LEADERSHIP/ MANAGEMENT practice EAQ

The nurse as a leader is teaching about the Organizational Behavior Modification (OB Mod) theory of leadership to a group of student nurses. Which statement made by the student nurse indicates effective learning?

"I should use punishment sparingly."

A client with asthma and depression is admitted to the hospital. Which tasks delegated by the delegator would indicate the task is applicable for the registered nurse?

"Teach the client how to use a meter dose inhaler."

UAP give bath and change bed linen on Kaposi sarcoma (associated with HIV)

-tell UAP to wear gloves and gown when handling linen

Postop RR decrease from 14 to 6 after opioid. 30 minutes later decreases to 4. Narcan given

-why wait so long to call HCP

Telephone triage at clinic office. Which client is most acute and should be scheduled for the first available appointment.

21 y/o with kidney transplant, fever of 102, flu-like symptoms

RN assigned to care for four surgical clients. Which client should nurse see first.

3 postop, 1 preop

The nurse leader working in a 50-bed surgical unit accrued 765 client days in November and 189 of the clients were discharged during the month. What is the average length of stay for November? Record your answer using a whole number. _____ days

4 The formula for average length of stay is number of client days divided by the number of discharges. 765/189 = 4 days.

.Charge nurse takes over for nurse on break, which client checked first

40 ml dark colored urine

Emergency room, who to take care first

A female client with severe right lower abdominal pain who is febrile and vomiting.

Which factors should be assessed to determine the level of followers' readiness according to Hersey's model? Select all that apply.

According to Hersey's model, the delegator should check the ability and willingness of the delegatee before delegating any task. Information about family history may not be required for delegating a task. According to Hersey's model, work experience and educational qualifications are not considered as factors required to determine followers' readiness.

In which environments is the functional model of care most likely to be utilized? Select all that apply.

Ambulatory clinics Extended care facilities

Patient uses the call system alarm

Ask a coworker to respond to the client whose call bell is alarming.

Which emergency care actions are priority for a hospitalized client who develops an anaphylactic reaction after receiving a medication? Select all that apply.

Assess the respiratory status. Call the Rapid Response Team. Discontinue the intravenous drug.

Situational-contingency theory

Assessing each situation and determining the action based on the people involved indicates the application of situational-contingency theories of leadership. The leader should present a task structure that has clarity of goals The leader should develop trust and respect between leaders and followers The leader should reward followers for their excellent work.

Morning lab, follow-up first

BNP assay, MI with SOB 1000

According to the Model for Differentiated Nursing Practice, which entry-level nurse is most prepared for prioritization of client care?

Bachelor's degree registered nurse

What points should the nurse consider when delegating a task? Select all that apply.

Before selecting a delegatee for any particular task, it is important to understand the skill set and capabilities of the delegatee because selection of delegatees is based on specific skill sets. Selecting a delegatee based on his or her competency is an important aspect of delegation. Being certain about the capabilities is a crucial element of delegation. Willingness is not a crucial element for selecting a delegatee. In a rural setting the generally longer tenures of employees may make the delegation process easier.

Which is a potentially life-threating condition found during the primary triage survey that would necessitate priority nursing care?

Concussion

Signed witnessed DNR

Confirm current resuscitation wishes with client and family

The registered nurse is delegating tasks for nursing assistants caring for a client who requires more attention. Which element should be considered when selecting the suitable nursing assistant for delegation of a task?

Critical thinking is of utmost importance for selecting a suitable nursing assistant for delegation of a task in a situation where a client requires more attention, as the delegatee should be able to perform the task effectively. Time, safety, and stability are also the elements for effective delegation, but these are suitable depending on the situation for assigning a task and delegation.

Intervention best to delegate to LPN

Duragesic

The client who has a history of allergy to bee stings is brought to the emergency department following a bee sting. What are the interventions to be followed in correct order?

EPI, REMOVE STINGER, BENADRIL, SALINE

The nursing leader is giving a demo on using computerized provider order entry (CPOE) to a newly hired nurse for automatic dose calculation. The nurse leader observed that the staff nurse was not concentrating on the instructions and seemed distressed. After completing the demo, the nurse leader asked the staff nurse to operate the CPOE, but the nurse misused the system. Which communication barrier does the nurse leader suspect to be the reason?

Emotions and personality

The nurse manager asks the staff nurse to participate in creating new guidelines for providing services to the client. Which management strategy is utilized by the nurse manager?

Empowerment of staff

What is the application of Roger's diffusion theory?

Engages key leaders in a change to infuse the energy from early adopters

Glucometer checks post 2 days consistently 50-60 mg/dl higher

Evaluate calibration of glucometer in use per manufacturer guidelines.

Which activity indicates improper follow-through on the part of the delegatee?

Failure to report results

The nurse manager is implementing a change in evening care for clients to include back rubs to promote sleep. The nurse manager convinces the managers of various nursing units and also supports nursing staff who are willing to implement the change. Which component of Kotter's eight step model is involved in this scenario?

Forming a powerful coalition

What are the desirable actions of the nurse as a transformational leader? Select all that apply.

Fostering a shared vision Providing coaching and mentoring

Which healthcare settings are appropriate for delegating care according to the functional model of nursing? Select all that apply.

In the functional method, each healthcare provider knows the expectation of his or her assigned role and completes tasks quickly and effectively. This model works well in emergency situations and ambulatory clinics. Hospice settings are not suitable for this type of care, because in hospice care the client requires chronic and continuous care. Inpatient care settings are not suitable for the use of the functional model of care delivery because these settings need acute care and continuous care by careful monitoring. Acute care agencies are not suitable for the functional model because acute and more specific individualized care is required.

Which organization advocates nurses taking a prominent role in the healthcare arena?

Institute of Medicine

Which actions make the nurse a transformational leader?

Introducing a vision for the future nurses

Which healthcare team member would the nurse expect can be delegated with the task of administering oral medication to a client per the functional model?

LPN

Which healthcare team members began to increase in number during World War II and are delegated for providing care to clients at home? Select all that apply.

LPN LVN UNP

hospice nurse end of life care

MUCOUS MEMBRANE MOIST

Which actions should a nurse leader avoid in order to implement changes effectively?

Maintaining a boss-employee relationship with the staff

What should the nurse educator emphasize when teaching about mass casualty incidents (MCIs)? Select all that apply

Mass casualty incidents (MCIs) involve large numbers of victims. An MCI is a man-made or natural event or disaster that causes permanent changes within a community. It overwhelms a community's ability to respond with existing resources. MCIs always require significant assistance from resources outside the affected community.

Which actions in the delegation process represent accountability? Select all that apply.

Monitoring client care and seeking the outcome report represents accountability of the task in case of conflicts. Assessing the ability of the delegatee and educating about the task indicates responsibility. Providing open and honest feedback to the delegatee improves work performance and client care outcomes. The nurse can assist other registered nurses with delegation decisions regarding safety issues, urgency to intervene, or potential negative client outcomes.

Hierarchy of Needs Theory

Motivating staff by providing hierarchy of human needs indicates the application of hierarchy of needs theory of leadership.

Most immediate, intervention by nurse

Pneumothorax with 80 SpO2%

Which team member is responsible for 24-hour client care when using an adapted case method?

Primary nurse

The nurse is caring for a client with trauma in the emergency unit. Which action should the nurse perform as the highest priority?

Providing adequate oxygen supply.

What factors are most important for the nurse to consider when delegating responsibilities?

Staff member's level of education and expertise

While preforming nasotracheal suctioning, the nurse notices that the client has blood pressure of 90/70 and a heart rate of 50 beats per minute. What is the priority nursing intervention in this situation?

Stopping the suctioning procedure immediately

The nurse is triaging a group of clients injured in a tornado using the three-tier system. Which conditions are triaged as life-threatening conditions? Select all that apply.

Stroke, active hemorrhage, chest pain with diaphoresis, and respiratory distress are life-threatening conditions and should be triaged as emergent. Clients with skin rash are categorized as nonurgent as care can be delayed without fear of deterioration. Displaced or multiple fractures are triaged as urgent, meaning they require quick treatment but are not life threatening.

The registered nurse (RN) is the team leader for a group of clients using the functional model of nursing. The team of nurses includes two licensed practical nurses (LPNs) and an unlicensed assistive personnel (UAP). Which task will the RN delegate to the UAP?

Taking vital signs

The nurse is caring for four clients in the emergency department. In what order should the nurse prioritize client care?

The client with severe respiratory distress should be treated immediately as the condition of the client is critical and may be life-threatening. The client with chest pain due to ischemia may be treated within 10 minutes after treatment of the client with respiratory distress. One of the most common reason for someone with a gynecologic disorder to come to the ER is for bleeding. This would take precedence over cystitis. Also the client with a gynecological disorder may require multiple diagnostic studies to determine the condition, and this can be delayed up to 1 hour. The client with cystitis may only require a simple diagnostic procedure to determine the condition and begin treatment.

Respiratory rate decreases 14/ min -> 6/ min -> 4/min

The decision regarding when to call the health care provider

In what order should the tasks be performed by the nurse leader when implementing evidence-based practice?

The first step of evidence-based practice is to search and collect for the most relevant best evidence. Then appraise the evidence that is rapid critical appraisal, evaluation, and synthesis. After appraising, integrate the best evidence with one`s clinical expertise and client preferences and values in making a practice decision. Then evaluate the outcomes of the practice design. The last step is to disseminate the outcomes of the evidence-based practice or change.

A client is hospitalized with dehydration. Which tasks are appropriate to delegate to a licensed practical nurse? Select all that apply.

The licensed practical nurse records the vital signs, administers fluids orally, and performs oral-rehydration therapy and may be under the supervision of the registered nurse. Feeding the hospitalized client and helping the client to change clothes are performed by the unlicensed nursing personnel.

Which strategy of the nurse leader regarding the quality improvement (QI) process requires revising?

The quality improvement process mainly focuses on *preventing errors* rather than correcting them. The task of the QI process includes staff development. The team of the QI process involves the interprofessional team and the outcomes are set with the input of clients and the staff.

