Leadership exam 1 study

_____ is an expected part of change and is often related to fear and anxiety. a. Depression b. Resistance c. Acceptance d. Denial

ANS B Resistance to change should be expected as integral to the process of change. It may be rooted in anxiety or fear.

Culture change within nursing homes was initiated by the: a. Nursing Home Reform Act. b. National Citizens' Coalition for Nursing Home Reform. c. Pioneer Network. d. Eden Alternative.

ANS: A A series of quality improvement programs were implemented in nursing homes following the passage of the Nursing Home Reform Act legislation in 1987.

A staff nurse is facing a dilemma between meeting clinical ethical standards and meeting organizational goals. The nurse manager understands that the best way to assist staff members in resolving ethical dilemmas effectively is to focus on: a. doing the right thing and taking the right action. b. meeting clinical standards before organizational goals. c. meeting organizational goals before clinical standards. d. referring indecisive staff members for additional training.

ANS: A Although the domain of clinical ethics is the care of clients, the domain of organizational ethics is a facility's business-related activities. Together, clinical and organizational ethics reflect a health care facility's concern that, whether related to the continuum of care or the continuum of services related to that care, ethical dilemmas should be resolved based on values-centered principles that focus on doing the right thing and taking the right action.

A patient who is not fully informed about his or her health status is an example of a violation of which ethical principle? a. Autonomy b. Justice c. Utilitarianism d. Confidentiality

ANS: A Autonomy refers to the client's right of self-determination and freedom of decision making. A patient who is not fully informed is denied the freedom and access to make a decision.

The court has found that a registered nurse (RN) harmed a patient by violating his rights. The nurse is ordered to pay the patient a large sum of money. The court has determined that the nurse has committed a: a. civil act. b. criminal act. c. critical wrong. d. quality breach.

ANS: A By definition, civil acts are wrongs that violate the rights of individuals by tort or breach of contract.

The first stage of planned change involves: a. accepting the need for change. b. cognitive redefinition. c. integration and stabilization. d. problem solving.

ANS: A Change must begin with an awareness of the need for change and end with a general acceptance of the necessity of change

Characteristics of a Magnet hospital include: a. multidisciplinary collaboration. b. nursing leader authority. c. physician control. d. social worker retention.

ANS: A Characteristics of a Magnet hospital include nursing autonomy, practice control, and collaboration. Nursing support, collaborative partnerships with physicians, and nursing practice are other aspects.

An example of an external variable that may affect communication is: a. circumstance. b. personality. c. thoughts. d. feelings.

ANS: A Communication may be affected by the interaction of external variables (others, a situation) and internal variables (you). Internal factors are the only thing under our own co

A nursing preceptor is giving feedback to a new nurse who currently is being oriented. Her preceptor suggests a better method of interacting with a family member by saying, "You might want to be cognizant of your non-verbal behaviors when talking with clients. Rather than continuing to chart when you are talking with an American family, stop charting, move closer to the family and client, look at them during the conversation, and take time to let them share their concerns." This preceptor is giving advice about: a. interpersonal communication. b. clarity. c. image. d. intention.

ANS: A If the verbal message is clear, but the non-verbal communication is not congruent, then listeners may misinterpret, distrust, or not even hear the intended message. In this situation, the nurse's non-verbal behavior may suggest that she is not interested in interacting with the family.

A staff nurse came in to work the 7 PM to 7 AM shift. She had met her friends for "happy hour" earlier in the evening. Her breath smells of alcohol. If this nurse is allowed to provide care for patients, she may be at risk for: a. maleficence. b. melange. c. nonmaleficence. d. nonmelange.

ANS: A Maleficence is doing harm to the patient whether it is intentional or unintentional, such as an omission. If the nurse is intoxicated, she may fail to meet the standard of care.

How is culture represented at the unit level, with an underlying belief in patient-centered care? a. Open visiting hours in the critical care unit (CCU) b. Strict visiting hours in the CCU c. Tape-recorded report d. Verbal handoff conducted at the nurses' station

ANS: A Open visiting hours in the CCU convey the importance of family as partners in care delivery. This is a representation of culture within a nursing unit where a relationship-based nursing care model is used, and it represents an underlying belief in patient-centered care.

Organizational _____ affects the quality of nursing care and patient outcomes. a. culture b. climate c. fiscal stability d. case mix

ANS: A Organizational culture affects the quality of nursing care and patient outcomes. The manner in which staff perceives culture, manages boundaries, and translates values has an impact on patient care

A communication model that focuses on compassion, expression of emotion, and providing validation via support is the: a. validation, emotion, reassurance, activity (VERA) framework. b. situation, background, assessment, and recommendation (SBAR) Communication Theory. c. nonviolent communication (NVC) model. d. Human Relationship Model.

ANS: A The VERA (validation, emotion, reassurance, activity) framework for communication was developed to meet a need for nursing students who were at a loss to communicate with persons with communication difficulties (Hawkes et al., 2015).

A nursing manager recognizes that the changes that she is expected by administration to implement will be met with staff resistance. She is committed to determining the root of the resistance and communicating positively with her staff. The nurse manager's actions characterize her as a(n): a. change agent. b. implementation expert. c. restructuring motivator. d. supervisory threat.

ANS: A The change agent needs to anticipate resistance, determine why it is occurring, and try to determine what the person who is resisting is trying to protect.

Organizational tones are based mostly on: a. unspoken cultural norms. b. commitment to success. c. communication behavior. d. leadership styles.

ANS: A The entire tone of the organization is based mostly on unspoken cultural norms. Because nurses make up the bulk of the health care workforce, having nurse leaders at the helm of the organization can influence the culture and climate of the organization as a whole.

A small critical care unit forms a team of nurses to implement bedside rounds at shift change. The nurses have researched the efficacy of bedside rounds and have determined that this evidence-based practice will lead to improved communication of patient status. Which type of change does this demonstrate? a. Transforming care at the bedside b. Second-order change c. Emergent change d. Organizational change

ANS: A Transforming care at the bedside was an initiative created to improve quality and safety on medical-surgical acute care units by engaging in changes to improve practice.

The postoperative patient with anterior cervical laminectomy is complaining of tightness in his throat. His voice is raspy. The staff nurse asks the unit secretary to page Dr. Julio stat. This is an example of _____ leadership. a. authoritarian b. democratic c. laissez-faire d. servant

ANS: A Authoritarian leadership uses directive and controlling behaviors in which the leader determines policies and makes decisions in isolation. The leader orders subordinates to carry out the tasks or work. This style is helpful in crisis situations.

A professor at the local college of nursing is teaching at a new clinical site. She notes that the nurses greet each other and their clients with warmth and a smile. She also notes that the policies and procedures encourage nursing autonomy. Nurses and physicians seem to have a collegial relationship. These observations best describe the _____ of the unit. a. climate b. culture c. interactions d. operation

ANS: A Climate is the perception that individuals have about a particular unit or environment

Which of the following are crucial leadership traits to exhibit in the nursing profession? a. The nurse leader needs to by dynamic b. The nurse leader shows good interpersonal skills c. The nurse leader is a visionary for the organization and the profession d. The nurse leader is able to inspire e. The nurse leader allows corporate executives to determine department goals

ANS: A Leadership is considered key to the success of health care organizations. A nurse leader needs to be dynamic, show interpersonal skills, and be a visionary for the organization and the profession. The ability to inspire and motivate followers to carry out the vision is crucial. Effective nurse leaders set department goals without micromanaging.

