager is evaluating infusion pumps for 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.

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.

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.

In a telehealth organization, a nurse who is licensed in New York and Pennsylvania provides teaching to a patient who resides in Pennsylvania. The patient charges that the teaching failed to provide significant information about a potential side effect, which led to delay in seeking treatment and untoward harm. Under which state nurse practice act and standards would this situation be considered? a. New York b. Pennsylvania c. Neither New York or Pennsylvania d. Both New York and Pennsylvania

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.

One means of ensuring that nurses floated to other patient care areas in healthcare organizations are qualified to work in those areas is: a. Employing additional staff to assist with orientation processes. b. Cross-educating staff members to other areas of the institution. c. Transferring clients to units where the staffing pattern is optimal. d. Orienting staff members to all client care areas as part of their general orientation to the institution.

The parents of a toddler who dies after being brought to the ER launch a lawsuit, claiming that the failure of nurses to pursue concerns related to their son's deteriorating condition contributed to his death. The senior nurse executive is named in the suit: a. As a global respondent. b. Under the doctrine of respondeat superior. c. As a frivolous action. d. Under the element of causation.

To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk manager. Risk management is a process that attempts to identify potential hazards and: a. Compensate for previous injuries. b. Eliminate these risks before anyone else is harmed. c. Supersede the need for staff members to file incident reports. d. Discipline staff members who have been involved in previous incident reports.

Which ethical principle is primarily involved in informed consent? a. Veracity b. Autonomy c. Beneficence d. Nonmaleficence

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

Benchmarking

A client refuses a simple procedure that you believe is in the client's best interest. The two ethical principles that are directly in conflict in such a situation are: a. Fidelity and justice. b. Veracity and fidelity. c. Autonomy and beneficence. d. Paternalism and respect for others.

A staff nurse in the area that you manage has excelled in the delivery of client education. You are considering implementing a new job description that would broaden her opportunity to teach client and orient new staff members to the value of client education. The ethical principle that you are most directly reinforcing is: a. Justice. b. Fidelity. c. Paternalism. d. Respect for others.

From the information supplied in this chapter, which statements 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.

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.

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.

Several nurses on an adolescent psychiatric unit complain that the teens are becoming unmanageable on the 11-7 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.

The clinic nurse understands that problem solving is best defined as: a. A higher-order thinking process. b. Selecting the best option for reaching a predefined goal. c. Identifying the gap between "what is" and "what should be." d. Determining creative approaches to resolving a problem or issue.

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.

You volunteer at a free community clinic. A 13-year-old girl claims to have been diagnosed with SLE and presents with chlamydia. The team leader at the clinic advises that: a. The state-defined age of legal consent is 18; therefore, no treatment can be delivered. b. The teen is underage and should be referred to the family general practitioner. c. Care can be provided as long as consent is voluntary and information about treatment and options is provided. d. Treatment is provided as long as telephone consent is obtained from a parent or legal guardian.

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

Call a meeting of all staff to discuss this issue

Trust is an important aspect of helping relationships, therapeutic communications, and the positive communications model. Which statement does not involve or operationally define trust? Trust:

Can be described as a belief that although the nurse is capable of helping in times of distress, the nurse is unlikely do so

From the information presented in this chapter, which of the following statements best defines an accomplished team? Effective teams:

Can create a form of synergism in which the outcome is greater than the sum of the individual performances

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.

Chart audit

The nurse manager used a mediator to help resolve conflicts on the unit. During the mediation process, the nurse manager saw signs of potential team-building. One key concept of an effective team is:

Commitment

The state of being emotionally impelled, demonstrated by a sense of passion and dedication to a project or event, describes:

Commitment

The unit manager was addressing nursing students in the lounge area and was discussing team leadership and team effectiveness. She stated, "One can agree to disagree with another team member's perspective even when one doesn't necessarily see that perspective as being the correct one." In being creative, which of the following basic rules was she talking about?

Committing to resolution

The night nurse understands that certain factors need to be considered before delegating tasks to others. These factors include the:

Complexity of the task and the potential for harm.

The mediator asked each staff member to reflect on his or her communication style. Which of the following best describes communication? Communication

Consists of thoughts, ideas, opinions, emotions, and feelings

The staff development educator developed strategies to help nurse managers actively listen. Guidelines for active listening include which of the following?

Cultivate a desire to learn about the other person

. During a staff shortage, you hire an RN from a temporary agency. The RN administers a wrong IV medication that results in cardiac arrest and a difficult recovery for the patient. Liability in this situation: a. Is limited to the temporary agency. b. Is restricted to the RN. c. Could include the RN, the agency, and your institution. d. May depend on the patient's belief regarding the employment relationship.

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.

After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of teenagers who are unmanageable. 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.

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.

On your nursing unit, you employ LPNs, RNs, and advanced practice nurses. You will need to be familiar with at least: a. Two nursing practice acts. b. Two nursing practice acts in most states. c. At least one nursing practice act. d. One nursing practice act and a medical act.

Sue, a nurse manager, has a staff nurse that has been absent a great deal for the past three 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.

The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports about 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.