The nurse leader is giving a speech on leadership skills to followers. Which questions enable the nurse leader to evaluate the understanding level of the followers? Select all that apply.

The question such as "what did you 'hear' in the process of this communication?" cannot be answered by a "yes" or "no" and requires a detailed explanation of the things that are taught. The questions starting with "how" are usually open-ended and require the person to answer in detail. Therefore these questions can help the nurse leader evaluate the understanding level of the followers. The questions such as "are you getting my points?", "would you all like a break?", and "can I change the topic in a little while?" can be answered by a "yes" and "no." Therefore these questions do not help the nurse leader to evaluate the understanding level of the followers.

Which description by the nurse is a correct explanation of delegation?

The transfer of responsibility for the performance of an activity

What motivation factors would the nurse describe as forming a part of two-factor theory of leadership? Select all that apply.

The two-factor theory is comprised of motivation factors and hygiene factors. The motivation factor promotes job enrichment by creating job satisfaction. It includes recognition and achievement. The hygiene factor includes salary, status, and security, which help avoid job dissatisfaction and motivate workers by meeting their safety and security needs.

The registered nurse is delegating a task for unlicensed assistive personnel l (UAP). Which client's care would be suitable for delegation to the UAP?

The unlicensed assistive personnel (UAP) can monitor the temperature of client B every hour. Discharges from the surgical site of client A should be monitored, but the UAP may not have appropriate knowledge. Abdominal pain should be monitored in client C, but the UAP is not qualified to understand the condition of the client. Respiratory rate cannot be monitored by the UAP as it is the responsibility of the more qualified UNP.

What should the mental health nurse keep in mind when preparing to meet with a group of staff nurses who cared for victims of a disaster that occurred in the community? Select all that apply.

The usual arrangement for the most effective group interaction is a circular configuration of chairs. Staff involved in the incident need protected time to undergo stress debriefing, which generally lasts from 1 to 3 hours per session. Food should be available so that hunger is not a distraction. Typical "ground rules" for stress debriefing include strict confidentiality of information shared during the session and unconditional acceptance of the thoughts and feelings expressed by people within the group. This means that the session should not be audiotaped. The setting should be private. An auditorium would not be private.

Which point should the nurse exclude when developing strategies to project a powerful image?

Using authoritative language

Two-factor theory

Using motivator factors liberally to inspire work performance indicates the application of two-factor theory.

When should a nurse cut away all the client's clothing? Select all that apply.

When fabric may get fused to the client's skin due to burns When rapid access to the client's body is critical for resuscitation

Which right is applicable when the delegator and delegatee understand a common work-related language?

When the delegator and delegatee understand a common work-related language, then right communication is applicable. Right person is applicable when the delegatee has appropriate knowledge and experience to perform a task. Right supervision is applicable when the delegator is able to monitor and evaluate the client appropriately. Right circumstance is applicable when the delegation process is applicable for the situation.

Who functions as a liaison between team leaders and other healthcare providers?

charge nurse

Which employee should be competent in critical thinking, leadership, communication, and time management skills? Select all that apply.

charge nurse RN

The senior manager reviews the performance of the transformational leader on the basis of the feedback given by the nurse leader's team. Which statements describe the attributes of a transformational leader? Select all that apply.

charismatic, motivational, individualized consideration

Who is the designated delegator?

nurse manager

Which client should be treated first, according to the disaster triage tagging system?

red tag

The nurse as a leader is teaching a group of student nurses about the five domains of a professional nurse's portfolio necessary for leadership. Which statement of the student nurse indicates a need for correction?

sympathetic

The registered nurse is teaching a group of nursing students about leadership principles. Which statement made by a nursing student indicates the need for further teaching?

"A leader has a formal position." Leader does not necessarily have a formal position to indicate that he or she is a leader; rather, leadership refers to the performance. Leaders are those medical professionals who can intervene with courage when needed. Leaders are also able to organize a group of colleagues to solve an organizational problem. A nursing medical professional becomes a leader after promotion.

During a peer review, the manager finds that a newly appointed nurse leader encourages "bottom up" interaction among the workers. To which statement of the staff does the manager relate this?

"He/she involves us in shaping policies for client care." "Bottom-up" interaction values every nurse as a human resource with rich perspective. Therefore involving peers in shaping policies is an example of a "bottom-up" interaction. Willingness to accept responsibility is a generally desired attribute. Empathy to others' experiences shows emotional intelligence. A leader who unleashes constructive energy demonstrates the concept of focus on emergence.

A registered nurse as a leader is teaching novice leadership skills to a newly appointed leader. Which statements made by the new leader indicate effective learning? Select all that apply.

"I should resolve conflict." "I should deal with difficult people." "I should learn how to work in groups. Novice leadership skills include resolving conflict, dealing with difficult people, and learning how to work in groups. These skills contribute to future leadership success and can create skills that lead to some expertise. Ensuring that operations run smoothly is a skill of a manager. A manager will ensure that well-developed formulas are applied to situations.

The nurse leader is teaching nursing executives regarding the primary nursing model of practice implemented in healthcare systems. Which statement made by the nurse executive indicates effective learning?

"I will incorporate total client care from the client's admission to discharge."

Which statement made by the nurse leader would satisfy the basic expectations of the client?

"I will return at 5 o'clock pm."

A registered nurse is teaching a nursing student about disaster management during an accidental fire in an industry. Which statement by the student indicates the need for further teaching?

"I will risk my life to move clients to a safe location if needed." The nurse should never risk injury to self or staff members while moving clients or attempting to extinguish a fire. The nurse can ask the help of ambulatory clients to rescue and move other clients who are at risk. Clients who sustain mild injuries can be asked to walk so that stretchers can be used for people in greater need. If a client has breathing difficulty, respiration should be manually maintained until the client iis rescued from the fire.

Which questions should the delegator assess to determine the right task? Select all that apply.

"Is the task legally appropriate to delegate?" "Is the task appropriate to delegate based on institutional policies and procedures?"

The nurse leader conducts an education session for the nursing staff regarding case management. Which statement made by the nursing staff indicates they do not understand the role of case management?

"It represents that primary health prevention is managed by a single case manager."

Which task can be safely delegated by a registered nurse (RN) to unlicensed nursing personnel (UNP) for a client with thrombocytopenia?

"Positioning the client" Clients with thrombocytopenia are at risk of bleeding with slight bruising. Therefore tasks that do not risk bruising the client may be delegated to the UNP. The RN should shave the client and maintain oral hygiene. Intravenous infusions should not be administered by a UNP to any client.

The leader is teaching a nursing student about systems theory. Which statement by the student nurse indicates the need for further teaching? Select all that apply.

"Systems theory accounts for unpredictability." "Systems theory focuses on the effect of random events." Systems theory tends not to account for unpredictability and random events. In contrast, chaos theory focuses on unpredictability and random events. Systems theory involves open as well as closed systems. It is viewed as inputs, throughputs, and outputs. A system theory involves a system that consists of structure, technology, people, and environment.

The registered nurse is teaching a group of student nurses about the role of the nurse as a leader. Which statement by a student nurse indicates effective learning

"The goal of the nurse manager is to develop a shared vision of the future with direct care nurses." The goal of a nurse manager as a leader is to develop a shared vision of the future with direct care nurses. The nurse manager ensures that the day-to-day elements of the workplace are being performed correctly. The nurse executive has a plan for identification of charge nurses and should be aware of information on succession planning. The primary goal of the nurse executive is leadership within the workplace.

A leader observes the direct care nurse making more frequent errors and being anxious. Which advice provided by the leader to the direct care nurse would help to manage the stress?

"Time-management skills are important for stress reduction."

During an interview for a nurse manager position, the panel asks the nurse about the primary role of a leader. Which answer provided by the nurse would be most appropriate?

"To inspire followers" The primary role of a leader is to inspire the followers by actively participating in the task along with the followers. It also involves changing the workplace to increase work satisfaction. The other roles of a leader are to provide training to the followers, to share views about the task with the followers, and to increase the feeling of self-worth in the followers. All these are reflected in the concept of transformational leadership

The nurse manager reviews the performance report of a direct care nurse and asks the nurse to focus on "emotional intelligence" in order to be promoted as the nurse leader. Which statement would the nurse leader most likely use while advising the nurse on areas for improvement?

"Try to be more sensitive to the experiences of others." Emotional intelligence is advising the nurse to be more sensitive to the experiences of others. The process of thinking systematically requires the nurse to balance short-term and long-term objectives. Under the "explaining" process of Gardner's tasks of leading/managing, the information type to be shared is determined. The involvement of the nurse in shaping the policies and practices of client care is an example of shared governance.

Safely assess last drainage

-Jackson-Pratt, no postop drainage after 8 hours

Nurse determines that an IV vesicant chemo infusion is infiltrated

-apply cold compress

Triaging ER client assess first

-elderly -child -female -male

Evening shift on med unit is busy, only nurse on the unit is busy with an unstable patient. HTC is on the phone with the unit secretary for an order for OTC laxative PRN. What is the best response?

-the nurse will call you back as soon as possible to obtain the order

old client to rn (going to give to most experienced nurse)

72 YEAR OLD WITH DM 1

Four nurse leaders are performing Gardner's tasks. Which nurse leader is implementing Gardner's task of "serving as symbol"?

A Gardner's task of "serving as symbol" includes the representation of the nursing profession, values, and beliefs of the organization to clients, their families, and other community groups. Therefore nurse leader A implements Gardner's task of "serving as symbol." Being honest and keeping promises to clients and families in the nursing profession indicates the implementation of Gardner's task of "developing trust" by nurse leader B. Nurse leader C implements Gardner's task of "managing" by assisting clients and their families with planning, priority setting, and decision making. Nurse leader D implements Gardner's task of "managing" by ensuring that the organizational systems work on the client's behalf.

The nurse is caring for a client with a platelet count of 50,000 cells per microliter. Which recommendation is inappropriate for the client?

A client with platelet count of 50,000 cells per microliter has thrombocytopenia. The client should be encouraged to shave with an electric razor, rather than with a straight blade. Walking with sturdy shoes or slippers preserves foot skin tissue and helps to reduce the chances of cuts. Forceful blowing of the nose can result in bleeding. The use of a soft-bristle toothbrush helps to prevent injury to the gums.