A nursing unit has demonstrated lower patient satisfaction scores during the last quarter. The manager of the unit has formed a small team to set long- and short-term goals for the unit with action plans to increase patient satisfaction. This is an example of which management process? a. Planning b. Organizing c. Coordinating d. Controlling

ANS: A Planning is the managerial function of selecting priorities, results, and methods to achieve results.

Good leaders need to be able to demonstrate an intuitive skill of empathy and expressiveness when dealing with others in the workplace. This requires sensitivity and awareness of the emotions and moods of others and is known as: a. social awareness. b. self-awareness. c. self-management. d. relationship management.

ANS: A Social awareness is an intuitive skill of empathy and expressiveness in being sensitive and aware of the emotions and moods of others.

Which of the following traits describe a transactional leader? (Select all that apply.) a. Functions in a caregiver role. b. Surveys their followers' needs and sets goals for them. c. Uses charisma to produce greater effort in followers. d. Focuses on the maintenance and management of ongoing and routine work. e. Motivates followers to perform to their full potential.

ANS: A, B, D A transactional leader is a leader or manager who functions in a caregiver role and is focused on day-to-day operations. Such leaders survey their followers' needs and set goals for them based on expectations. They are also leaders who are focused on maintenance and management of ongoing and routine work. Transformational leaders use charisma to produce greater effort and are able to motivate followers to perform to their full potential over time.

A nurse manager at Great Lakes Hospital is meeting with the dean of a well-recognized university who is the keynote speaker today at the nursing conference. He remembers that one of the RNs is interested in attending a well-known university to obtain a doctorate. The nurse manager arranges for the RN to meet with this dean. The nurse manager is exhibiting leadership behaviors consistent with: (Select all that apply.) a. feminist perspective. b. servant leadership. c. transactional leadership. d. transformational leadership. e. authoritarian leadership.

ANS: A, B, D This behavior nurtures personal growth (servant leadership) and assists the RN to attain his or her fullest potential (transformational leadership). This behavior also helps the RN build a connection with the dean, a representative of the university (feminist perspective).

Which ethical principle is violated when the RN tells the hospital accountant that the patient is HIV-positive? (Select all that apply.) a. Beneficence b. Veracity c. Confidentiality d. Autonomy e. Fidelity

ANS: A, C Beneficence means "doing good for clients and providing benefit balanced against risk." The hospital accountant had no need to know; therefore, there was no benefit for the patient for him to be told. Confidentiality prohibits disclosures of information gained in certain relationships to third parties without the consent of the original source of the information. Without the patient giving express consent, the hospital accountant has no need for this information, and it is a breach of confidentiality.

What drivers of change are impacting nursing care? (Select all that apply.) a. Transparent communication b. Overabundance of nursing staff c. Evidence-based practice d. Information technology e. Reduced acute care needs

ANS: A, C, D An explosion in information technology capacity is altering the speed and transparency of communication and information delivery. The impact of a nursing shortage, increased demand for nursing care, and the drive to incorporate evidence-based practice are changing the face of nursing care.

Effectiveness and sustainability of change is based on the skilled communication of leadership and stakeholders endorsing the change process. What are some barriers that can interfere with change? (Select all that apply.) a. Inwardly focused cultures b. Transformational leadership c. Fear of the unknown d. Arrogant attitudes E. Safety culture

ANS: A, C, D Kotter (1996) suggested the following are needed to empower people to make change: communicate the vision to employees, make structures compatible with the vision, provide the training employees need, align information and personnel systems, and confront supervisors who undercut needed change. Further, he suggested that structures, skills, systems, and supervisors are generally the four barriers to any transformational process.

Which of the following behaviors build trust between leaders and employees in an organization? (Select all thatNappRly.) a. Sharing relevant information b. Encouraging competition via winners and losers c. Reducing controls d. Meeting expectations e. Avoiding discussion of sensitive issues

ANS: A, C, D Leadership is founded on trust. Behaviors that build trust include sharing relevant information, reducing controls, and meeting expectations. Trust-destroying behaviors include being insensitive to beliefs and values, avoiding discussion of sensitive issues, and encouraging competition.

Effective communication is fostered through which of the following ingredients? (Select all that apply.) a. Trust b. Humility c. Respect d. Empathy e. Sympathy

ANS: A, C, D Trust, respect, and empathy are the three ingredients needed to create and foster effective communication.

Researchers study organizational climate in order to examine how the work environment influences behaviors. Which of the following characteristics are utilized to study climate? (Select all that apply.) a. Supervisor support b. Unit staffing and its effect on incident reporting c. Autonomy d. Peer cohesion e. Rewards and recognition

ANS: A, C, D, E Some characteristics that are used to study climate are decision making, leadership, supervisor support, peer cohesion, autonomy, conflict, work pressure, rewards, feeling of warmth, and risk.

To establish legal liability on the grounds of malpractice, the injured party must prove which of the following? (Select all that apply.) a. A duty of care was owed to the injured party. b. An agreement was made to assume another party's liability. c. There was a breach of duty. d. Causation was present. e. Actual harm or damages were suffered by the plaintiff.

ANS: A, C, D, E These four elements are required to establish legal liability on the grounds of malpractice.

During periods of stress and change, which of the following strategies should managers use to provide emotional support to staff members? (Select all that apply.) a. Reframe difficult questions. b. Communicate facts through e-mail. c. Provide active listening. N R I G B.C M d. Promote action steps and soUlutSionsN. T O e. Keep staff informed of decisions. f. Communicate with participation.

ANS: A, C, D, E, F Emotional responses are an expected part of change, and managers need to be able to provide emotional support to staff during periods of stress. Some of the effective strategies are active listening, promoting action steps and solutions, keeping staff informed of decisions, soliciting input, encouraging participation, and reframing difficult questions.

To reach Magnet status the nursing service in a hospital must attain competency in which of the following areas? (Select all that apply.) a. Professionalism b. Use of critical thinking skills c. Business skills and principles d. Leadership e. Communication and relationship management f. Knowledge of the health care environment g. Implementation of an acuity-based staffing system

ANS: A, C, D, E, F Magnet hospitals are recognized for the nurse's critical role in the business of health care. Professionalism, leadership, communication, and the ability to work with others as well as understanding the business and principles of running a hospital business and health care environment are required.

The probability of effectiveness of the change process can be increased through several techniques. Which of the following actions will likely increase effectiveness? (Select all that apply.) a. Explain the rationale for a change so that individuals understand it. b. Simply announce the change without laying a foundation. c. Give participants all the information they need. d. Rely only on formal authority in implementing change. e. Help individuals cope with change.

ANS: A, C, E Announcing the change without laying a foundation and relying only on formal authority in implementing change are actions to be avoided when implementing change within an organization.

Hospitals and long-term care facilities wishing to achieve Magnet Recognition Program® must meet which of these components? (Select all that apply.) a. Transformational leadership b. Incident reporting c. New knowledge d. Actual staffing ratios e. Empirical outcomes

ANS: A, C, E Today, hospitals and long-term care facilities wanting to achieve Magnet Recognition Program® status must meet five key components identified by the ANCC (2016): transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and empirical outcomes.