To satisfy duty of care to a patient, a nurse manager is legally responsible for all except: a. Notifying staff of changes to policies related to medication administration. b. Scheduling and staffing to ensure safe care. c. Delegating in accordance with practice acts. d. Supervising the practice of the physician.

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

When decision making, critical thinking, and problem solving are considered, which of the following statements are accurate and valid points? a. The professional decision maker approaches problem solving by beginning with an outcome already in mind. b. Involvement in decision making is of little use unless you are an expert decision maker. c. Many models aid the nurse in improving his or her decision-making skills. d. The nursing decision maker who is successful recognizes that only those with similar experiences should be involved in decision making.

A healthcare organization is committed to improving patient outcomes as part of the quality improvement (QI) process and examines its executive structure and organizational design. This approach recognizes which model of QI? a.Donabedian b.Benchmarking c.Employee involvement and innovation d. QSEN

Donabedian

You are charged with developing a new nursing curriculum and are committed to developing a curriculum that reflects the needs of the profession and of the workplace. To address deficits that may already be present in nursing curricula related to the workplace, you include more content and skills development related to:

Effective communication in the workplace

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

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

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

Facilitates active staff participation in decision making related to quality nursing care

You ask Evelyn to check what is left in Mrs. N.'s inhaler when makes visits also to check if she is receiving positive effects from medication. for 3 weeks that Mrs. N. is using the inhaler and that there is enough medication left. day of her last visit to Mrs. N. is admitted to hospital in severe respiratory distress. When admitted, reports not been using inhaler for 4 weeks.

Failure to follow through.

The chief nursing officer decided that the nurse managers need a series of staff development programs on team-building through communication and partnerships. She understood that the nurse managers needed to build confidence in ways of handling various situations. The greatest deterrent to confidence is:

Fear that one can't handle the consequences

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

Flowchart

At Hospital Ajax, staff members are reluctant to admit to medication errors because of previous litigation and a culture that seeks to assign blame. This culture demonstrates: a.QM principles that emphasize customer safety. b.A deep concern with improvement of quality and processes. c.Effective employee orientation and development in relation to QM. d.Goals that are inconsistent with QM

Goals that are inconsistent with QM

The mediator suggested to the unit staff that a group agreement needed to be made so meetings could become productive. For example, the group agreement, "We will speak supportively," prevents:

Gossip and backbiting

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 char

Histogram

With the rise in workplace violence in the emergency 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

Hold staff accountable for safe practices

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.Identify a clinical activity for review. c.Establish a benchmark. d.Establish outcomes

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.

Identify the standard

A mediator suggested that the nurse manager and staff members decide on a method to resolve conflicts. It is important to have agreements about how team members will work together because:

If there are no agreements, each member will make up his or her own procedures without consensus

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)

Improvement in patient outcomes

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

Improves outcomes

The unit manager is working in a large metropolitan facility and is told that two UNPs are to be assigned to work with her. Delegation begins with:

Matching tasks with qualified persons.

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

Measurable and nursing-sensitive

You are working in a home health service and have 3 UNPs assigned to your team. You have worked with two; the third is new. The two experienced UNPs have patients with complex illnesses. The third has been assigned to patients with less complex illnesses.

Meet the new staff member at the first patient care site and call the others with questions to determine whether anything is unusual.

Bennis, a researcher and writer, posits that effective leaders share three fundamental qualities. Which of the following is not a fundamental quality?

Motivation

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.

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

NDNQI

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

Never-events

Before beginning a continuous quality improvement project, a nurse should determine the minimal safety level of care by referring to the:

Nursing care standards

Which of the following exemplifies accountability? Karen, the nurse manager on 5E:

Outlines her rationale for reduction of RN coverage on nights to the Nursing Practice Committee after serious patient injury.

Functions such as "delegates tasks to assistive personnel" that are outlined in a position description for an RN Team Leader would be considered:

Passive delegation.

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.

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

Healthcare agencies and hospitals expect their practitioners to be effective team members. Two key players in the healthcare team are nurses and physicians. Which of the following statements accurately defines the roles and responsibilities of nurses and physicians?

Physicians are the first point of contact. They focus on the disease process, whereas nurses focus on the holistic needs of patients

With delegation, responsibility and accountability remain with the:

Professional who delegates.

You are a member of a team assigned to care for 15 general medical/surgical clients. You have all worked well together in the past in this same type of care. If you are assigned to coordinate this team's work, your best strategy, based on the Hersey and Blanchard model, would be to:

Provide minimal direction and let them come to you with questions.

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.

Recommending that a multidisciplinary team should assess the root cause of errors in medication

Leslie, a UNP, transfers a patient while using improper technique. The patient is injured, and as a result, a suit is launched in which both Sarah (the delegator) and Leslie (the delegatee) are named. Sarah is named in the suit because she:

Retains accountability for the outcomes of care for the patient.

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.

Risk management programs are not designed to assign blame

Which of the following is not a necessary requirement for formation of a team? In forming a team, the leader should keep in mind that the team:

Should include only members with similar personalities

After staff meetings lately, Sharon, the head nurse, observes her staff in small groups, having animated discussions that end abruptly when she approaches. Sharon reflects on this observation and realizes that:

Staff members are very committed to the team and have strong opinions

A key advantage that a nurse manager has in terms of delegating is that:

Team skills can be used more effectively.