While caring for a post-operative client, the delegator has assigned a task to a delegatee. Which statements made by the delegator indicates that the delegatee has the experience to perform the task? Select all that apply.

A delegatee with good experience may need little guidance. He or she knows what to do and when to report. As the delegatee has experience, he or she should just remember that the delegator is available at all times; the delegate can report at any time. The delegator should also make it known that the delegatee's competencies are known. The delegator tells a delegatee who is new to a task what is necessary to perform that task. The delegator will share expectations about the delegatee's performance when that delegatee can do the work and when he or she is new in assisting the registered nurse (RN). When the delegatee can do the work and is new in assisting the RN, the delegator tells the delegatee the appropriate conditions for notifying one another.

The nurse leader is teaching about the role of followers to the nursing staff. Which statement made by the nursing staff is true regarding the followers' traits? Select all that apply.

A follower demonstrates collaborative behavior in daily practice. A follower cooperates with the leader and peers to reach the team goal. A follower demonstrates collaborative and cooperative behavior with staff, to help reach the team goals. Enforcing the policy mandates or contracts and maximizing the results from existing resources are the responsibilities of a manager. Demonstrating a positive feeling at the workplace is the duty of a leader.

Which member of the healthcare team would the nurse claim performs functions through passive delegation?

A pharmacist performs functions through passive delegation. Unit secretaries may not be eligible to perform any activity because they do not have formal preparation and legal recognition. The licensed practical nurse does not delegate, but rather acts as a delegatee. The unlicensed assistive personnel are also delegatees.

Clients are sent to an emergency department for care, and tags are given to the clients based on a priority basis. Which client should be given a red tag?

A red tag is given to indicate the need for immediate treatment due to life-threatening conditions. The client with third degree burns should be given a red tag. A client with burns between 15% and 40% should be tagged red. This condition is critical because untreated burns are prone to fluid and electrolyte problems and life-threatening infections. A client with a closed fracture may not require a red tag as his or her condition is not likely critical or in need of immediate treatment. Closed fractures usually do not cause infection since the fracture may not come in contact with the skin. A client with severe abdominal pain can be given a yellow tag. A client with bruises and superficial lacerations should be given a green tag as the client can wait for some time for suturing the lacerations.

The emergency department (ED) nurse is triaging clients. Which client should be prioritized?

A school-age client with asthma presenting with dyspnea

Which factors are associated with transformational leadership? Select all that apply.

A shared vision Increased self worth of followers Coaching and mentoring by the leader Transformation leadership involves sharing a vision with team members to accomplish goals. This type of leadership promotes self-worth in the followers through positive reinforcement. The leaders practicing the transformational leadership facilitate coaching and mentoring of followers for skill enhancement. Transactional leadership involves arrangements where the followers do the task and get paid for it. The mistakes that happen during the task are corrected in a reactive manner.

What entity outlined the principles of delegation for registered nurses?

ANA

What does the nurse understand is the collaborative definition of delegation according to the American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)?

According to the ANA and the NCSBN, delegation is the process for the nurse to direct another person to perform nursing tasks and activities. The process of guiding, directing, and influencing the outcome of an individual's performance of an activity is defined as supervision. The transfer of accountability and responsibility indicates assignment. According to the NCSBN, delegation is defined as the act of transferring the authority to perform a selected nursing task in a selected situation to a competent individual.

Which component of delegation is retained while the delegator is delegating the client's care task to the nursing aide?

Accountability

A nurse manager is helping staff reach optimal functioning to enhance organizational functions. Which Gardner's task is reflected in this leadership behavior?

Achieving workable unity Achieving workable unity is one of Gardner's tasks for leading and managing. Nurse managers should help staff reach optimal functioning to enhance organizational functions. Nurse managers enact motivation by relating to and inspiring staff to achieve the mission of the organization and the associated vision. Affirming values is involved in assisting the staff in explaining organizational values and strengthening staff members to be more attuned to the organization. Envisioning goals involves creating a vision of how systems support client care objectives and assisting in enhancing the vision of clinical and organization performance.

The nurse executive is seeking to improve client care by helping multidisciplinary leaders achieve optimal functioning. Which behavior related to Gardner's tasks of leading is the executive exhibiting?

Achieving workable unity The leader in an executive position helps multidisciplinary leaders achieve optimal functioning by applying Gardner's task of achieving workable unity. Managing involves helping other executives and corporate leaders with planning, priority setting, and decision making. Affirming values involves helping other organizational leaders in the expression of community and organizational values. Developing trust involves assisting and representing nursing and executive views openly and honestly.

A nurse is helping a client determine and articulate personal values about health problems. The nurse also explains the effect of these problems on lifestyle adjustments. Which Gardner's task of leadership is the nurse leader applying?

Affirming values Values are the connecting thoughts and inner driving forces that give purpose, direction, and precedence to life priorities. According to the Gardner's tasks of leadership, helping the client sort out and articulate personal values that are related to health problems is affirming values. It also involves explaining the effect of these problems on lifestyle adjustments. Explaining includes teaching and interpreting information to promote well-being in the client. Managing involves assisting the client with planning, priority setting, and decision making. This also includes ensuring that organizational systems work on behalf of the client. Motivating includes inspiring clients or family members to achieve their vision.

The nursing student is comparing the causative agents of hyperthermia and hypothermia. Which causative agent is common to both conditions?

Alcohol is the causative agent that is common to both hyperthermia and hypothermia. Barbiturates and phenothiazines can cause hypothermia. Cardiovascular disease can cause hyperthermia.

The nurse observes a dispute between staff members due to differences in perspective concerning nursing practices. Which approaches of the nurse as a leader would be appropriate in building up negotiation "loop-backs" to resolve the conflict? Select all that apply.

Allowing a cooling-off period if the resolution fails Informing of the full consequences of failing to resolve the issues The principal of conflict resolution through building in the "loop-backs" to negotiation includes a cooling-off period after the failure of a resolution. It also includes reviewing the possible consequences to the members for not resolving the issues. For building in consultation before and after the negotiations, an open forum for discussion is provided. The open forum also includes the use of political skills for facilitating communication before confrontation.

Which interventions are in the scope of a licensed practical nurse (LPN)? Select all that apply.

Ambulating the client Assisting the client with bathing Administering intramuscular medications

The most immediate follow-up

An UAP is assigned to check a client for fecal impaction.

The nurse leader and the team received recognition because of a follower on the team. What could be the most important action of the nurse leader?

An effective leader generally is eager to share the rewards, appreciation, and recognition among the team. This increases team spirit and makes the followers follow eagerly. The nurse leader can share the recognition with the family, friends, and other higher professionals, but only after sharing it with the team.

Which aspects are considered when determining the willingness of a nursing assistant before delegating a task? Select all that apply.

An individual's *willingness* is related to *attitude, confidence, and commitment.* Ability is related to knowledge and skills in a specific situation. Personality characteristics can influence the effectiveness of the delegator.

Which priority assessments should be included by the nurse when caring for a client who is experiencing depression? Select all that apply.

Appetite, activity status, emotional status

A nurse manager in a cancer care facility finds that the nursing care team is demotivated due to consecutive deaths of two terminally ill cancer clients. Which action of the nurse manager would help renew the team's energy?

Arranging a notice board in the unit and posting photos or messages reflecting achievements of the team A good leader keeps the team's spirits high by helping them renew their energy levels. The nurse manager may post motivating messages or photos on the notice board to motivate the team members. Counseling the team members may not help in motivating them as there could be further similar incidences in the unit. Shifting the team to another nursing unit with less likelihood of deaths may make the team members emotionally weak. The reason for the team members to be low in energy is unlikely to be their emotional attachment to the clients; keeping them emotionally detached may not help motivate them for client care.

While caring for a client who was injured in a tornado, the nurse finds that the client is disoriented. Which is the most appropriate nursing intervention to prevent injury in the client?

Asking a family member or significant person who cares for the client to remain with the client will help to reduce confusion in the client. It is the most important intervention to prevent injury in the client. Keeping rails up on the stretcher will help to prevent injury in the client but it is not the most appropriate intervention. Keeping the stretcher in the lowest position will prevent injury but it is not the most appropriate intervention in clients. Maintaining adequate lighting in the room will help to prevent injury from a fall but it is not the most appropriate intervention in case of disoriented or confused clients.

Client has reported feeling of being constipated

Assist the client to drink warm prune juice.

Why does the leader ask the direct care nurse, "Do you block cooperative efforts to resolve issues?"

Avoidance in conflict management style means that conflict is postponed. Often people do this when they have far more important issues pressing, when they have to gather more information, or when people need to cool down. Therefore the question asked by the leader to the direct care nurse, "Do you block cooperative efforts to resolve issues?," indicates that the direct care nurse may be using avoidance. Competing means perusing one's own needs and goals at the expense of others. When a direct care nurse uses competing, often the leader may ask "Are you surrounded by people who agree with you all the time and who avoid confronting you?" Negotiating is similar to trading, and if the direct care nurse practices this often, the leader may ask "Do you ignore large, important issues while trying to work out creative, practical compromises? Accommodation in conflict management style means neglecting our own needs, goals, and concerns in favor of satisfying those of others. With regular use of accommodation by a direct care nurse, the leader may ask "Do you think people are using you?"

Which behavior on the part of the nurse helps develop trust among subordinates?

Behaving with consistency

Which actions do effective followers expect from their leader? Select all that apply.

Being respectful towards them Giving a future-focused direction to them Recognizing them in appropriate situations

The nurse leader is promoted to nurse manager and has a plan of implementing an effective client counseling center in the outpatient department. The nurse gathers data from different healthcare providers and compares methods. Which type of quality improvement does the nurse implement?

Benchmarking Benchmarking is a process of conducting a widespread search to identify the best method, which helps to identify desired standards of quality performance. Risk management involves analyzing problems and minimizing losses after an occurrence of an adverse event. Quality management refers to a philosophy that defines a healthcare culture emphasizing customer satisfaction, innovation, and employee involvement. Performance improvement involves individual performance appraisal.