Which of the following behavioral aspects are present in the feminist perspective leadership style? (Select all that apply.) a. Builds relationships. b. Focuses on completing tasks and achieving goals. c. Empowers others. d. Fosters an environment of mothering. e. Supports bargaining of tasks and roles. f. Promotes personal growth.

ANS: A, C, F Leaders using the feminist perspective build connections, empower others, and support personal growth to promote teamwork and to accomplish goals.

The IOM report, To Err Is Human: Building a Safer Health System, recommends building a safety culture within an organization. This refers to keeping both patients and nurses safe. The organization supports nursing by: (Select all that apply.) a. moving from a reactive culture to one that is fair and just. b. demonstrating authoritarian behaviors. c. mandating nurses to meet patient needs. d. providing a safe and efficient workspace.

ANS: A, D Included in the concept of a safety climate is a focus on nurse's health and safety. Nurses working in hospitals have one of the highest rates of work-related injuries, especially back injuries and needlesticks. One major shift in an organization's safety climate is the move from a punitive and reactive culture to a fair and just culture. In a fair and just culture, expectations for system and individual learning and accountability are transparen

E-mail is a great tool for communication. When should e-mail not be used? (Select all that apply.) a. When you are mad. b. When scheduling a meeting c. When you are canceling or apologizing d. If there is any chance your words could be misunderstood e. When rebuking or criticizing

ANS: A, D, E Electronic communication has assisted us to be better informed regarding our patients. However, within the professional health care realm, there is a tendency to rely on these modes of communication when other methods would be preferable and more appropriate. For instance, there are definite times when a face-to-face conversation is preferred to an e-mail. Warrell (2012) noted that there are four times you should never use e-mail: (1) when you are mad, (2) when rebuking or criticizing, (3) if there is any chance your words could be misunderstood, or (4) when you are canceling or apologizing. In our busy professional lives, it is easier to send off a quick e-mail than to pick up the phone or walk down the hall; however, e-mail distances us from others and is really only the preferred means of communication when information is simply being conveyed.

A nurse manager at Morgan Hill Community Hospital is known to be an excellent nursing manager by the personnel working on her nursing unit. The nurse manager exhibits which of the following behaviors? (Select all that apply.) a. Knows the personnel and addresses them by name. b. Intervenes when she receives complaints. c. Has a consistent style that never varies. d. Is visible on the nursing unit by all shifts on a frequent basis. e. Evaluates a number of aspects of problems prior to making decisions. f. Uses decision by consensus to resolve conflicts. g. Fosters collaboration.

ANS: A, D, E, G These behaviors foster teamwork and positive morale.

Almost all changes encounter: a. attitudes. b. resistance. c. knowledge. d. communication.

ANS: B Almost all changes encounter some resistance as a natural phenomenon. Resistance may be rooted in anxiety or fear.

Climate is best defined as the: a. health and well-being of the structure of a facility. b. perceptions that individuals have about an environment. c. style in which individuals treat each other. d. temperature in the nursing units of an institution.

ANS: B Climate is defined as the perceptions that individuals have about a particular unit or environment

The process in which information, perception, and understanding are transmitted from person to person is: a. articulation. b. communication. c. evaluation. d. pronunciation.

ANS: B Communication is the process in which information, perception, and understanding are transmitted from person to person.

_____ communication patterns exist between colleagues and serve to contribute to a hostile work environment, high turnover, burnout, and job dissatisfaction. a. Defensive b. Disruptive c. Negotiating d. Humanizing

ANS: B Documentation in literature is extensive regarding disruptive and distracting communication interactions not only between nurses and colleagues but also between nurses and patients. The research indicates that nursing personnel experience high turnover rates, job dissatisfaction, and burnout; many registered nurses are leaving the profession. The work environment is described as hostile to nurses, and patient outcomes of increased severity of illness and mortality have been directly related to poor communication skills of the staff.

The identification of forces that drive and restrain change is called a(n): a. equilibrium evaluation. b. force field analysis. c. status quo analysis. d. refreezing system.

ANS: B Driving and restraining forces influence any situation. A force field analysis facilitates the identification and analysis of driving and restraining forces in any situation.

The transformational leader engages staff by: a. punishing errors. b. sharing vision and decision making. c. taking a top-down approach to leadership. d. making unilateral decisions for the team.

ANS: B Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism

During a staff meeting, a group of RNs has complained that medications are not arriving to the unit in a timely manner. The nurse manager suggests that the group resolve this issue through the development and work of a multidisciplinary team led by one of these RNs. This scenario demonstrates: a. adaptation. b. empowerment. c. flexibility. d. relationship management.

ANS: B Empowerment is the giving of authority, responsibility, and the freedom to act. In this situation, the manager has given authority, responsibility, and the freedom to act in the investigation and resolution of this issue.

On admission, the patient was found to have a blood glucose level of 218. The RN knows that except in emergency situations, it is hospital policy to obtain physician's orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. The nurse's actions are an example of: a. breach of contract. b. common negligence. c. intentional malpractice. d. medical oversight.

ANS: B Examples of common negligence allegations in nursing malpractice suits include patient falls, use of restraints, medication errors, burns, equipment injuries, retained foreign objects, failure to monitor, failure to ensure safety, failure to take appropriate nursing action, failure to confirm accuracy of physicians' orders, improper technique or performance of treatments, failure to respond to a patient, failure to follow hospital procedure, and failure to supervise treatment (Cooper, 2014).

The use of a new idea or method is the definition of: a. change. b. innovation. c. resistance. d. stereotyping.

ANS: B Innovation is the use of a new idea or method

The nursing manager of a telemetry unit has developed a policy in which all nurses automatically are scheduled to have a day off from work on their birthday unless they request to work on that day. He also gives a small gift to each nurse who becomes certified in his or her specialty area. This manager's actions are positively affecting the _____ of the unit. a. climate b. culture c. interactions d. operation

ANS: B Key areas under the leader's control in which culture can be affected are staff recruitment and retention, welcoming new staff, orientation, celebrating and recognizing staff accomplishments, facilitating change, and promoting a learning environment.

Which of the following is true about negotiation? a. It commonly results in a win-lose situation. b. It is aimed at solving problems, conflicts, or disputes. c. It is used only in contract and labor union disputes. d. It is the exchanging of favors or trading activity.

ANS: B Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. It is used to solve problems, conflicts, or disputes.

The major responsibility for upholding patient care standards belongs to the: a. chief executive officer of the facility. b. nurse manager. c. on-call physician. d. staff nurse providing patient care.

ANS: B Nurse managers carry the major responsibility for developing and upholding the standards of care for staff nurses.

A hospital system is implementing an electronic health record. The facility conducts education and training for nursing staff, medical staff, and ancillary staff over a period of 6 months. This is an example of: a. emergent change. b. planned change. c. transformation. d. innovation.

ANS: B Planned change is a decision to make a deliberate effort to improve a system.

The number one cause of preventable medical errors is: a. hostile work environments. b. poor communication. c. ineffective leadership. d. staff competency.

ANS: B The Agency for Healthcare Research and Quality (AHRQ) has collected data regarding patient safety over many years. They discovered that poor communication was the number one cause of preventable medical errors (Kleiner et al., 2014). After discovering the staggering number of preventable medical errors and recognizing that communication problems were cited as the number one contributor, the AHRQ partnered with the Department of Defense (DOD) and developed the TeamSTEPPS program (AHRQ, 2016).