During staff development programs, staff nurses verbalize their frustration about their workloads and having to delegate so many tasks to others. One of the main reasons that delegation has emerged as an issue is because of:

The complexity of client care.

During a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on:

The development level of the followers and the type of behavior of the leader.

Sally (RN) and Melissa (RN) have shared an ongoing conflict since the first day that Melissa worked on the unit. Sally has confided to another colleague that she doesn't even know why the conflict started or what it was about. This is an example of:

The enduring nature of first impressions

"I really wish that my supervisor would realize and acknowledge all the things I do well..." In nursing, this has been identified as a problem. Which statement is part of the solution? Focus on:

The strengths of the individual rather than the weaknesses

Which of the following would be most in line with Hersey and Blanchard's concepts?

The team of caregivers on day shift are familiar with their roles and with the patients. The nurse manager decides to work on the unit budget in her office.

The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are angry and ask for a meeting to discuss the change. After hearing their concerns related to reduction in professional autonomy and care quality, you: 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. Visioning involves engaging with others to assess the current reality, specify the end point, and then strategize to reduce differences. This requires trusting relationships that acknowledge the differences in values and ideas. When done well, the nurse and the nurses within a unit experience creative tension that inspires working in concert to achieve desired goals.

At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. It would now be best to: a. Arrange another meeting in a week's time so as to allow a cooling-off period. b. Turn the dispute over to the director of nursing. c. Insist that participants continue to talk until a resolution has been reached. d. Back the unit manager's actions and end the dispute.

a. Arrange another meeting in a week's time so as to allow a cooling-off period. According to the principles outlined by Ury, Brett, and Goldberg, a "cooling-off" period is recommended if resolution fails.

Sarah wonders about the direction that you have given regarding management of incontinent, confused patients. She brings you evidence that she has found regarding incontinence interventions and asks you if she and you could talk about the guidance that you have given after you have had an opportunity to read the articles she has given you. This is an example of (select all that apply): a. Assertiveness. b. Followership. c. Management. d. Insubordination.

a. Assertiveness. b. Followership. This is an example of followership in which a staff nurse is demonstrating assertive behavior and presenting evidence that may influence the decision making of her nurse leader and manager.

Which of the following patients would be at greatest risk in 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. Safer health care involves the patient as an active consumer who keeps and brings a list of all medications, including natural remedies, and questions if there are doubts, concerns, or lack of understanding.

The SBAR approach to patient safety encourages: a. Consistency in assessment and practices. b. Continuing education. c. Multidisciplinary approaches. d. Patient feedback.

a. Consistency in assessment and practices. The use of SBAR (Situation, Background, Assessment, and Recommendation) checklists are designed to decrease omission of important information and practices.

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 went and: 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. The Five Steps to Safer Health Care for Patients includes the step of asking questions if there are doubts or concerns. The nurse can encourage patients to take a larger role in care by taking these steps and by providing patients with coaching in the steps.

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 The National Quality Forum (NQF) outlines nursing-centered intervention measures related to prevalence of pressure sores, ventilator-associated pneumonias, volunteer turnover, nursing care hours per day, and skill mix of staff.

A dispute arises between an RN staff member and an LPN over a patient issue. The tension between the two begins to affect other staff members, who are drawn into the conflict; eventually, the team becomes polarized toward either the RN or the LPN. This situation might have been prevented through: 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 initial step in conflict resolution should have involved an expedient response to the issues and putting a focus on the issues involved in the dispute between the LPN and RN through negotiation involving the two parties, before the dispute involved others.

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 walk patients. The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea. The best initial strategy in this situation would include: a. Exploring the values 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 they are approached again. c. Dropping the idea and trying for the change in another year or so. d. Hiring the assistants and allowing the RNs to see what good additions they are.

a. Exploring the values of the RN group in relationship to this change. Influencing others requires emotional intelligence in domains such as empathy, handling relationships, deepening self-awareness in self and others, motivating others, and managing emotions. Motivating others recognizes that values are powerful forces that influence acceptance of change. Leaving the RNs alone for a period of time before implementation does not provide opportunity to explore different perspectives and values. Avoiding discussion until the team changes may not promote adoption of the change until there is opportunity to explore perspectives and values related to the change. Hiring of the assistants demonstrates lack of empathy for the perspectives of the RN staff.

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. Managed care combines delivery of needed care with business principles of efficiency and cost. Nurse managers who know business principles become conduits for ensuring safe, effective, affordable care.

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 Practices that were once mostly studied in hospital settings are now scrutinized for implementation in other settings, such as outpatient clinics, rural settings, and nursing homes.

You pull 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, you explain that the organization values patient-centered care and suggest that evidence supports that acting as an advocate and a listener is helpful to families. You ask the staff for ideas as to strategies that are effectively patient-centered in these situations. In this situation, you are taking on which role? a. Leadership b. Management c. Follower d. Visionary

a. Leadership As a leader, you provide and communicate vision and direction based on evidence and experience, and you engage others in decision making that moves them toward the vision with a reasonable level of risk taking.