While having a group discussion in an organization, one of the team members criticizes an idea of another team member. Which strategy should the leader apply to resolve the issue?

Brainstorming Brainstorming can be an effective method of generating a large volume of creative and innovative ideas. The leader should apply this strategy to encourage ideas of all the team members, irrespective of any criticism, to resolve the issue. The purpose of focus group strategy is to explore issues, identify problems, and generate information. Delphi technique is a decision-making strategy that involves systematically collecting and summarizing opinions and judgments on a particular issue from followers. Nominal group technique strategy allows group members the opportunity to provide input into the decision-making process.

4 clients, iv infusing

CEFTATRIAXONE IN 5% DEXTROSE

Who is responsible for establishing systems to monitor and verify the competency requirements related to delegation in an organization?

CNOs

Receptionist is responsible for taking client calls. Who to call back first?

Casted right leg has a funny feeling tingling sensation.

A newly promoted registered nurse (RN) is about to start delegation for the first time in her career. Which experiences foster professional self-confidence in the early career stage for an RN? Select all that apply.

Clinical delegation experiences foster professional self-confidence in the early career of an RN. The nursing practicum experiences of applying theory to practice and developing clinical judgment will also advance the RN's ability to become a successful delegator and foster professional self-confidence. Engagement with a nursing mentor fosters professional self-confidence in the early career of an RN. The RN must have the ability to comprehend the legal authority of delegation decisions.

The hospital management is planning a study that compares the benefits and harms of a particular method to the benefits and harms of alternative methods when treating clients with chronic disorders. Which approach does the nurse manager follow to improve client care?

Comparative effectiveness research (CER) CER is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. Diffusion of innovations describes how innovations spread through society in different stages of decision, implementation and confirmation. PBE is a research methodology that helps inform practice decisions by examining outcomes in the real world. In PAR, the members of the community being studied are integral members of the research team and are involved in identifying the questions and addressing the issues in the research project.

A registered nurse is teaching a group of newly hired licensed registered nurses, licensed practical nurses, and unlicensed nursing professionals. Which teaching strategies would be appropriate to develop competencies? Select all that apply.

Competencies can be developed through different teaching strategies such as case studies, online learning, and clinical nursing practice. These strategies can help in improving the learning ability of the student nurses, licensed practical nurses, and unlicensed nursing professionals. Teaching experience and demographics may not be required to develop competencies.

Hospital management has replaced some equipment to provide more effective treatment. The nurse, as a leader, wants the team to support and implement this change successfully. Which actions of the nurse leader are effective in this situation? Select all that apply.

Conducting a dialogue with the team members Encouraging the team members to develop new skills Encouraging the team members to increase competency in different areas Dialogue allows the team members with different perspectives to come together and find common goals. Discussing the new equipment, developing new skills, and increasing competency in different areas ensure effective action of the leader to bring a change in an organization. Simply gaining knowledge about the change does not allow the team to support the change. The nurse leader should instruct the whole team to implement the change effectively

The nursing leader stated, "The reimbursed cost is less than the full charge for a service in the hospital." Which type of health reimbursement does the nurse leader describe?

Contractual allowance When the reimbursed cost is less than the full charge for a service in the health organization, a contractual allowance or discount exists. Offering rewards and incentives to high performing organizations is value-based purchasing. In cost-based reimbursement, all allowable costs are calculated and used as the basis for payment. In a prospective payment system, the third-party payer decides in advance what will be paid for a service or episode of care

What is the status of the unit secretary as a member of the healthcare team, which is in the span of control of a registered nurse (RN)?

Devoid of legal authority

Increase of nurse-to-patient ratio by 25%

Disseminate factual information to all nursing staff to avoid misinformation and rumors.

Which action would a nurse leader specifically take to promote a health care climate where curiosity, reflection, and change are embraced?

Empowering staff to be life-long learners and risk takers A nurse leader who empowers staff to be life-long learners and risk takers is promoting a health care environment where questioning the status quo, reflecting on processes and advocating for change when appropriate is welcome and encouraged. The nurse leader should serve as coach, maintain a good relationship with the team, and collaborate with the team to problem solve, but these actions are not specific to creating a culture of curiosity, reflection and change.

A manager is planning to implement Gardner's Managing task of leadership. Which leadership and management behaviors would the leader display? Select all that apply.

Ensuring that organizational systems work on the client's behalf Assisting the client and client's family with planning, priority setting, and decision making

Medication error remains unchanged

Examine medication administration data to determine use of new policy by nursing staff.

Which skills would be essential for an effective nurse manager to develop and improve collaboration with others? Select all that apply.

Flexibility Ability to listen to others Ability to share information and ideas

Which statement effectively describes the steps to be taken by healthcare personnel when responding to healthcare facility fires?

For clients on life support, the nurse should maintain their respiratory status manually until they are removed from the fire area. The nurse should discontinue oxygen for all clients who can breathe without it. After everyone is out of danger, the nurse can seek to contain the fire by closing doors and windows and using an ABC extinguisher, if possible. Bedridden clients can be moved from the fire area in bed, by stretcher, or in a wheelchair. If required, however, one or two staff members can move these clients on blankets or carry them.

The chief operating officer conducts an interview for the position of nurse leader and asks about Kotter's eight-step model. Which attribute cited by the nurse relating to helping build the momentum is correct?

Forming a powerful coalition The formation of a powerful coalition may help build the momentum and support individuals through the change experience. Removing obstacles may keep one alert for barriers in structure. A culture with continuous improvement may be created by building on the changes. The changes in the culture are anchored with the recognition of the people who helped make the changes.

The behavior of four nurses in different situations is given below. Which nurse exhibits a behavior that can be characterized as delegation according to Hersey's model?

Hersey's model describes "delegation" as the leader's behavior of observing or monitoring if the delegatee has the ability, willingness, and expertise to accomplish the work and there is an established relationship, as with nurse B. Nurse A exhibits guiding or directing, described as "telling," in which the delegator simply tells the individual what is the task to be done and how to perform the task. This happens if the relationship is limited. "Selling" is exhibited by nurse C and is the process of explaining and persuading, which happens if a situation involves a new task and the relationship is ongoing. "Participating" is exhibited by nurse D and is the ability of encouraging the delegatee to perform the task and taking an active part in problem solving, which may occur during the execution of a given task.

Which question asked by a nurse leader establishes and maintains a human rapport with staff?

How are your children? Establishing interpersonal relationships and understanding each other's feelings by asking questions such as "how are your children" ensure establishing and maintaining human rapport. Questions such as "how is your daily work going?", "can you tell me some daily obstacles you run into?", and "do you support changes made by the organization?" indicate a professional relationship and do not indicate establishing of human rapport.

The nurse leader is giving a speech on leadership skills to followers. Which questions enable the nurse leader to evaluate the understanding level of the followers? Select all that apply.

How can you solve a conflict at the workplace?" "What did you 'hear' in the process of this communication?"

Which question related to quality of decisions would the nurse leader consider while assessing the degree of conflict resolution?

How creative are the resulting plans? The question about the creativity of resulting plans should be considered while assessing quality of decisions. The willingness of the people to work together, development of understanding, and generation of the mutual respect and concern for each other are related to quality of relationships.

The nurse manager noticed that one of the staff nurses is giving excuses for performing one task on time but ignoring another assigned task. What does the nurse manager do in this situation?

Identify the reason for procrastination. Sometimes nurses procrastinate, so the nurse manager should identify the reason for this behavior and provide the solution to break the task down into manageable pieces so that they can finish the task in time. The nurse manager should not recommend not performing the task, but instead should motivate the nurse to complete the work assigned. Planning to reward the nurse for accomplishing each of the smaller tasks is beneficial; he should not punished. Another technique for this situation is to advise the nurse to select the least attractive element of the task to do first, so that the rest will seem easy.

What are the attributes of a nurse leader? Select all that apply.

Identifying the needs of others Using critical-thinking skills in making decisions Using focused energy and stamina to accomplish a vision A nurse leader should possess attributes such as identifying the needs of others. A nurse leader should also use critical-thinking skills in making decisions and focused energy and stamina to accomplish a vision. Accepting responsibility willingly and performing follow up on the consequences of actions taken are the responsibilities of a follower.

The nurse is teaching a group of students about the manifestation of alkalosis in the central nervous system. Which statements by a student nurse are accurate? Select all that apply.

If clients suffer from the alkalosis, the manifestation in the nervous system would involve paresthesias. The client will also have a positive Trousseau sign and have anxiety and irritability. The Chvostek sign would also be positive, not negative. The client would show signs of anxiety and irritability. The central nervous system should have increased activity with alkalosis, not decreased.

Which skills would be essential for an effective nurse manager to develop and improve collaboration with others? Select all that apply.

In order to collaborate effectively, the nurse should be flexible, must be willing to listen to others, and must share information and ideas with others. The nurse manager should plan a thoughtful response, consider others' perspective first, and not react hastily. The nurse manager should not share his or her own anger or frustration with other staff.

What is the key element of success for a nurse manager as a leader?

Including the direct care nurses in decision making Involving the direct care nurses in decision making is an essential element of success for a nurse manager as a leader. An effective leader should lead a team either with limited or many team members. Allocating different nurses or resources for specific tasks and resolving the financial issues of the organization are the jobs of a nurse manager.

A nurse leader is educating student nurses in helping clients to perform their difficult self-care activities. Which key idea from a Source of Power is this statement referring to?

Information power Information power arises from one's possession of selected information that is needed by others. Information power is involved when a leader teaches student nurses to help clients in performing their difficult self-care activities. Position power is possessed by virtue of one's position within an organization or a group. Coercive power arises from fear of someone's real or perceived fear of another person. A referent power is involved when a student nurse is granted association with a powerful person.

A direct care nurse performs exceedingly well on a cancer project. As a result, the managerial team decides to promote the nurse to a managerial position. Which actions by the nurse would justify the decision of the panel? Select all that apply.