The Institute of Medicine (IOM) report, Crossing the Quality Chasm, was useful in describing the challenges related to moving from _____-centered to _____-centered care. a. patient; provider b. provider; patient c. patient; facility d. provider; financially

ANS: B The IOM report, Crossing the Quality Chasm, describes challenges in care provision and details the shift of moving from provider-centered care to patient-centered care. The need for patient and family participation is a dominant force in treatment decisions.

According to the ___________ people move through a series of states when modifying their behavior. a. Organizational Change-Readiness Scale (OCRS) b. Transtheoretical Stages of Change Model c. Rapid Cycle Change d. plan-do-study-act model

ANS: B The Transtheoretical Stages of Change Model used research to show that people move through a series of stages when modifying their behavior. Readiness to change is a key aspect.

An experienced nurse has recently taken a position on a telemetry unit in the local hospital. After 2 weeks on the job, he finds that the staffing is not what was discussed during his employment interview with the nurse manager. Which approach would be most appropriate for the nurse to take? a. Give 2 weeks' notice and begin seeking employment at another hospital. b. Discuss the situation with the nursing manager who interviewed him. c. Talk to other employees about the staffing situation. d. Notify the charge nurse that this was not what was explained to him prior to employment.

ANS: B The nurse should discuss the situation with the nursing manager who interviewed him before quitting. Perhaps there is a temporary problem affecting staffing that could explain the situation. If after this discussion it is believed that the staffing is not now or ever will be as it was relayed to him in the interview, then he should seek employment elsewhere.

Which communication format was developed to address the communication arm of the TeamSTEPPS model? a. NVC (nonviolent communication) b. SBAR (situation, background, assessment, and recommendation) c. VERA (validation, emotion, reassurance, activity) d. MI (motivational interviewing)

ANS: B To address the "communication arm" of the TeamSTEPPS model strategies such as SBAR have been created to enhance teamwork communication. One of the strategies that has been well documented and is familiar to nurses is SBAR, which stands for situation, background, assessment, and recommendation.

The charge nurse of a small nursing unit would like to gain staff acceptance of a time-intensive, budget-imposed change required by the hospital administration. She plans to emphasize several evidence-based research projects that have shown improved patient health outcomes as a result of implementing this change. This is an example of which of the following organizational change concepts? a. Budget-oriented change b. Transformation c. Resistance d. Emergent change

ANS: B Transformation is the use of new ideas, innovation, and creativity to change fundamental properties of the state of a system.

The definition of veracity is: a. being loyal and faithful to commitments and accountable for responsibilities. b. the norm of telling the truth and not intentionally deceiving or misleading clients. c. a prohibition of disclosure of information. d. a right of limited physical or informational inaccessibility.

ANS: B Veracity is the norm of telling the truth and not intentionally deceiving or misleading clients.

A nursing executive is leading a multidisciplinary team of professionals who have worked well together on prior initiatives. Which of the following leadership styles might work best in this situation? a. Authoritarian b. Democratic c. Transformational d. Transactional

ANS: B Democratic leadership would work best in this situation. This approach implies a relationship and person orientation and policies are a matter of group discussion and decision.

Which of the following is true of management activities? a. Inspiring a vision is a management function. b. Management is focused on task accomplishment. c. Management is more focused on human relationships. d. Management is more important than leadership.

ANS: B Management is focused on task accomplishment.

A quality improvement team is working to enhance teamwork among the staff in a newly developed Alzheimer's program. Which of the following statements would be an expected behavior that illustrates quantum leadership? a. "After the meeting today, each member on this team will be a role model of good communication techniques to other staff members." b. "How would you describe an ideal collaborative practice environment?" c. "What do you think about sharing our opinions today in a mutually respectful manner as we move around the table?" d. "You folks are highly motivated and smart enough to develop a plan on your own. I'll support you as needed."

ANS: B Quantum leadership fosters an environment of curiosity, questioning, and exploration. Answer A depicts an authoritarian leadership style.

A nursing unit has discovered a series of medication errors with regard to a particular computerized physician order set and the calculation within the order. The unit manager has a theory on changes that should be made within the order to decrease the confusion for nursing staff. However, the nurse manager realizes that changes would need to be made with pharmacy input as well as other nursing units within the facility and the multihospital system. Which of the following management theories is exemplified when the nurse manager considers the impact of change on the organization as a whole? a. Contingency theory b. Systems theory c. Complexity theory d. Chaos theory

ANS: B Systems theory helps managers recognize their work as being embedded within a system. Managers use this theory to learn that changing one part of a system inevitably affects the whole system.

The best leadership style for unfavorable conditions is: a. leader-member relations. b. task-oriented structure. c. position power. d. laissez-faire.

ANS: B The need for task-oriented leaders occurs when the situation is extreme. The best leadership style for unfavorable conditions is task-oriented.

A Middle Eastern man has just been diagnosed with terminal cancer. The family has asked the medical and nursing staff to keep this information from the patient because in their culture they are fearful of delivering bad news as it may cause the patient to give up hope. Which ethical principles and dilemmas might be faced by nursing staff? (Select all that apply.) a. Justice b. Autonomy c. Veracity d. Confidentiality

ANS: B, C Autonomy refers to the rights of the patient to participate in decision making. Veracity refers to telling the truth. The nurses caring for the patient may feel that they are not being truthful about the treatment plan and decision-making process in this case.

Which of the following are examples of patient privacy or security breaches? (Select all that apply.) a. Encrypted e-mail communications b. Fax transmission sent to incorrect physician office c. Prescription given to patient with wrong label attached d. Case management coordinator obtaining information about a patient's diagnosis e. Discharge summary given to patient's spouse

ANS: B, C Fax transmissions sent to the incorrect physician's office or prescriptions given to a patient with the wrong label attached are examples of privacy or security breaches under HIPAA. Electronic transmissions should be end-user encrypted for data security.

The nurse manager in a large emergency department utilizes agency nursing for staffing. Which of the following should the nurse manager do to help the facility avoid corporate liability? (Select all that apply.) a. Assume that the agency has reviewed the license status of the individual. b. Ensure that those who report to them remain competent and qualified and have current licensure. c. Report incorrect mixes of staff for effectively meeting the health care needs of clients. d. Assign the staff members to the role of mentor and educator.

ANS: B, C Nurse managers can help the facility avoid corporate liability by, among other things, ensuring that those who report to them remain competent and qualified and have current licensure. Nurse managers should also report dangerously low staffing levels, incorrect mixes of effective staff, and incompetent, illegal, or unethical practices.

A client's wife is concerned about her husband's declining health. He has been admitted with an acute myocardial infarction and has had two myocardial infarctions before this admission. He is not a candidate for surgery. She and her husband have discussed "no breathing machine" for long-standing care, but she is unsure of his wishes if he were to need a "breathing machine" for a short period. The nurse discusses his current condition and care with the client and his wife. She also organizes a team meeting consisting of the client's physicians, social worker, pastoral care person, and nursing staff. During this meeting, the nurse helps the wife share her concerns and the client's concerns with the rest of the team. What type of communication technique is being utilized by the nurse? (Select all that apply.) a. Bargaining b. Negotiation c. Persuasion d. Spiritual assessment e. Collective action

ANS: B, C Persuasion is the conscious intent by one individual to modify the thoughts or behaviors of others. Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. Persuasion and negotiation are used to ensure that all members of the teamwork together in a co-operative manner. The nurse, the patient, and the spouse all communicate the wishes of the patient to convince the team to abide by the autonomous decisions of the patient and spouse.