During a discussion of concern about approaches used with aggressive patients in the emergency department, several staff members express concern for their safety. It is important for the nurse manager to: 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. One of the five rules for leaders is to listen to the constituents—in this instance, the staff members who have safety concerns. Active listening in the United States means establishing direct eye contact and asking probing questions. Listening does not obligate the leader to any one course of action. Action will be based on what is best for the group.

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 and developed. d. Succession planning and formal education related to leadership are ineffective.

a. Management can be taught; leadership depends on abilities. Leadership is an abilities role that is reflective of rich personal experience. It can be developed and refined through such strategies as coaching, mentorship, and reflection. Management can be taught and learned.

A family is keeping vigil at a critically ill patient's bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with such situations. What role are you assuming through this action? a. Manager b. Leader c. Follower d. Laissez faire

a. Manager As a manager, you are concerned with managing and coordinating resources to achieve outcomes in accordance with established clinical processes. Referral to a social worker alleviates demand on staff time and is consistent with hospital procedures.

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. The IOM report (2004) points to the need to involve nurses in decisions that affect them and the provision of care.

If you are supporting the steps in the AHRQ document "Five Steps to Safer Health Care," you would ensure that: 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 The Agency for Healthcare Research and Quality (AHRQ) outlines "Five Steps to Safer Health Care," which suggests that safe, patient-centered care is facilitated by assisting patients to become active partners in their own care.

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. The actions of the clinical instructor reflect competencies outlined by: a. QSEN. b. IHI. c. DNV/NIAHO. d. AHRQ.

a. QSEN. The Quality and Safety Education for Nurses (QSEN) project provides resources related to competencies that prelicensure and graduate students need to develop to serve as safe practitioners. These competencies include leading and managing, teamwork and collaboration.

The successful integration of informatics into healthcare settings is key to: a. Quality decision making and processes related to management of resources. b. Accessing current information about business practices. c. Leveraging ideas from other managers. d. Speeding up calculations and decisions in budget development.

a. Quality decision making and processes related to management of resources. The use of informatics to research evidence and alternative models of delivery, to compare data and solutions with those of other managers, and to enhance the coordination and delivery of patient care can assist managers in making solid decisions about resource utilization. The use of informatics is embraced by Generation X-ers and Millennials who grew up with technology, but may be more difficult for older staff.

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 rejects any attempt to intervene therapeutically to resolve the issue. He 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. Goleman suggests that emotional intelligence involves insight and being able to step outside of the situation to envision the context of what is happening as well as being able to manage emotions such as frustration effectively

As a manager, the development of your decision-making skills related to safe patient care is facilitated by: 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. Reflection on how well decisions were enacted enables knowledge of the complexity of situations and ramifications of the decisions made. Reflection enables elimination of strategies and methods that are inappropriate in meeting needs and aids in narrowing choices of best actions to take.

In accordance with changes by the Joint Commission (TJC), Pleasant Valley Hospital amends its safety practices and policies to emphasize: 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. When the TJC, a not-for-profit organization that accredits healthcare organizations, changed its focus from processes to outcomes, it emphasized patient safety and issues setting-specific annual patient safety goals.

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. As a nurse, you would: 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. The Five Steps to Safer Patient Care identifies that encouraging patients to ask questions when there are doubts and concerns and ensuring understanding before surgery is performed are ways in which nurses can support patients in having greater influence in their own care. In this situation, asking an interpreter to help enables access to information for the patient and active assessment of his understanding.

Becky graduated five 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. Leadership involves radiating positive energy and the ability to inspire and motivate others. Management can be taught through formal instruction, but leadership is attained through reflection on rich personal experience.

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 sets the tone, which allows nurses to feel in control of the environment. b. 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 sets the tone, which allows nurses to feel in control of the environment. Covey suggests that Smart Trust is a method for restoring trust in organizations. Smart Trust Actions include declaration of the leader's intent and assumption by the leader that others also have positive intentions. Building trust involves signaling goals and intended actions in advance. Actions such as promising external rewards such as additional learning opportunities, workload relief, and compensation are consistent with transactional leadership, which leads to low to stable commitment and limited satisfaction.

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 to management of incontinence in elderly 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 to management of incontinence in elderly patients. Nurse managers have the responsibility of day-to-day decisions for their units and interpret established policy, procedures, and mandates. They meet their goals by organizing, staffing, controlling, and solving problems. By contrast, leaders develop a vision and translate that direction into action.

During staff meetings, you make it a regular practice to encourage shared problem solving and to recognize those who go beyond basic roles and responsibilities to contribute to a positive team environment and to quality patient care. This practice exemplifies: a. Values-based management. b. Shaping of workplace behavior. c. Cooperation and collaboration. d. Recognition of institutional priorities.

a. Values-based management.

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. People notice differences in workplaces and tend to choose those that evidence a high degree of trust between leaders and followers. Stephen M.R. Covey suggests that trust begins with self and that leaders must focus first on developing character and confidence, which is their credibility. Credibility enables leaders to trust themselves and gives others someone or something that they can trust.

During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is: a. Empowering. b. A leadership tag. c. A symbol. d. A management task.

b. A leadership tag. According to complexity theory, leadership tags, which are similar to values, reflect the patient-centered philosophies and values-driven characteristics that define an organization and give it personality.