Inspiring new ideas Establishing short-term goals Demonstrating positive feelings Maximizing results from existing resources The leader provides new ideas with a long-term effect on the progress of the organization. He/she should also provide a positive atmosphere by giving an equal importance to the followers. Providing short-term goals and maximizing results from existing resources are the job responsibilities of a manager. The willingness to lead and follow peers is the quality of a good follower.

In evaluating risks, what does the nurse understand is the responsibility of risk managers?

Involving perspectives from numerous disciplines Involving perspectives from numerous disciplines helps to discover underlying problems that a single discipline might miss. Risk managers should use multiple data sources, multiple data collection techniques, and multiple perspectives to collect and interpret data accurately. Both qualitative and quantitative data should be assessed and analyzed for implementing actionable plans to prevent adverse events.

The nurse leader mentors the staff on types of conflict. Which statement of the leader describes intrapersonal conflict?

It arises due to imbalances between the nurse's personal and professional priorities. Intrapersonal conflict arises due to imbalance between the nurse's personal and professional priorities. The conflict due to a difference in opinions with others causes interpersonal conflicts. Organizational conflicts arise from a discord between policies and procedures. Organizational conflict also arises from hierarchical structure and role differentiation among employees.

What statements are related to a mentorship program organized by the nurse manager in a health organization? Select all that apply.

It expands the knowledge about cultural diversity. It involves selection of mentors who ascribe to transcultural values and beliefs. It should not make people of different cultures pattern their behavior after the prevailing culture.

A client who sustained a leg fracture is prescribed intramuscular analgesic medication. Which healthcare professional can be safely delegated this task?

LPN

The registered nurse is delegating tasks to the healthcare team. Which team member is most suitable for achieving an effective outcome in the care of a client who is bedridden for long periods with seizures?

Licensed practical nurse

Which conditions make a delegation more challenging for the registered nurses, delegatees, and clients? Select all that apply.

Limited resources Greater geographical area Vulnerable populations receiving care

What are some challenges faced in the process of delegation? Select all that apply.

Limited resources, vulnerable populations receiving care, and large geographic area Delegation is a complex process. Delegating a task when resources are limited is a great challenge. Delegation is also more challenging the larger the geographic area is where the task should be performed. The process of delegation also becomes more challenging when care is being delivered to vulnerable populations. Time conservation is a benefit of the delegation process even if the decision to delegate may not be based on time-saving considerations. Providing assistance with the client's activities of daily living is a benefit rather than a challenge of delegation.

When a bedridden client complains that he or she is thirsty, the nurse leader says, "I want to make you comfortable. Here is a glass of water, please take it." Which communication skill is the nurse leader using to make caring visible?

Making explicit her or his positive intent The nurse is making explicit her or his positive intent by explaining the purpose and by showing what he or she is doing in the client's best interest. Listening actively indicates acknowledging and reflecting back the person's feelings in a nonjudgmental way. Expressing appreciation refers to giving the personal gift of positive reward. Showing caring nonverbally can be done by using a facial expression, intonation, posture, eye contact, and body language to mirror the client's feelings. Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning, take a high-powered snack with you to eat 20 minutes before the examination. The brain works best when it has the glucose necessary for cellular function.

The nurse leader finds that a client with a severe vitamin B12 deficiency is extremely fatigued and tends to fall. Which theory does the student nurse think that the nurse leader would find appropriate for prioritizing the need of the client?

Maslow's theory Maslow's theory prioritizes the needs of the client and, if applying Maslow's theory, the nurse leader would provide for safety needs of the client first. Role theory is associated with an appreciable framework for the development and evaluation of staff. Complexity theory explains that change is an ongoing experience through which a system is adjusted. Situational leadership theory analyzes an individual's knowledge and the work-related task before delegation.

"In today`s workplace, female-male collaboration should provide efficacious models for the future." Which statements support this saying? Select all that apply.

Men and women must learn to work together. Women and men bring separate perspectives to resolving problems. Men and women must learn to work together and value the contributions of others and the differences they bring to any situation. Not all male managers make decisions on limited data. Women and men bring separate perspectives to resolve problems, which can help them function more effectively as a team on the nursing unit. Women may be better at collaborating and getting others to collaborate in accomplishing a task; men reportedly seem to be better at deciphering what needs to be done. Women are perceived to have a more participative management style; however, this does not mean that all male managers use an authoritative management model.

Which actions in the delegation process represent accountability? Select all that apply.

Monitoring client care Seeking the outcome report

The nurse leader asks the team members not to talk to each other while writing their ideas for solving a predefined problem. Which type of group decision-making style does the nurse leader follow?

Nominal group technique In the nominal group technique, team members are asked to write their ideas for problem solving without talking to each other in order to avoid comments and elaboration of the ideas. Focus groups explore issues and generate information in identifying problems. The brainstorming method is used to generate a large volume of creative options. The Delphi technique involves collecting and summarizing opinions and judgments on a particular issue from respondents, such as expert panels, interviews, surveys, or questionnaires.

While having a group discussion in a decision-making process, the leader has asked the team members to silently write down their ideas. The merits of each idea were discussed, and the best one was chosen based on highest ranking. Which strategy is involved in this scenario?

Nominal group technique The nominal group technique has group members silently provide written input into the decision-making process. Choosing the ideas based on highest ranking is done after discussing the merits of the ideas. This technique allows equal participation among members and minimizes the problem of dominance. The focus group strategy is used to identify problems or to evaluate the effects of an intervention during a face-to-face discussion but not through writing the ideas. The brainstorming strategy is applied during a decision-making process to generate innovative ideas in spite of having criticism from team members. The Delphi technique is used to achieve consensus among team members by reconsidering and judging the opinions.

OB Modification Theory

OB Mod theory of leadership uses positive reinforcement to motivate followers to repeat constructive behaviors in the workplace. According to this theory, the leader uses punishment sparingly as the results are unpredictable in supporting the desired outcome.

During the process of delegation, the delegator's behavior is noted to be observing and monitoring. How is the relationship between the delegator and delagatee in this situation?

Observing and monitoring behavior of the delegator indicates delegating, which is done when the relationship between the delegator and delegatee is established. The delegator's behavior is guiding or directing when the relationship between the delegator and delegatee is limited. The delegator's behavior is encouraging or problem solving when the relationship between the delegator and delegatee is new or developing. The delegator's behavior is explaining or persuading when the relationship between the delegator and delegatee is developing or ongoing.

Evaluate cardiac monitor system

Organize a committee of ICU nurses to identify potential problems of the new monitoring system.

A client with foot ulcers is admitted to the hospital. The nurse manager should delegate the task of maintaining hygiene to which staff members to maximize efficient use of human resources? Select all that apply.

PCA UNP

RN gathering supplies to assist HCP with bedside thoracentesis when ED calls to report on a client with unstable angina

PN assist with thoracentesis, RN gets report, UAP prepares room

5 y/o boy with mumps is transferred to the peds unit. Nursing intervention most important to implement?

PPE cart placed in front of the clients door

The nurse as a leader teaches staff about organizational disciplines to support change and evolution. Which statement of the nurse is relevant in the context of maintaining self-awareness and using reflection?

Personal mastery fosters openness in the face of change. Personal mastery fosters openness by maintaining self-awareness and using reflection. Team learning promotes the team thinking together to share ideas, knowledge, and perspective. System thinking considers the organization as a complex entity; this helps in seeing the movement of the organization. Shared vision creates a common viewpoint to understand the direction of movement of the organization.

A staff nurse states "I am sorry, I am responsible for the situation" while communicating to the nurse leader. Which communication pattern is the staff nurse using?

Placation Placation means to appease. By saying "I am sorry, I am responsible for the situation," the staff nurse is taking the blame. An irrelevant pattern is used when someone is trying avoid a situation or ignore his or her feelings. Congruence is used when matching inner feelings with words. While blaming others for any situation, attribution of blame is applied.

Which task can the registered nurse safely delegate to the unlicensed assistive personnel (UAP) while caring for a client with gastroesophageal reflex disease?

Positioning the bed

A registered nurse (RN) delegates a task to a licensed practical nurse (LPN). What should the RN do when the LPN executes the task improperly?

Provide constructive feedback.

Respiratory therapist cross-trained avoiding HIV positive client

Provide the employee with feedback about the observed behavior.

While reviewing the work of a team, the nurse observes a conflict among the members. How should the nurse build in consultation before and feedback after the negotiations in a conflict resolution?

Providing a forum for open discussion Providing a forum for open discussion will help to build in consultation before and feedback after the negotiations. Examining the real issues of all parties will help to focus on interests in conflict resolution. Providing the necessary resources to those involved to offer support will help to impart motivation, skills, and resources in conflict resolution. Allowing a "cooling off" period before reconvening if resolution fails will help build in "loop-backs" to negotiation in conflict resolution

A client who was in an accident is admitted to the hospital. Which decision making approach by the nurse leader indicates the 'satisficing' approach?

Providing preliminary care to the client

Which behavior of the nurse as a leader indicates Gardner's task of renewing at an executive level?

Providing self-care to enhance the ability to care for clients, families, staff, and the organization

The nurse manager threatens a staff nurse about being penalized for poor performance in the unit. Which type of leader behavior did the staff nurse experience?

Punitive Punitive behavior is experienced in transactional leadership; this occurs when the nurse manager aims at punishing the staff nurse by penalizing for poor performance. Charismatic behavior and intellectual stimulation are seen in transformational leadership. Laissez-faire behavior is the hands-off style in which the manager allows a high degree of autonomy and self rule.

Which healthcare professional does the nurse know is authorized to delegate work to other healthcare members?

RN

The nurse as a leader in the healthcare setting is studying how the communities and cultures that make up society relate to healthcare delivery. Which aspect of systems thinking theory of leadership is the nurse applying in this situation?

Recognizing the dynamic, complex, and interdependent nature of systems

The registered nurse (RN) is caring for a client who underwent brain surgery. The registered nurse delegated the task of reinforcing ambulation to the licensed practical nurse (LPN). Who is accountable for the client' scare?

Registered nurse

Sequential compression devices

Report any change in color in the client's feet or legs.