Which of the following are examples of intentional torts that may occur in the health care field? (Select all that apply.) a. Slip and fall in the hospital cafeteria b. Patient restrained by the neck utilizing the nurse's arm c. Ovary removal against the patient's signed consent d. Restraining a patient without a physician's order e. Hospital-acquired pressure ulcer

ANS: B, C, D Common intentional torts within the health care setting include assault and battery, medical battery, and false imprisonment.

Which of the following statements reflects just culture within an organization? (Select all that apply.) a. Just culture is a punitive reaction to patient errors. b. Just culture occurs when the organization is transparent about its mistakes. c. Interpersonal learning is balanced with personal accountability and discipline. d. Expectations for system and individual learning are apparent. e. Serious safety events are reported to senior leadership and kept confidential.

ANS: B, C, D In a just culture, organizational, individual, and interpersonal learning are balanced with personal accountability and discipline. In a fair and just culture, expectations for system and individual learning and accountability are transparent. The organization freely discusses mistakes with the intention of learning from them.

Learning organizations adapt to change through their ability to be open, dynamic, and responsive to changes in the environment. Which of the following learning disciplines are true of these types of organizations? (Select all that apply.) a. Learning is conducted in individual parts rather than in groups. b. Viewing the organization as an interrelated system is known as systems thinking. c. Individuals utilize mental models to understand how their vision affects their decisions and actions. d. Shared vision is conducted within a group to determine plans to get to the preferred future. e. Personal mastery encourages individuals to create results as they see fit.

ANS: B, C, D Mental models allow individuals to develop, create, and project a personal vision and understand how these views affect their decisions and actions. Shared vision is encouraged within a group for development of plans. A sharing of learning skills is encouraged as a group so that learning can occur as a group. The organization is viewed as an interrelated system, rather than in unrelated parts, in systems thinking.

NVC communication processes are grounded in: (Select all that apply.) a. confrontation b. empathy c. compassion d. honesty e. assertiveness

ANS: B, C, D NVC communication utilizes a four-part communication process grounded in compassion, empathy, and honesty. The four parts include making an observation, expressing a feeling, expressing a need, and making a request without demanding.

Which of the following patient-related events may be considered as examples of common negligence allegations in a nursing malpractice suit? (Select all that apply.) a. Staffing levels in the medical unit b. Patient fall with injury c. Heparin error d. Failure to utilize rapid response team with change in vital signs e. Failure to ensure telemetry monitor is on the correct patient

ANS: B, C, D, E Examples of common negligence allegations in nursing malpractice suits include patient falls, use of restraints, medication errors, burns, equipment injuries, retained foreign objects, failure to monitor, failure to ensure safety, failure to take appropriate nursing action, failure to confirm accuracy of physicians' orders, improper technique or performance of treatments, failure to respond to a patient, failure to follow hospital procedure, and failure to supervise treatment.

Which of the following definitions apply to management? (Select all that apply.) a. It is a process of inspiring people to accomplish goals through support and confidence building. b. It is the process of coordination and integration of resources to accomplish specific goals. c. It includes the activities of planning, organizing, coordinating, directing, and controlling. d. It is a process of planning and directing human effort to achieve established objectives. e. It is the directing of the organizations' money, facilities, and supplies to achieve results.

ANS: B, C, D, E Management is defined as the process of coordination and integration of resources through planning, organizing, coordinating, directing, and controlling to accomplish specific goals. Management is a process of planning and directing human effort to achieve established objectives while ensuring that the organizations' money, facilities, and supplies are directed in a manner that achieves the best results.

Which of the dimensions of spirituality should nurses assess for in care delivery? (Select all that apply.) a. Culture b. Beliefs c. Values d. Social e. Religious

ANS: B, C, D, E Nurses need to assess for social, spiritual, religious, and cultural values and beliefs because they may affect individual patients' health care decisions and preferences.

Group readiness levels can be assessed in four stages. Which of the following statements is accurate regarding group readiness? (Select all that apply.) a. Members are organized and secure about their roles in the forming stage. b. At the forming stage, the group needs direction in defining goals. c. During the storming period, there is more willingness to accept the group goals. d. The group becomes self-managing during the norming period. e. During the performing period, the members willingly perform the task.

ANS: B, C, E At the forming readiness level, the group needs direction in defining task goals and objectives as opposed to personal goals. The members are uncertain and insecure about their role in the group. This initial period is chaotic. During the storming period, there is more willingness to accept the group goals and objectives but there are still differences of opinion, competition for recognition, and attempts to influence the group. During the norming period, there is greater agreement on the task goals as the group develops cohesiveness and adjusts to the group and task. Finally, during the performing period, the members are thinking as one and willingly performing the task. There is camaraderie and team spirit as the group becomes self-managing.

Which of the following statements are accurate descriptors regarding change? (Select all that apply.) a. Organization-wide change is more sustainable when leadership imposes the change. b. Change within an organization is often externally imposed. c. Change within an organization may originate internally. d. Nurses do not need to participate actively in the organizational changes. e. Change is often complex and irrational

ANS: B, C, E Changes within an organization may be necessary due to external or internal demands. Change is seldom easy and may be complex and irrational.

Professional safeguards that protect the nurse from being wrongfully accused of malpractice include which of the following? (Select all that apply.) a. Code of Ethics b. Statute of Limitations c. Affidavit of Merit d. Standard of Proof e. Sources of Law

ANS: B, C, E Civil law controls those circumstances when an individual, the plaintiff, feels that he or she has been harmed by another. If the other person is a professional, the law provides for professional liability, also known as malpractice. Professionals are provided with many safeguards to avoid them being wrongfully accused of malpractice. The Statue of Limitations is a statutory time limit (most commonly 2 years) by which a plaintiff must file a lawsuit against a professional or lose that opportunity forever. An affidavit of merit is a sworn document by a like kind of professional (a doctor for a doctor defendant and a nurse for a nurse defendant) who reviews the injured patient's chart, and, based upon the reviewer's education and experience, makes a statement that the case has merit and should be permitted to go to trial. Laws are found in case books, as well as online in official reports and legal research services. A reported case is one that can be found in an official reporter. There are state as well as federal reporters. When entered into a reporter, the case is printed and becomes part of the ever-growing body of case law.

A group of nurses is showing resistance to changes the manager is making with regard to staffing. Which of the following ways can the manager deal with the emotionality of the situation? (Select all that apply.) a. Use persuasion. b. Give the nurses adequate notice of change. c. Avoid discussion. d. Explain the rationale and patient impact. e. Inform staff that senior leadership made the decision.

ANS: B, D A factor in determining how change is accepted depends upon how it is managed. The way to deal with emotionality is to avoid persuasion and to allow people to express their feelings. Staff should be given as much notice as possible when making changes in staffing or scheduling, and discussion is encouraged. Staff should be informed about the rationale for the decision as well as patient impact. Effective managers possess self-confidence to explain the change without blaming.