Recruiting among the emerging workforce (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 workforce? 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 A study of student nurses who represent this age group indicates that they want a leader who is receptive, approachable, a team player, and motivating.

5. The IOM Health Professions Education report highlighted patient safety concerns as: 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 IOM Health Professions Education report (2004) highlighted the education of health disciplines in silos as a major concern in patient safety and endorsed five recommendations.

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. Help the LPNs and NAs with their work, whenever possible. 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. Hygiene factors such as salary, working conditions, and security are consistent with Herzberg's two-factor theory of motivation; meeting these needs avoids job dissatisfaction. Motivator factors such as recognition and satisfaction with work promote a satisfying and enriched work environment. Transformational leaders use motivator factors liberally to inspire work performance and increase job satisfaction

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. Leaders who come out of the Baby Boomer generation may be more comfortable with collective action than followers who come out of the Emerging Workforce generation, who are more comfortable with interactions if they are seen as having value for them and with activities if they are seen as having benefit. A group that is highly weighted toward the Emerging Workforce generation may find the approach of a leader who is part of the Baby Boomer generation frustrating and may not understand the meaning or value of the meetings.

As a leader on a rehab unit, you encourage all staff members to see themselves as having a role in decision making and quality care. You see your role as involving particular responsibilities in decision making but not as a hierarchal role. This view of decision making and leadership is consistent with: a. Trait theories. b. Complexity theory. c. Situated theory. d. Emotional intelligence.

b. Complexity theory. Complexity theory involves envisioning each member of the team involved in decision making, management, and leadership, with the leader not seen in a hierarchal relationship to other team members.

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. The key to effective case management is proactive coordination of care from the point of admission to accomplish appropriate and effective outcomes. Case management involves components such as case selection, multidisciplinary assessment, collective planning, coordination of events, negotiation, and evaluation and documentation of the outcomes of patient status in measures of cost. Case management is employed in a variety of settings.

Joan, the nursing unit manager, finds it difficult to work with Thomas, a new graduate. Thomas has many ideas, and his manner of presenting them irks Joan. After reflection and discussion with others, Joan recognizes that she also feels threatened by his behavior. She comes to understand that Thomas is trying to establish his own role on the unit, is not trying to challenge her, and needs guidance, coaching, and affirmation. Joan is demonstrating: a. A positive self-concept. b. Deepening self-awareness. c. Leadership. d. Acquiescence.

b. Deepening self-awareness. According to Goleman (1995), stepping outside oneself to envision the situation while assuming ownership is a component of emotional intelligence.

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 issues with informed consent.

b. Demonstrating respect for patient rights. In demonstrating respect for and advocacy for informed consent, the nurse manager is reflecting a professional philosophy. Professional nurses are ethically and legally accountable to the standards of practice and the accompanying nursing actions delegated to others. Conveying high standards, holding others accountable, and shaping the future of nursing are inherent behaviors in the role of a manager

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. Learning organizations are concerned with providing opportunities and incentives for individuals and groups to engage in lifelong learning, in recognition of the positive impact that learning has on patient outcomes and staying abreast of new knowledge. Lifelong learning and reflection are also characteristics of leaders.

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 in making 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. Complexity theory suggests that systems interact and adapt and that decision making occurs throughout the systems, as opposed to being held in a hierarchy. In complexity theory, every voice counts, and therefore, all levels of staff would be involved in decision making.

The NQF provides a model for advancement of healthcare quality that could be used in healthcare organizations. The use of this model by the Centers for Medicare & Medicaid Services specifically affects the interaction between adverse events and: a. Staffing. b. Funding. c. Composition of executive councils. d. Composition of consumer-based councils.

b. Funding. The Centers for Medicare & Medicaid Services (CMS) have adopted a policy based on the NQF's "never events." The CMS will no longer pay for patient conditions or events that result from poor practice while patients are under the care of a health professional

As a nurse, you are responsible for teaching ostomy patients self-management skills postoperatively. Mr. Jones is 2 days postoperative after an abdominal perineal resection. In spite of patient-controlled analgesia, Mr. Jones acknowledges inadequate pain relief and rates his pain as an 8, utilizing a 0-to-10 pain scale. When you approach him for teaching, he turns away and closes his eyes. Which approach incorporating Maslow's hierarchy of needs motivational theory is most appropriate in this situation? a. Tell him you will let him rest today and see if he is feeling better tomorrow. b. Intervene to improve his pain management control and return later in the day to reassess his readiness to learn. c. Talk to the social worker about arranging home healthcare services at discharge to assist with teaching. d. Gently approach Mr. Jones and inform him of the importance of participating in postoperative teaching today because he may be discharged within several days.

b. Intervene to improve his pain management control and return later in the day to reassess his readiness to learn. Unless Mr. Jones' basic need for comfort is met, he will not be motivated toward higher-order needs related to self-esteem and competence.

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 be inspired, people must have a positive leader who radiates energy, a zest for learning, and an interest in the common good, and is engaged in self-renewal. This leader is hopeful and optimistic. Leaders, not managers, inspire others to work to their highest level.