Which behavior is an example of the nurse's role as an executive in the Gardner task of leadership?

Representing the organization and client care services on councils

The nurse notes a conflict between staff members during a meeting. Which principle should the nurse follow, as a leader, to put the focus on mutual interest?

Responding expediently to the issues Responding expediently to issues will help put the focus on interest in a process of conflict resolution. Providing a forum for open discussion will help build in consultation before and feedback after the negotiations. Reviewing with all parties the likely consequences of not proceeding will help build in "loop-backs" to negotiation. Working with staff or clients after the conflict to learn from the situation will help build in consultation before and feedback after the negotiations.

The nurse leader is representing the nursing unit and the values and beliefs of the organization to staff members. Which leadership task does the nurse's behavior indicate according to Gardner's tasks of leadership?

Serving as a symbol in a management position

Which leadership theory focuses on the role of leaders in relational and contextual terms?

Style theories focus on what leaders do in relational and contextual terms. The two-factor leadership theory refers to using motivator factors to inspire work performance. The expectancy theory of leadership refers to providing specific feedback about positive performance. The transformational theory of leadership refers to a process in which the leader attends to the needs and motives of followers.

Which action of the registered nurse (RN) represents his or her leadership ability?

Supervising the tasks assigned to unlicensed nursing personnel The nurse as a leader should supervise the tasks assigned to unlicensed nursing personnel to ensure the client's safety. Pursuing higher professional courses can help in self-growth but does not indicate leadership. Performing home visits and modifying a diet chart indicates the role of the nurse.

The nurse manager oversees an organization that provides secondary care for clients with cancer. Which service would be provided by this type of organization?

Teaching the client about prevention of infection

After resolution of a conflict, the nurse leader encourages a team member who was involved in the conflict. To be an effective leader, which action should the nurse leader avoid?

Telling the team member that he or she will get legal punishments for conflicts in future

The registered nurse, while teaching a group of nursing students about the characteristics of a good team player, states, "A good team player should work with determination and refuse to stop until the goal has been accomplished." Which characteristic is the registered nurse describing?

Tenacity Tenacity means giving your all with determination and refusing to stop until the goal has been accomplished. Selflessness is a characteristic that involves putting the other members of the team ahead of oneself. Dependability involves the nurse following through and doing what he or she agreed to do. Collaboration involves each person bringing something to the project that adds value to the team and supports the creation of synergy.

RN, PN, UAP are working as a team

The UAP obtains an oxygen saturation level while RN reports finding to the health care provider.

The registered nurse (RN) is delegating tasks to licensed practical nurses (LPNs) regarding client care. Which factors should be considered when delegating a task to the LPN? Select all that apply.

The decisions for delegation should be based on multiple factors such as the client's condition, complexity of the task, and predictability of outcomes. The number of LPNs may not be important information while assigning the tasks. Relationship status between the delegatee and the delegator are not important considerations for delegating a task to the LPN effectively.

While delegating a task, the registered nurse says to the delegatee, "Please tell me how you go about performing this procedure, and I will share with you my perspective about how frequently and under what conditions we need to communicate with and report to each other." What does this indicate?

The delegatee and delegator are creating mutual expectations.

Which healthcare professional would the nurse know is held accountable for the tasks performed by the patient care associate (PCA)?

The delegator is held accountable for tasks performed by the delegatee. In this situation, the delegator is the RN; therefore, the RN is held accountable for the tasks performed by the PCAs. The RN is also accountable for delegation to LVNs, UAPs, and UNPs as delegatees.

The nurse leader actively participates in the quality improvement process. Arrange the steps in a sequence that the nurse leader will follow while implementing the quality improvement process?

The first step of the quality improvement process involves identifying the needs that are important to the consumer of healthcare services. Collaborating with the interprofessional team to review the needs that are identified is done to avoid bias. The next step is confirming the needs and collecting the data on the current position of the service that helps in the improvised plan. This is followed by implementing the process and establishing the outcomes for which quality indicators are required. Then the next step is to select and implement the plan to meet the outcomes and objectives of quality improvement. Evaluating the plan is the last step and is necessary for quality improvement.

The nurse leader is calculating the productive hours of the staff nurse for that year. The nurse took a vacation for 19 days. Assuming an 8-hour workday, what are the productive hours of the staff nurse? Round your answer using a whole number. _____ hours

The formula for calculating the productive hours is (Total number of working hours per year - Nonproductive hours). So the nonproductive hours are (Total leave x Full time equivalent per day = Nonproductive hours) 26 x 8 = 152. Therefore, 2080 - 152 = 1,928 productive hours.

Which of these clients can be provided care safely by unlicensed nursing personnel? Select all that apply.

The greater the stability of a client, the more likely it is that unlicensed nursing personnel (UNP) can provide safe client care. It is also easy for a UNP to care for a client who is recovering. A client with pain is anxious and agitated, and it will take the UNP time to calm the client. Client care may be affected when the client is psychologically upset and has suicidal intentions.

A nurse manager agrees to mentor a newly recruited nurse who wishes to develop leadership qualities. Which statements hold true about this mentor relationship? Select all that apply.

The mentor should serve as a role model.The mentor should provide advice whenever necessary.The mentor should give appropriate feedback to promote improvement.

While assessing the airway patency of a client after a bomb blast, the nurse suspects severe brain injury and gives a score of 7 using the Glasgow Coma Scale (GCS). Which intervention is most appropriate for the client?

The most appropriate intervention for a client with a GCS score of 7 is preparing for endotracheal intubation and mechanical ventilation. The jaw-thrust maneuver is performed in a client if there is any risk of spinal injury. The use of large-bore catheters to maintain vascular access is done to perform resuscitation in traumatic conditions. Observing for chest wall trauma or other physical abnormalities may not be the appropriate intervention for a client with brain injury.

The nurse is assisting the registered nurse with delegation decisions regarding management of a client with shortness of breath. Which action by the nurse indicates a need for correction?

The nurse may not provide constructive feedback about the client care management during delegation decisions. The nurse may, however, provide constructive feedback to the delegatee to maximize the efficiency of the client care. The nurse may assist other registered nurses with delegation decisions by using three strategies: asking, offering, and doing. Asking involves inquiring about the client care problems and issues such as the respiratory rate. Offering involves suggesting ways to achieve desirable client care outcomes, such as asking the client to perform breathing exercises regularly. Doing involves demonstrating the specific task to improve client care—for instance, administering oxygen to the client.

The nurse is caring for clients who were brought to the hospital following a large-scale disaster. Which client would be suitable for the nurse to triage with a "green" tag?

The nurse will triage the clients according to priority for providing care. The client who is injured and is able to walk may not require immediate treatment and would be issued a green tag. The client who is severely injured and who has no chances of survival is tagged black. The client who is stable and requires re-triage after observation is tagged with a yellow tag, indicating that the client is not in immediate danger. A red tag issued to the client indicates that the client requires immediate care.

The registered nurse (RN) delegates the tasks of caring for a client with pressure ulcers. The client suffers further tissue necrosis during treatment. What could be the reason for this condition?

The patient care associate (PCA) is not authorized to irrigate the wound as improper technique can lead to tissue damage. The RN is qualified to perform wound care; therefore, cleaning the wound is not likely to lead to tissue necrosis. Pressure ulcers are associated with pain. The LPN administering oral analgesics may relieve the pain, but it will not cause tissue necrosis. Having the licensed practical nurse (LPN) reposition the client every 1 or 2 hours will minimize the risk of tissue necrosis due to pressure ulcers.

Which priority assessments should be included by the nurse when caring for a client who is experiencing depression? Select all that apply.

The priority assessment for a client experiencing depression is to inquire about appetite, activity status, and emotional status. These helps determine the level of depression. Irritability and restlessness are secondary assessments for determining the depression level of a client.

A green-tagged client arrives at the emergency department (ED) after a mass casualty incident (MCI) involving radiation. Which is the priority nursing action for this client?

The priority nursing action for a green-tagged client who arrives at the ED after exposure to radiation is implementing decontamination measures. This measure is the priority because it is essential that members of the healthcare team, and clients, are not exposed to the radiation while providing care. While the other nursing actions (performing a head to toe physical examination, placing a special bracelet with a disaster number, and taking a digital photo and placing it on the medication record) should occur during the admission process to the ED, these are not the priority actions.

How would the nurse arrange the steps in the quality improvement process to help the leader to minimize errors and achieve satisfaction on the part of the consumer of healthcare services?

The quality improvement process starts with identifying the needs that are most important to the consumer of healthcare services. It further proceeds with assembling an inter-professional team to review the identified consumer needs and services. Then the data are collected to measure the current status of these services. The quality improvement process proceeds with establishing measurable outcomes and quality status. Then selection and implementation of a plan is done to meet the outcomes. Finally, the data are collected for evaluation of the plan implementation and achievement of outcomes.

A client with chronic asthma is being cared for in the inpatient care unit. To assess the client on a regular basis would be delegated to which healthcare team member?

The registered nurse is a licensed nursing professional and is responsible for assessing the asthmatic symptoms of the client for providing care. The charge nurse is responsible for the coordination and assignment of tasks for the client's care. The patient care associate is an unlicensed assistive personnel whose scope of practice is limited from assessing the client. The licensed practical nurse does not assess the client's condition, but rather is responsible for providing treatment prescribed by the healthcare provider and delegated by the RN.

The nurse is learning about the types of injuries caused by explosive devices used as agents of terrorism. Which statement about the injuries caused by explosive devices does the nurse know to be true?

The shock wave generated by an explosion primarily causes blast injuries to the lungs, GI tract, and middle ear. Penetrating injuries are caused when shrapnel from the explosive device penetrates the skin; damage to the middle ear is not typical of penetrating injuries. Blast injuries result from the supersonic over pressurization shock wave caused by the explosion. Crush injuries, such as blunt trauma, often result from explosions in confined spaces causing structural collapse.

What would the nurse describe as "leadership" in nursing practice?