An elderly client becomes confused after surgery. He is in a room farthest away from the nurse's station. The client has been trying to get out of bed several times during the shift. The nurse documents this very well. The client falls out of bed and breaks his hip. Who can possibly be held negligent? (Select all that apply.) a. Client's wife b. Nurse manager c. Pharmacist d. Staff RN

ANS: B, D It is possible that the nurse and nurse manager could be held negligent. The nurse could be held negligent for not moving the patient closer to the nurse's station, calling the physician or nurse practitioner for medications or change in medications, or obtaining an order for a vest restraint. The nurse manager may be held negligent because of 24-hour accountability for the care of patients on his or her unit and possible lack of supervision.

Transformational leadership focuses on engaging staff to become stakeholders in a shared mission and vision. Which of the following are correct statements? (Select all that apply.) a. Transformational leaders have an authoritarian style of communication. b. Effective transformational nurse leaders engage their staff through role modeling and mentorship of inclusion behaviors. Communicating is a process competency. c. Transformational leaders have a rigid bureaucratic one-way communication network. d. The communication of transformational leaders is focused on positive interchanges. e. Effective transformational leaders listen more than they talk, are open to all new ideas, and create a culture of safety.

ANS: B, D, E Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism. Transformational leaders also know how to share vision and mission and how to motivate the workforce. This is accomplished by communicating the vision with passion and commitment that is contagious. Transformational leaders need to listen more than they talk, be open to all new ideas, and create a culture of safety, transparency, and empathy (Sears, 2010).

The nurse manager of a medical-surgical unit realized that there are differences in dealing with the varied generations of her nursing staff. How does the nurse manager communicate effectively with the Generation Y staff members (those born after 1980)? a. Typewritten memos b. Staff meetings held monthly for 2 hours c. E-mails or text messages d. Face-to-face interactions

ANS: C A work environment supportive to each generation is an important retention strategy. Tailoring the work environment to meet generational and life needs is a recurrent theme in being able to address staff retention.

One mechanism that ensures autonomy in the nursing profession is the: a. American Nurses Association B. Department of Health Professionals. c. Nursing Code of Ethics. d. Professional Regulatory Board.

ANS: C American Nurses Association's (ANA) Nursing's Social Policy Statement: The Essence of the Profession (2010, p. 25) indicates "competence is foundational to autonomy," with the profession ensuring nursing competence through professional regulation of nursing practice via standards and ethical codes of practice, legal regulation of nursing practice via state licensure requirements and law pertaining to criminal and civil wrongdoing, and self-regulation in which all nurses retain personal accountability for their own practice (Cooper, 2014)

"To do good for others" is an example of which ethical principle? a. Nonmaleficence b. Fidelity c. Beneficence d. Confidentiality

ANS: C Beneficence means doing good for clients and providing benefit balanced against risk.

A nurse is caring for an elderly patient who was admitted after sustaining a fall at home. When creating a care plan for the patient, she requests that the doctor order a home health visit to assess for home safety and medication compliance. In addition, the nurse is concerned about the nutrition of the patient and requests a dietitian evaluation. The nurse is demonstrating which of the following leadership skills? a. Care provider b. Business principles c. Care coordination d. Change management

ANS: C Care coordination is the delivery of nursing services that involves the organization and coordination of complex activities. The nurse uses managerial and leadership skills to facilitate delivery of quality care.

The nurse manager on a medical-surgical unit wants to change to "walking rounds" in the patients' rooms for change of shift report. In the past, it has been "face to face" at the nurses' station. The nurse manager is meeting resistance from the staff, because they think that it will take longer, and the nurses will not finish their shift on time. What could the manager do to increase the nurses' acceptance of this change? a. Inform all shifts that there have been some lapses in communication regarding patient needs and that involving the patient in the report will help alleviate this. b. Inform all nurses that to reach Magnet status, this type of change of shift report is required. c. Ask the nurses to participate in the planning and implementation of the change. d. Ask the nurses to try this type of change of shift report for 1 week and then have them evaluate it.

ANS: C Change is always difficult, especially when it has been forced on people, threatens their security, or seems unnecessary. Change is more palatable when nurses participate in the planning and implementation and see that it is worthwhile.

The nursing manager wants to change the culture of the nursing unit. Some of the older nurses are bullying the newer nurses, which seems to be affecting self-confidence in their new nursing roles. Which of the following strategies would be helpful in this endeavor? a. Assign mentors to the new nurses. b. Determine the roles of each nurse. c. Interview each nurse about his or her perspective. d. Suspend the bullying nurses for harassment.

ANS: C Changing the culture requires the following to be done: (1) identify the desired change; (2) assess the current status of the group; (3) create a shared need and group commitment to change; (4) use appropriate communication skills and personal contact to establish open discussion; (5) identify shared values and mission so that the group knows where it is going; (6) determine strategies; and (7) develop an action plan for change. Interviewing each nurse would provide an opportunity for personal contact and attempt to establish open discussion.

Culture is best defined as (the): a. deviation from the majority. b. differences in likes and dislikes. c. shared beliefs and values. d. similar views and opinions.

ANS: C Culture is described as shared beliefs and values. It provides a common belief system among its members but is not expected to hold similar views and opinions of its members.

What is the purpose of culture in an organization? a. To provide a perception of what it feels like to work in the organization b. To provide an organization's response to economic, social, and financial challenges c. To provide a common bond so that members know how to relate to one another and show others outside the organization what is valued d. To provide a small geographic area within the organization where nurses provide care

ANS: C Culture is the set of values, beliefs, and assumptions that are shared by members of an organization. The purpose of culture is to provide a common bond so that members know how to relate to one another and to show others outside the organization what is valued.

On admission, the patient was found to have a blood glucose level of 218. The RN knows that except in emergency situations, it is hospital policy to obtain physician's orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. Being aware of the hospital policy for medication administration, the patient's blood glucose level presented the nurse with a(n): a. assessment option. b. clinical choice. c. ethical dilemma. d. moral decision.

ANS: C Ethical dilemmas require that decisions be made about what is right and wrong in situations in which an individual has to make a choice between equally unfavorable alternatives.

The most common source of legal liability for nurse managers is a(n): a. medical malpractice suit. b. organizational nursing issue. c. tort. d. vicarious liability.

ANS: C In nursing, harm related to clinical practice commonly arises from negligent acts or omissions (unintentional torts) and a variety of intentional acts (intentional torts), such as invasion of privacy or assault and battery.

Which communication technique is most effective when handling patient complaints? a. Persuasion b. Bargaining c. Negotiation d. Non-verbal cues

ANS: C Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue.

Unspoken affective or expressive behaviors best describe which type of communication? a. Effective communication b. Ineffective communication c. Non-verbal communication d. Verbal communication

ANS: C Non-verbal communication is unspoken. It is composed of affective or expressive behaviors.

A new RN is observed breaking sterile technique by the perioperative nurse. This is an example of a violation of which ethical principle? a. Autonomy b. Justice c. Nonmaleficence d. Confidentiality

ANS: C Nonmaleficence means doing no harm to clients. A break in sterile technique could cause significant harm to a patient by causing an infection.