Chart audits have revealed significant omissions of data that could have legal and funding guidelines. As the unit manager, you meet with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. This is an example of: a. Leadership. b. Management. c. Decision making. d. Vision.

b. Management. The process of guiding others to meet established goals, outcomes, and procedures is management. This can require collaborative decision making to determine how best to reach pre-determined goals and follow established practices.

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. Encouragement of shared decision making, coordination of resources, and interface between internal and external factors and a unit are all associated with effective management but could be performed by a manager from any discipline. The nurse manager's unique role is modeling professional 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. A person can have an impressive title, but title or designation does not make the person a leader. A leader must have the ability to inspire others to follow.

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. This organization is concerned primarily with coordination of resources, application of current policy, and There is little evidence that the organization displays leadership, which involves trust, belief, hope, and vision.economic issues connected to the present. These behaviors are consistent with the management role.

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. Healthy work environments are facilitated by involving staff and others in decision making; gaining access to information is one characteristic of shared decision making. Shared decision making enables staff to feel valued in policy development and in directing and leading.

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. Whether or not the organization achieves financial stability is a function of financial envisioning and planning, but the style of leadership (transactional) that Kari is demonstrating is likely maintaining the status quo within the organization, without generating creative and innovative ideas to address the financial issues. Staff commitment is low to stable, and conformity to organizational goals is motivated by external rewards.

**A nurse executive who considers herself a Baby Boomer will have the challenge of convincing the emerging workforce 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. Baby Boomers mistrust authority and trust in collective action, based on successes with social movements in their formative years.

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 Transactional leaders tend to rely on position and power, and they tend to reward and punish according to performance and conformity with expectations.

Nurses on Unit 4 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. Nurse managers who are successful in motivating staff often provide an inclusive environment that facilitates clearly set, achievable goals that can result in both team and personal satisfaction.

You overhear a newly graduated RN telling one of your colleagues that leadership and management belong to the unit manager and not to her. As a nursing colleague, your response demonstrates understanding that the perception of the new graduate: a. Is correct. Leadership is not the role of the staff nurse. b. 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. Has been influenced by nurse leaders and managers who leave for other positions. d. Is related to the general perception that nurse leaders and managers are not satisfied in their jobs.

b. Would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals. Care coordination that involves the intersection of individual, family, and community-based needs requires that nurses have self-confidence, knowledge of organizations and health systems, and an inner desire to lead and manage. There is often a view that leadership is isolated to those holding managerial positions and that a direct care nurse is subject to following by adhering to the direction of others. Such views fail to acknowledge that to be a nurse requires each licensed individual to lead, manage, and follow when practicing at the point-of-care and beyond.

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 effective 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. Commitment to the vision that has been created is seen in the ability of the leader to influence, motivate, and persuade others. The transformational leader can motivate employees by encouragement of novel, innovative thinking. Drenkard (2013) describes true transformational leadership as occurring when the leader "created an environment that brought leaders and followers together to solve problems, create new ways of doing work, and manage change together" (p. 57).

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 her 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 so as to clarify issues. c. Ask each party to examine her 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 her own motives and issues in the conflict. Ury, Brett, and Goldberg outline steps to restoring unity, the first of which is to address the interests and involvement of participants in the conflict by examining the real issues of all parties.

A nurse manager has worked rapidly to bring the staff to accept changes in the unit's mission, so that downsizing can be avoided. This nurse manager is using quantum leadership by: 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. Quantum leadership assumes that change will occur and that managers assume an influential, facilitative role that encourages forward movement in change and encourages the view that problems are opportunities

You recently acquired a position as a unit manager. During your time on the unit, you have formed a strong social network among your staff, have promoted the development of relationships between your staff and workers in other areas of the organization, and have formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, you are engaging which principle? a. Empowerment b. Systematic thinking c. Development of networks d. Bottom-up interactions

c. Development of networks According to complexity theory, social networks evolve around areas of common interest and are able to respond to problems in creative and novel ways.

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 Nurse managers have responsibility for both patient and staff safety. High-risk areas, such as the Emergency Department, require special attention.

The Rehabilitation Unit at Pleasant Valley Hospital has a high number of falls. Which of the following 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 The IOM (2010) emphasizes the need for nurses to engage in lifelong learning and to use evidence and best practices to inform practice and ensure safety.

To increase safety in patient care areas of the Valley Hospital, the executive begins by: 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 needle-stick injuries.

c. Ensuring that the senior nursing officer attends the board meetings The IOM report (2004) highlighted the importance of the attendance of the senior nurse executive at board meetings to be a key spokesperson on safety and quality issues.

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 win-win 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 win-win strategy. When collaboration is used to solve a conflict or to create new directions, the energies of all parties are focused on solving the problem versus defeating the opposing party and creating the "best possible" versus an "okay" direction. When groups come together and mutual expectations are discussed and fostered, communication and collaboration are enhanced, which results in a more structurally empowered workforce.