The use of individual traits to interpret the environment in an emerging situation to execute a plan Leadership is defined as the use of abilities and traits by an individual to interpret the environment in an emerging situation to execute a defined plan. In followership, each member contributes optimally and follows a peer who leads in the setting. The ability to plan, direct, control, and evaluate other members in situations with a pre-established outcome is management. Collaboration is the transfer of responsibility for the performance of a task while retaining the accountability for the outcome.

A nursing student compares the pathophysiology of submersion injury in victims of freshwater drowning and victims of saltwater drowning. Which statement made by the nursing student indicates effective learning?

There is a difference in tonicity of both saltwater and freshwater with that of normal body fluids. When either saltwater or freshwater is aspirated by the submerged victim, the osmotic gradient caused by the aspirated fluid causes fluid imbalances in the body. Freshwater is hypotonic and saltwater is hypertonic. Only hypertonic saltwater draws fluid from the vascular space into the alveoli. Destruction of surfactant and alveolar-capillary membrane occurs in case of both saltwater and freshwater aspiration.

A client with cardiac failure is admitted to the hospital. The primary nurse is unable to attend to the client. The nurse leader appoints the associate nurse in providing care to the client. Which strategy does the associate nurse implement in providing care to the client?

To work on the plan implemented by the primary nurse

Two clients in one room. One client has MRSA the other one neutropenia. What intervention should the nurse implement?

Transfer client with neutropenia to a private room.

Which factors does the registered nurse consider in the decision to delegate process? Select all that apply.

Two factors responsible for the decision to delegate process are predictability of outcomes and complexity of the task to be performed. Evaluation, nursing judgment, and pervasive functions are not factors in the decision to delegate process.

A client with tongue occlusion has loss of gag reflex and alterations in level of consciousness. The blood gas test shows oxygen saturation as 40mm Hg and carbon dioxide saturation as 75 mm Hg. Which type of support provides immediate relief to the client?

Upper airway obstruction may occur with tongue occlusion, which is associated with loss of gag reflex and alterations in the level of consciousness. The client suffering from severe hypoxia (O 2 saturation of 40mm Hg) and who is hypercapnic (CO 2 saturation of 75 mm Hg) requires an emergency tracheotomy for relief within 2 minutes. Laryngeal repair is performed to prevent laryngealstenosis and to cover exposed cartilage. The abdominal thrust maneuver clears upper airway obstruction caused by a foreign body. Autotitrating positive airway pressure resets the pressure throughout the breathing cycle in a client with severe sleep apnea.

The registered nurse is assigning a task to an unlicensed nursing personnel (UNP). Which key elements are considered while assessing the UNP's ability to perform work? Select all that apply.

While assessing the work to be assigned to an unlicensed nursing personnel (UNPs), the registered nurse should consider the elements of safety, stability, and critical thinking. Attitude is one of the multiple factors that influences the effectiveness of the leader. Ethnicity is not a factor that plays a role in the process of delegation.

A nurse leader has resolved a conflict within the team. Which further action of the nurse leader prevents the same conflict in the future?

Working with the team members after the conflict The nurse leader should work with the team members or staff after resolving the conflict to learn from the situation and to prevent repetition of the conflict in the future. The nurse leader should teach the importance of unity within the team rather than punishing the responsible member. Separating the member responsible for the conflict does not prevent repetition of the conflict. The nurse leader should supervise the team but should not ask another person to do it.

A nurse is conducting a health campaign in a school. During the health campaign, the nurse finds that the school management has replaced the registered nurse (RN) with a trained clerk. What should the nurse, as a community opinion leader, do?

Write a letter to a local newspaper editor opposing the decision of the school board

The nurse leader is evaluating different Bleich's tasks of followership performed by four different student nurses.Which student nurse's action indicates the need for correction?

a The nurse leader who follows Bleich's task of management, not task of followership, is responsible for eliminating barriers or obstacles to increase the work effectiveness. Therefore student A's action is not a task of followership but a task of management. Student nurse B demonstrating accountability to the team effort; student nurse C offering knowledge, skills, and abilities to achieve the task; and student nurse D taking reasonable risks as a preventive measure for fearing change or unknown circumstances indicates effective implementation of Bleich's task of followership.

The charge nurse is identifying tasks for staff caring for clients using functional nursing. Which tasks should be assigned to the licensed practical/licensed vocational nurse (LPN/LVN)? Select all that apply.

administering topical measuring capillary blood glucose

Delegated to UAP`

apply abdominal binder

Nurse should assess the client with which problem first

arterial occlusion

The registered nurse is delegating a task for unlicensed assistive personnel l (UAP). Which client's care would be suitable for delegation to the UAP?

b

If a leader is using the simplest and fastest method of communication with his or her constituents, which of the five rules of the leader best describes this approach? Select all that apply.

balance time

0200 nurse phones HCP to request med for client who is unable to sleep four times the the dose. Nurse questions, HCP sleepy says "yea, ok" action first

call HCP about dosage

charge nurse, rn, pn

cardiac cath, no pedal pulses

A medical-surgical unit is expecting a large volume of client admissions after a train derailment. Which member of the nursing care team will prioritize care for the unit?

charge nurse

Which task followed by the executive nurse is a leadership development task?

clear vision

The registered nurse is reviewing the clinical data of four clients. Which client care can be delegated to the licensed practical nurse (LPN)?

client A The licensed practical nurse (LPN) scope of practice includes administering oral, topical, intramuscular, and subcutaneous except for intravenous medications. Client A is prescribed non-steroidal anti-inflammatory drugs for dental pain that can be either administered orally or intramuscularly. This client care falls under the scope of LPN. Client B is prescribed replacement fluids for severe dehydration, which must be given intravenously. This intervention is out of scope for the LPN. Blood products transfusion should be made only by the registered nurse. Client C care is out of scope for the LPN. Dextran is administered intravenously to maintain the volume of blood during hemorrhage. This intervention in client D is out of scope for the LPN.

Which theory states that leaders should expand and respond to a dynamic change rather than prescribing and approaching change as a lock-step, pre-prescribed method?

complexity theory

What is the priority nursing intervention for a client with a migraine?

decrease pain

Which characteristics of the delegatee should be considered to determine that he or she is the "right person"? Select all that apply.

experience willingness competence

Which care settings are more suitable for unlicensed nursing personnel (UNP)? Select all that apply.

extended long-term

A client is hospitalized with an overdose of benzodiazepines and presents with a respiratory rate less than 10 breaths per minute. Which nursing intervention should be provided as the first priority?

give oxygen

Which are the organizational outcomes of transformational leadership? Select all that apply.

increased loyalty increased commitment increase performance

The registered nurse assigned a task to unlicensed nursing personnel (UNP). The UNP observed a change when measuring a client's blood pressure. What is the responsibility of the UNP in this situation?

inform the RN immediately

The nurse manager sends the nursing team to perform a pediculosis screening at an elementary school and stays behind to catch up on administrative work. Which leadership quality does the manager fail to demonstrate in this instance?

leading by example

A medical care facility is seeking to establish an orthopedic center of excellence. The nurse manager teaches direct care nurses about opportunities available to them in the process. Which task would a direct care nurse be eligible for?

lit review

The nurse leader teaches student nurses about ways of making care visible. During a follow up visit, the leader observes the nurse holding the client's hand after finding him or her anxious before radiation therapy. Which communication skill applied by the student nurse shows effective learning?

nonverbal

The registered nurse (RN) is caring for an older client who has been admitted to the hospital. The RN allocates several tasks to the unlicensed nursing personnel (UNP). In order to evaluate the understanding of the UNP, the RN asks the UNP to describe which tasks have been allocated. Which responses given by the UNP indicate effective understanding of the tasks? Select all that apply.

oral care sponge bath recored BP

Which member of the healthcare team would the nurse claim performs functions through passive delegation?

pharmacist

The nurse is caring for a group of clients on a surgical unit. What action should the nurse implement first

prepared for OR

Which motivator factors to inspire work performance are in accordance with the two-factor theory? Select all that apply.

recognition achievement

uap, colostomy

record amount

The nurse is caring for a pregnant client with hypertension. Which client care tasks are most suitable to be delegated to the patient care associate (PCA)?

record vital signs

What does the nurse say is the advantage of an appropriate delegation?

reduce stress

An emergency department consists of five nurses who take care of 30 clients. Which responsibility of the registered nurse is most helpful in overcoming this overwhelming situation?

span of control

The nurse is caring for a client admitted with fluid overload. Which tasks are most appropriate to be delegated to the patient care associate? Select all that apply.

vital signs urine output reposition

The nurse leader teaches the student nurse about the quality assurance (QA) process. Which statement made by the student nurse indicates ineffective learning?

"The major task is staff development."

The registered nurse (RN) and unlicensed assistive personnel (UAP) have been working together for two years. Which statement made by the RN would be appropriate after delegating a task to the UAP?

"You know what to do and when to report."

The head nurse of the emergency department is teaching a group of student nurses about Critical Incident Stress Debriefing (CISD) in emergency nursing. Which statement of the student nurse indicates a need for *further teaching?*

*"The coleader is responsible for keeping unauthorized people out."* A CISD team is a component of a CISM program. It is called to deal with the emotional needs of healthcare team members after a devastating event. A doorkeeper is a third member of CISD team who is responsible for keeping inappropriate people, such as media and spectators, out. The coleader is a peer of the group being debriefed. The doorkeeper talks to the person who leaves the session early and makes an effort to obtain follow-up from the person. The team leader has a background in a mental health/behavioral health-related field.

Which component of delegation is suitable to all the members on the healthcare team?

*Authority* is the component of delegation that is suitable for all the members on the healthcare team. Supervision is a right of delegation in which the delegator supervises the other assistive personnel to perform the task. Accountability is the component of delegation that is suitable for delegators such as registered nurses (RNs). Communication is the right of delegation in which the delegator gives the directions to perform the task.

Which element creates an integrative process that fosters effective delegation decisions by the registered nurse?

*Stability is the element that creates an integrative process that fosters effective delegation decisions.* Ability is the factor that needs to be assessed to determine the level the leaders determine. Liability is the person's responsibility and accountability for individual actions. Ethnicity does not play a role in the process of delegation.

Which nursing care delivery system works well in emergency situations that necessitate prioritization of care?