A nurse manager is evaluating the efficiency of a process on the nursing unit. The manager believes that the unit could be more efficient if one aspect of this process were delegated to unlicensed personnel. To establish whether the delegation of this duty would be legal, he should check with the: a. ANA. b. current federal defense attorney. c. state nurse practice act. d. policy and procedure manual of the unit

ANS: C Nurse practice acts exist for each state and govern the legal practice of nursing, including standard of care, delegation, and supervision.

A human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading is known as: a. advisement. b. consultation. c. persuasion. d. suggestion.

ANS: C Persuasion is a human communication activity designed to influence another to change attitudes or alter behaviors by the use of techniques such as argument, reasoning, or pleading.

The chief nursing officer (CNO) of a hospital system works with senior leadership for approval to initiate an electronic health system. He recruits a nursing informaticist and a chief medical informatics officer to begin the process of planning the education and rollout of the new electronic system. The CNO could be viewed as the: a. resister. b. innovator. c. change agent. d. strategist.

ANS: C The change agent is a person or thing that produces a particular effect or change. The change agent can be a person who functions as a change facilitator.

Patient surveys reveal that patients do not know which caregiver is the registered nurse (RN). A task force consisting of nursing staff is formed to develop a plan to address this issue. Many ideas are discussed to reinforce the role of the professional nurse and to make it easy for patients to recognize the RN, such as changing the dress code. Decisions resulting from this task force will mostly reflect the: a. goals. b. mission. c. climate d. values.

ANS: C The climate of the unit is evident in policies, unit norms, dress code and appearance, environment, communication, and teamwork.

The development of new practices in response to new evidence is called: a. altered direction. b. organizational flux. c. planned change. d. status revision.

ANS: C The development of new practices in response to new evidence or best practices occurs regularly and falls under planned change. One example is the broad adoption of evidence-based protocols and practices as a way of making sure that desirable outcomes are achieved.

A small geographic area within a larger hospital system, where nurses work interdependently to care for a group of patients, is known as the: a. nurses' station. b. subculture. c. nursing work group. d. community.

ANS: C The nursing unit, or nursing work group, is a small geographic area within a larger hospital system, where nurses work interdependently to care for a group of patients.

A nurse is interviewing for a position at a prominent hospital in her community. She notes a separate physicians' dining room, but all other professionals and visitors eat in the same dining area. The physicians have a separate parking area. Nurse practitioners and physician assistants are asked to park in the staff lot. What might these observations suggest? a. The mission statement supports collaborative care. b. The philosophy of the organization depicts inequality. c. The values and actions may not be congruent. d. The vision for nursing is defined clearly.

ANS: C The values drive the way that resources are distributed. In this case, the values of nursing and actions of the organization may not be congruent.

The personal leadership skill for nurses that consists of self-awareness, discipline, motivation, social awareness, and relationship management is known as what? a. Leadership. b. Management. c. Emotional intelligence d. Vision

ANS: C Among the important personal leadership skills for nurses is emotional intelligence (EI). EI traits are emotional factors consisting of five defining attributes: self-awareness, self-regulation or discipline, motivation, social awareness, and relationship management.

The role of the _____ is to provide leadership and direction for all aspects of nursing services with a focus on integrating the system and building a culture. a. nurse manager b. care provider c. nurse executive d. senior leader

ANS: C The nurse executive's role and functions concentrate on long-term administration of an institution or program that delivers nursing services, focusing on integrating the system and building a culture.

Why is it important for nursing staff to have insight into the culture of their unit? (Select all that apply.) a. So they can understand religious practices b. To allow time for peers to access the Internet more often c. To enable nurses to understand staff behaviors d. To improve staff communication e. To allow nursing staff insight into expectations and norms

ANS: C, D, E Nurses' insight into culture enables them to better understand staff behaviors and relationships, norms, change processes, expectations, and communication.

A communication system developed originally to address communication patterns in critical situations is: a. VERA framework. b. NVC model. c. crucial conversations. d. TeamSTEPPS.

ANS: D Communication effectiveness becomes crucial in times of emergency or disaster. TeamSTEPPS was initially developed to address communication issues between nurses and providers during critical patient events.

Over lunch in the cafeteria, student nurses are sharing educational information about the patients for whom they are caring. This is a(n): a. breach of beneficence. b. example of maleficence. c. potential assault and battery charge. d. violation of the Health Insurance Portability and Accountability Act (HIPAA).

ANS: D HIPAA provisions have heightened awareness about and encouraged strategies to protect a patient's privacy in health care transactions. This is an example of breach of confidentiality.

On admission, the patient was found to have a blood glucose level of 218. The RN knows that except in emergency situations, it is hospital policy to obtain physician's orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. Because of the nurse's actions, the admitting hospital may be found to be: a. a judicial risk. b. an ostensible authority. c. indemnified. d. vicariously liable.

ANS: D If a nurse negligently injured a client during the course of and within the scope of employment, not only would the nurse be directly liable for damages, but also the health care organization would be vicariously liable.

A process used to achieve and internalize knowledge, skills, and behaviors of professional nursing in order to belong and participate is referred to as professional: a. actions. b. conduct. c. ownership. d. insight.

ANS: D Insight can be described as a process used to achieve knowledge, skills, and behaviors of a certain group to belong and participate. Nurses' insight enables them to better understand behaviors, relationships, norms change processes, expectations, and communication.

Interpersonal communication is defined as: a. the conscious intent by one individual to modify the thoughts or behaviors of others. b. a combination of written and spoken communication. c. a theory used to describe a manner of communicating. d. communication between two or more individuals involving face-to-face interaction.

ANS: D Interpersonal communication is defined as communication between two or more individuals involving face-to-face interaction while all parties are aware of the others on an ongoing basis

Nurse managers are able to respond better to ethical dilemmas when they have access to the organization's: a. mission and vision. b. patient safety plan. c. medical staff bylaws. d. ethics committee

ANS: D It is critical that nurses and administrators have access to and inclusion on the health care organization's ethics committee. Nursing professionals are ideal members because of their responsibilities and experiences associated with patient care.

The nurse on a medical unit is caring for a 19-year-old with complications from a congenital heart defect. The client's mother is consistently at the bedside asking questions and attempting to direct the treatment plan. Which of the following shows how the nurse should communicate with the mother? a. Discuss personal information that the client shared with the nurse in confidence. b. Provide the mother with any information required for continuity of care. c. Explain that client confidentiality prevents the nurse from disclosing information. d. Ask the client if he gives permission for the nurse to share information with the mother.

ANS: D It is the nurse's legal and ethical duty to protect the adult "child's" autonomy and not simply accept a parent's intervention, without lawful authority, just because it may seem easier at the moment. The nurse must obtain permission from the client before sharing information with the mother.

Which ethical principle is violated when there are insufficient community resources to meet the needs of low-income families? a. Nonmaleficence b. Autonomy c. Beneficence d. Justice

ANS: D Justice is the norm of being fair and giving all equal treatment. When low-income families do not get the same community resources as others, justice is not being served.

Individual members of a group will adapt to change at different rates. Which of the following groups would take the longest to accept change? a. Early adopters b. Late majority c. Innovators d. Laggards

ANS: D Nurse leaders need to recognize that change will be accepted at varying rates and target interventions accordingly. The five categories in order are innovators, early adopters, early majority, late majority, and laggards.