In response to the situation in Question 15, you approach the unit manager to apprise her of your concerns that the family dynamics of the patient involved may lead to staff-family and patient-family conflicts. You suggest that the physician may need to discuss the treatment plan with the family. The unit manager advises that he will arrange this discussion. If, after the meeting with family members, this is identified as a desired approach, you support the manager's decision. Your actions indicate that you are acting in what role? a. Leadership b. Management c. Follower d. Evidence-based

c. Follower In the followership role, you bring to the manager your concerns about potential litigation and maximization of outcomes and accept the direction given by the manager in response to your concerns.

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. An appropriate action in this situation would be: 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. Crossing the Quality Chasm emphasizes the importance of rendering care with the client (client-centered) rather than to the client. In this situation, the patient includes family in transparent discussions about quality needs and takes a team approach that involves healthcare professionals, the family, Mary's needs, and evidence associated with safe practice.

You walk into Mr. Smith's room and find him yelling at the LPN, Miss Jones. He is obviously very upset and after you speak with him regarding his behavior, you determine that he has not slept for three nights because of unrelieved pain levels. The LPN is very upset with Mr. Smith and calls him an "ugly, old man." You acknowledge her feelings and concerns and then suggest that Mr. Smith's behavior was aggressive, but is related to lack of sleep and to pain. "Can you both, together with Mr. Smith, determine triggers for the pain and effective approaches to controlling his pain?" This approach demonstrates: a. Lack of empathy and understanding for Miss Jones. b. Concern with placating Mr. Smith. c. Leadership behavior. d. Management behavior.

c. Leadership behavior. The situation between Mr. Smith and Miss Jones is a complex situation involving unrelieved patient symptoms and aggressiveness toward a staff member. Providing engaged, collaborative guidance and decision making in a complex situation where there is no standardized solution reflects leadership.

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 exactly 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. Mentors need to have experience and some success in the leadership area of interest, as well as interest in the future development of the novice. The mentor can be geographically distant or close and able to provide advice and feedback.

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 healthcare. c. Negative organizational culture. d. Quantum leadership.

c. Negative organizational culture. Organizational culture refers to the basic assumptions and values of an organization and whether they contribute to relationships and decision making that is marked by empowerment, information sharing, and truthfulness. Positive work cultures contribute to a perception of being respected in the work environment. Collaborative organizational cultures are essential for nurse managers to proactively work in today's complex healthcare environment in a manner that engages them in their work. Interpersonal relationships can be fostered with organizational designs fostering a culture of collaboration, reward and recognition, communication, and a mentoring environment.

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. Transformational leadership involves engaging those being led and inspiring shared vision in moving toward a goal that all will accept as desirable. This involves enabling and empowering others to believe that their input and effort will make a difference in solving problems.

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. Followers usually hold opinions about decisions that are made; these opinions can be favorable or not, which means that external motivation and affirmation are rare. Leaders have to be confident in their own abilities and enthused about the vision that they have created.

As the manager, you have been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperatively that is being operationalized throughout your organization. Which of the following illustrates effective leadership? 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. A RN who is already familiar with the new approach volunteers to take the lead in mentoring and teaching others how to implement it. Followership occurs when there is acquiescence to a peer who is leading in a setting where a team has gathered to ensure the best clinical decision making and actions are taken to achieve clinical or organizational outcomes. Followership promotes good clinical decisions and use of clinical resources.

After consulting with practice environments about quality and safety concerns in health care, the Dean of Health Programs at U.S. University develops: 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. Health Professions Education identified that education related to health disciplines in silos leads to compromised communication and inability to function as an integrated whole for patient-centered care.

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 on organizing an in-service would be. 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 Communication of a vision and risk taking are leader traits, whereas coordination is associated with manager traits. Taking responsibility while conceding authority to the leader is characteristic of followers.

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). In organizational structures where decision making occurs at the POS, nurse managers are given some self-control, which includes preparing and implementing a budget that meets the long- and short-term needs of their unit without requiring hierarchical approval.

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 Clear and open communication, accountability and clarity of roles, and participatory decision making are considered by the AONE to be important to a healthy environment. Challenge and excellence are not specifically identified by the AONE as important to healthy work environments.

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. As technology improves, informatics must be integrated with budget and personnel as a critical resource element. Basing practice on evidence-based care can assist in making solid decisions about resources and in leading and encouraging staff toward positive changes in patient outcomes. EHRs, for example, are expected to enhance coordination of care, improve health outcomes, and increase accuracy of diagnoses.

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 life-work balance.

d. Encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in life-work balance. According to Covey, effective leaders continually engage in learning and self-renewal, as well as in maintaining a balanced life, radiating positive energy, believing in other people, being concerned with the common good, and being synergistic.

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. Informatics such as Smart Bed facilitates effectiveness and efficiency in care. By becoming an early adopter of technology, staff members, particularly older staff, who may be less comfortable with technology, are encouraged to value its use in care delivery and management.

In preparation for redesignation as a Magnet Hospital, how would you prepare? 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. Through the MagnetTM model, organizations must demonstrate how they provide excellence in five areas. Between designation and redesignation as a MagnetTM organization, greater emphasis is placed on empirical quality results.