A memo sent to the unit nurse manager reads that beginning next week; all nursing staff will be expected to conform to a new dress code selected by the hospital board of directors. The nurse manager understands that change will be more effective through which manner of communication? a. Storytelling b. E-mail c. Discussion d. Open communication

ANS: D Open communication within the change process, early involvement of staff, listening to their input and concerns, and engaging them in the change may be the most effective means to assess readiness for change.

A medical-surgical unit utilizes a group of nurses and patient care assistants to determine ways to reduce the number of falls in the unit. They conduct Internet research to locate best practice interventions. They create fall risk alerts in the unit, and they implement hourly rounding to assess the need for toileting. After putting these small changes into place, they will evaluate the data to determine effectiveness. This project is an example of: a. rapid response teams. b. Failure Modes and Effects Analysis. c. root cause analysis. d. Rapid Cycle Change.

ANS: D Rapid Cycle Change is used in health care to improve patient safety and quality. It is based on the idea that changes are tried on a small scale to see how they work.

An organization has encountered a serious patient safety event that was reported to the state, The Joint Commission, and the Centers for Medicare & Medicaid Services (CMS). An extensive plan of correction was received, and the organization had to make some immediate changes in practice. Additionally the organization anticipates a costly lawsuit. What is the best method of educating staff about the practice changes that were issued? a. "These changes need to be made because the state and CMS require it." b. "We understand this is a knee-jerk reaction, but please change the practice while the surveyors are in the building." c. "We need to make this change because it will help our lawsuit." d. "This change is being made so that there is no further harm to another patient."

ANS: D Rapid Cycle Changes or those that are emergent are put into place to improve patient care, with the emphasis on patient safety and quality goals. Staff should not be educated that the changes are made based upon regulatory requirements or the avoidance of litigation. Misconceptions or inaccurate information can create resistance to change.

How is the refreezing stage of change similar to the nursing process? a. Refreezing is similar to the assessment phase of the nursing process. b. Refreezing is similar to the problem identification phase of the nursing process. c. Refreezing is like the planning and implementation phase of the nursing process. d. Refreezing is like evaluation in the nursing process.

ANS: D Refreezing is like evaluation in the nursing process.

Which of the following factors is used to describe the degree to which successful planned change is thought to be better than the status quo? a. Complexity b. Compatibility c. Trialability d. Relative advantage

ANS: D Relative advantage is one of the factors that helps determine successful planned change. It is the degree to which the change is thought to be better than the status quo.

Which of the following exemplifies a safety climate within a nursing unit? a. Asking nursing staff to work a double shift b. Encouraging nurses to take the blame when a medication error occurs c. Asking staff to report medication errors only d. Asking staff to report near-misses of adverse events

ANS: D Safety climate refers to keeping both patients and nurses safe. Part of a safety culture encourages nurses to report adverse events as well as near-misses of adverse events. Factors that influence avoidance of errors include staffing levels, excess fatigue, education, and experience.

The nursing manager has assumed responsibility for ensuring that tasks within her department are delegated legally and are performed appropriately. In so doing, she has accepted which of the following nursing roles? a. Ethical b. Ombudsman c. Paralegal d. Supervisor

ANS: D Supervision includes monitoring the tasks performed, ensuring that functions are performed in an appropriate fashion, and ensuring that assigned tasks and functions do not exceed competency or require a license to perform.

How is culture measured within an organization? a. Through the use of time-motion studies b. Through the use of quantitative instruments c. Through the use of qualitative instruments d. With a combination of qualitative and quantitative measures

ANS: D The choice of a measurement instrument would be directed by definition, purpose, and context for the cultural assessment. It is likely that a combination of qualitative and quantitative measures would be the best means of capturing the culture of an organization.

A nurse manager recognizes that her staff's emotional responses to organizational change are similar to: a. adaptation techniques. b. integrative tactics. c. symptoms of mental illness. d. the grief model.

ANS: D The grief model is the most accurate, because change produces a longing for what is familiar, even if it is not what is best or realistic.

What is the purpose of a mission statement? a. To provide a method of achieving success and a competitive advantage b. To aid recruitment c. To guide members on problem solving and relationship management d. To offer a snapshot of strategic priorities

ANS: D The mission statement for an organization offers a snapshot of strategic priorities and is an important way to get a sense of organizational values. A deeper understanding of cultural issues in an organization helps people understand how to improve outcomes.

Determining the origin of errors with a focus on prevention is known as which of the following? a. A civil investigation b. A voluntary reporting program c. An administrative review d. A root cause analysis

ANS: D To change the culture from "who dunnit?" to an environment that is respectful and open to learning, it is necessary for the climate to change. It is essential to be able to discuss mistakes freely, with the intention of learning from them by doing a root cause analysis.

Interpersonal communication and the ability to apply _____ are two critical skills every nurse needs to enhance professional practice. a. vision b. supervision c. delegation d. problem solving

ANS: D Every nurse needs two critical skills to enhance professional practice. One is a skill at interpersonal relationships. This is fundamental to leadership and the work of nursing. The second skill is applying the problem-solving process. This involves critical thinking, problem identification, and the development of objectivity.

Nursing management is defined as: a. delegation of authority and responsibility and the coordination of tasks. b. the integration of resources through planning, organizing, and directing. c. the process of influencing patients to accomplish goals. d. the coordination and integration of nursing resources by applying the management N R I G B.C M USNT O process to accomplish nursing care and service goals and objectives.

ANS: D The coordination and integration of nursing resources by applying the management process to accomplish nursing care and service goals and objectives is the definition of nursing management.

_____ are vital to good leaders because they are able to take the vision of the leader and achieve the determined goals. a. Managers b. Motivators c. Visionaries d. Followers

ANS: D Without followers, there is no leadership. Followers are vital because they accept or reject the leader and determine the leader's personal power.

A medical-surgical unit reports higher rates of patient satisfaction coupled with high rates of staff satisfaction and productivity. Which of the following is attributed to the data findings? a. Effective leadership b. Management involvement c. Mentoring d. Rewards and recognition

a. Effective leadership

A staff registered nurse (RN) is leading a multidisciplinary clinical pathway team in the development of care for patients with total knee replacement. Which of the following statements exemplifies leadership behaviors in a clinical pathway team meeting? a. "Nursing is responsible for pain control of the total knee replacement patient." b. "Our pharmacist has provided some excellent pain control literature." c. "Physical therapy's expertise is in rehabilitation, not pain control." d. "Total knee replacement patients require optimal pain control."

a. Effective leadership

A staff registered nurse (RN) is leading a multidisciplinary clinical pathway team in the development of care for patients with total knee replacement. Which of the following statements exemplifies leadership behaviors in a clinical pathway team meeting? a. "Nursing is responsible for pain control of the total knee replacement patient." b. "Our pharmacist has provided some excellent pain control literature." c. "Physical therapy's expertise is in rehabilitation, not pain control." d. "Total knee replacement patients require optimal pain control"

b. "Our pharmacist has provided some excellent pain control literature."

Leadership is best defined as: a. an interpersonal process of participating by encouraging fellowship. b. delegation of authority and responsibility and the coordination of activities. c. inspiring people to accomplish goals through support and confidence building. d. the integration of resources through planning, organizing, and directing.

c. inspiring people to accomplish goals through support and confidence building.