As a manager with a high percentage of young professionals, you increase job satisfaction among this young staff by: a. Providing high levels of job structure and task orientation. b. Developing schedules that are fair and observing contractual obligations. c. Utilizing skills in the staffing mix to optimize the delivery of patient care. d. Establishing opportunities to self-schedule.

d. Establishing opportunities to self-schedule

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. Which 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. The manager role involves guiding others through a set of derived practices that are evidence-based and known to satisfy preestablished outcomes such as participation in a competency program. This involves engagement of staff through sharing of concerns and ideas. A close analysis of the IOM report and the summary of the PPACA suggests that no health reform can unfold without active nursing engagement. Each document emphasizes that nurses must lead, manage, and behave as active collaborators with other members of the health team and with those being served.

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. This may be attributable to: a. The overload of staff nurses. b. Resistance to change by staff. c. A change in reporting systems. d. Fewer clinical leaders to remove barriers to care.

d. Fewer clinical leaders to remove barriers to care. Eliminating barriers to the implementation of best practices is the role of managers and leaders. When there are insufficient resources for leadership to encourage a culture in which evidence-based practice is embraced, frontline nurses recognize this as a stumbling block for delivering quality care.

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. Staff members often look to nurse managers to lead them in addressing workplace issues with higher levels of administration. To do this, nurse managers must possess the ability to address power sources in the work environment and to define power-based strategies, such as in organizing a following of other nurse managers with similar concerns.

10. As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety and reducing morbidity and mortality on your unit. Which of the following 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% The Future of Nursing advocates for having 80% of the nursing population at a baccalaureate-prepared level. This recommendation reflects research that suggests that improved mortality and morbidity rates occur with a better educated workforce.

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. As part of your strategy to reduce errors, it is important to a. Re-visit 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. Keeping Patients Safe: Transforming the Work Environment of Nurses (2004) identified many past practices that had a negative impact on nurses, and thus on patients, and recommended the inclusion of nurses in direct care in decision making involving their practice. Future of Nursing: Leading Change, Advancing Health (2010) also emphasizes the role of nurses as leaders in changes that improve health.

Susan, a new graduate on the dialysis unit (Question 18 above), 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." Followers under transactional leadership feel secure about what will happen next or what is needed to be rewarded; therefore, they learn to "play the game."

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 Organizing the information into online modules is an application of Drucker's organizational analysis and the division of activities, decisions, and relations into manageable tasks.

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. An effective leader is eager to share the glory with those who have worked with him or her to achieve outcomes and success. The act of acknowledging the achievement to the senior executive and of sharing the positive feedback with his staff empowers the staff and builds a support base for the leader

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

d. Quantum Quantum theory is one way a manager can serve as an agent of change when patient care work/workflow must be redesigned. Quantum theory recognizes the need to understand behaviors and relationships before changing them, the connectedness of parts such as workflow and relationships, and the need to be analytical, flexible, and empathetic.

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. The NDNQI measures are specifically concerned with patient safety and aspects of quality of care that may be affected by changes in the delivery of care or staffing resources. The quality indicators address staff mix and nursing hours for acute-care settings, as well as other care components. The NDNQI project is designed to assist healthcare organizations in identifying links between nursing care and patient outcomes.

According to the complexity theory, which of the following should 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 According to complexity theory and the principle "Think systematically," you cannot ignore objective data or nonmeasurable data, as both inform decisions.

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. The nurse manager's decision and actions are based on: a. An established clinical pathway. b. Confirmatory scientific evidence. c. Unit protocol. d. Tacit knowledge / experience.

d. Tacit knowledge / experience. The nurse manager is employing knowledge and experience in determining that the patient is dying, because the course of dying is not standardized and cannot be determined by clinical pathways.

In designing a quality, safe healthcare environment, the primary emphasis needs to be on: a. Evidence-based practice. b. Informatics. c. Staffing. d. The patient.

d. The patient. Focusing on the patient moves care from concern about who controls care to a focus on what care is provided to and with patients, which was an aim identified in the IOM report Crossing the Quality Chasm.

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 complexity of nursing and the healthcare environment demands that all nurses assume roles of manager, leader, and follower, depending on the situation. Nurses are involved in providing leadership in direct patient care, in leading others at a unit or organizational level, in moving the profession forward, and in participating in legislative and policy arenas. Consumers depend on nursing leadership to carry the healthcare agenda forward.

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 Leaders are those who do the best job of sharing their vision of where the followers want to be and how to get there. It is the ability to inspire others to bring a vision (such as evidence-based decision making) to reality and is not necessarily tied to status or information flow.

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. You are employing _____ leadership. a. Situational b. Trait-based c. Contingency-based d. Transformational

d. Transformational Transformational leadership involves attending to the needs and motives of followers, which results in creativity, improvement, and employee development.

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 involves technology. Which of the following strategies 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. The Institute for Healthcare Improvement (IHI) is dedicated to rapid improvement in patient care through a variety of mechanisms such as rapid cycle change. Rapid cycle change diffuses innovation and changes quickly through early adopters who share information and energy over time and act as role models for others.

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. Placing the nurse on unpaid leave may threaten the nurse's capacity to meet physiologic needs and demotivate the nurse. Unsatisfactory coverage of shifts on short notice could affect patient care and threaten the needs of staff to feel competent. Arranging the schedule around the wife's needs meets the needs of the staff and of patients while satisfying the nurse's need for affiliation.

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