*The functional method of delivering care works well in emergency and disaster situations. Each care provider knows the expectations of the assigned role and completes the tasks quickly and efficiently.* Team nursing, primary nursing, and Patient-Centered nursing delivery systems are not supported by evidence as working well in emergency situations.

New clinical documentation

-Need to discuss new clinical documentation that helps save lifes and require one more document

Most important to assign which client to a RN rather than PN

-Pain scale of 9

PN reports to RN, patient pulled out CVC, UAP is with him in room. Stat dose of oral antianxiety med. RN assign care

-RN with CVC, PN stat med, UAP VS on new admission

45. Charge nurse is making assignments in an inpatient psych unit. Which task should be given to the LPN

-admin of routine meds

Pt diagnosed with unstable angina is scheduled for cardiac cath. Select all.

-assess chest pain or armpit pain, check pulses on both feet, assess groin access site, monitory VS per post op protocol.

Women health fair, PN helping RN

-assist with bone density prep

PCA to PO. BP increases 120/72 to 150/90. Additional questions/comments to HCP

-can PCA be reinitiated

UAP to assemble nephrostomy tube

-change bag to leg bag

PN observes that LPN performed a dressing change. But when the PN goes the check the patient she notices that the dressing is 2 days old. What should the PN do first?

-consult the LPN about the discrepancy

Assess first

-coronary syndrome with increasing SOB

Female resident who is mentally alert and lives in a long-term care facility reports that a staff member slapped her

-does she know the name of the person

Making assignments for the day, which info provided during change of shift report is most important for the charge nurse to consider?

-elderly female client who refuses to be cared for by a male nurse

Multidisplinary team

-elderly man with BGL 400 Assess first -constipation -weakness -pressure ulcer with skin flap -hep A

Warrants immediate attention

-female with RLQ pain in abd, febrile and vomiting

67 y/o female client recently widowed, increased confusion/disorientation.

-medical eval, managed healthcare plan

Nationally known management consultant is expensive and is here to give a presentation at a local hospital. What is the best way to make sure that the information is received and passed onto other staff members?

-send 2 nurses to get information

Elderly male who is ketoacidotic becomes agitated when the nurse attempts to orient the client to time and place. What room is the best for this client?

-the room next to nurses station

UAP stuck in palm by needle with Hep

-wash hands with soap and water

Patient being transferred from PACU, what would finish the report... cardiac patient

-when was the last narcotic given

Four nurse leaders are performing Gardner's tasks of leading and managing. Which nurse leader is implementing Gardner's task of managing?

A Gardner's task of managing involves assisting other executives and corporate leaders with planning, priority setting, decision making, and ensuing human and material resources are available to meet their health needs. Therefore nurse leader A is implementing Gardner's task of managing. Gardner's task of envisioning goals involves assisting staff in formulating their vision of enhanced clinical and organizational performance; this is being done by nurse leader B. Nurse leader C is implementing Gardner's task of motivating by inspiring clients and their families to achieve their visions. Nurse leader D is implementing Gardner's task of developing trust by sharing the organizational information with the team.

The nurse is working with a group of clients in a community health center. Which client should the nurse consider at highest risk for developing pneumonia?

A blood urea nitrogen level of 25 mg/dL, a respiratory rate of 38 breaths/min, and a blood pressure of 80/60 mm Hg are symptoms of pneumonia. Therefore client C has the highest risk for pneumonia. A 55-year-old client with abnormal uterine bleeding and tumors of 8 mm in uterus has uterine fibroids. They are benign and do not affect client A's respiratory status. Client B, a 28-year-old with a carotene level of 90mcg/dL, creatine level of 1.8 mg/dL, and a folate level of 23 ng/mL may have hyperthyroidism but is not at risk for pneumonia. A folate level of 3 ng/mL and a haptoglobin of 16 mg/dL in client D, who is 33-years old, indicates hemolytic anemia and is not a risk for pneumonia.

While caring for an 8-year-old victim of an earthquake, the nurse finds that the child has trouble sleeping, startles easily, and experiences "flashbacks" of the disaster. What is the appropriate nursing intervention in this situation?

A client who is unable to sleep, startles easily, and experiences "flashbacks" of disasters displays symptoms of posttraumatic stress disorder (PTSD). Therefore the nurse should refer the child to a clinical psychologist or psychiatrist. Restraining the child does not address the PTSD and would be unethical. Administering sedatives may help the child sleep but would not address the PTSD. Placing the child's favorite toy beside him or her in bed may provide comfort but would not address the underlying PTSD. Test-Taking Tip: Disasters can disturb the victims physically and mentally. Use this information to answer this question accurately.

A client on diuretic therapy developed metabolic alkalosis. What does the nurse consider to be the priority nursing care while correcting alkalosis?

A client with *alkalosis* has *hypotension and muscle weakness*, which increases the risk for injury due to falls; therefore, to prevent injury, the *priority nursing care is to prevent falls. * Monitoring electrolytes daily until they return to normal is NOT the priority nursing care. Antiemetics are prescribed for vomiting and are given low priority. Once the client is protected from the risk of injury, diuretic therapy is adjusted.

What is the correct order of steps that should be followed by a leader to create a vision and foster major organizational transformation?

According to the Kotter's eight-step change model, the first step towards creating a vision and fostering major organizational transformation is creating urgency. Generating open dialogue about external and internal realities will impact the need to change. The next step is forming a powerful coalition. Developing a core group of change advocates will help build momentum as well as support individuals through the change experience. Next, creating a vision for change may involve lots of small alterations, and may or may not be a larger or inspiring vision. Communicating the change vision to people is the next step. People tend to pay attention to what is reinforced, so communicating regularly and consistently is required to sustain the effort. The next step is removing obstacles. This includes having alerts for barriers in the structure and processes that limit the ability to change and removing these barriers. The last step is to report the changes and honor the people who helped make it happen, in order to inspire others.

Which information supports the development of a critical pathway? Select all that apply.

Actions occur in steps. Client improvement is measured against criteria. Algorithms are used in the provision of client care. Care requires participation by physical and occupational therapists.

Which care activities would be involved in a correct delegation process? Select all that apply.

Activities such as cleaning the client's body and assisting the client with oral feeding can be performed by the licensed practical nurse (LPN) and unlicensed assistive personnel (UAP). It is always the responsibility of the registered nurse (RN) to guide the UAP while performing any activity. The UAP is not allowed to perform activities such as providing medication. The LPN should not evaluate the client condition; it is the responsibility of the RN. STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question.

Nurse receives a prescription over the telephone

Administer a nebulizer breathing treatment.

The nurse is caring for a client with severe menstrual bleeding and abdominal cramps. Which task is appropriate to be delegated to the licensed practical nurse (LPN)?

Administration of oral analgesics

The registered nurse of a disaster management team teaches the staff nurse about Ebola. Which statements made by the staff nurse requires further teaching? Select all that apply.

Antiviral drug therapy is not yet available for Ebola infection, so it cannot be treated. Ebola is transmitted by direct contact with body fluids of the affected client. The vaccine for Ebola is not yet approved by the FDA for use in the market. Isolation of a client with Ebola is required to prevent the spread of the virus. The Ebola infection is suspected if the client experiences unexplained bleeding.

While delegating a task, the registered nurse says to the delegatee, "Please tell me how you go about performing this procedure, and I will share with you my perspective about how frequently and under what conditions we need to communicate with and report to each other." What does this indicate?

Asking a delegatee how he or she performs the procedure and sharing each other's perspective and when to communicate indicates that the delegator and delegatee are creating mutual expectations. When the delegatee demonstrates a task, it indicates that the delegatee requires explanation. The delegator will direct the procedures to the delegatee when the delegatee has limited knowledge. The delegator will motivate the delegatee when the relationship between the delegatee and delegator is established.

The nurse is providing post-procedure care to a client after an arthroscopy. What will be the nurse's priority while providing care to the client?

Assessing the neurovascular status of the client's affected limb

A hospital is planning to implement the functional model of nursing. Which action performed by a nurse leader would be effective under this model?

Assigning individual duties to different nurses and nursing students for different tasks

The leader has planned to assist staff in order to achieve workplace unity. Which of Gardner's tasks would the leader apply in practice?

Assisting clients to accomplish optimal functioning

Which of these clients is most appropriate for delegation to a cross-trained technician?

CLIENT A A cross-trained technician, when paired with a registered nurse (RN), may perform respiratory therapy, phlebotomy, and electrocardiography. Care of client A can be safely delegated to a cross-trained technician. Though the cross-trained technician can record the ECG, he or she may not monitor the continuous ECG. Monitoring of vital signs is also the role of the RN. Leg exercises may be taught by the RN or by a physician. The other licensed assistive personnel may be delegated the task of reinforcing the teaching, but this is not an appropriate role for the cross-trained technician.

The registered nurse (RN) is delegating care for several clients to the licensed practical nurse (LPN). Which client is suitable for delegation?

CLIENT B The licensed practical nurse (LPN) is able to monitor Client B's condition since the LPN can understand the condition of the client and is able to monitor the changes in the wound and the discharge from the operative site. Client A requires administration of intravenous fluids during dialysis, which the LPN is not eligible to do. In client C, the condition is severe and monitoring is needed by the registered nurse (RN). In client D, the unlicensed nursing personnel (UNP) can assist with food and fluid intake, which allows the LPN to take care of other clients who require assistance in wound care and monitoring.

A medical care facility is seeking to establish an orthopedic center of excellence. The nurse manager teaches direct care nurses about opportunities available to them in the process. Which task would a direct care nurse be eligible for?

Conducting a literature review In an orthopedic center, the direct care nurse is eligible for participating on the council to conduct a literature review on topics related to orthopedic product lines, innovative orthopedic joint replacement procedures, and programs related to the orthopedics evidence-based practices for joint replacement. The other activities such as developing a budget, conducting a needs assessment, and forming an advisory committee are not the responsibilities of a direct care nurse. The members responsible for developing budget are assistant vice president of client care services and orthopedic product line manager/nurse manager. The Director of Nursing, orthopedic product line manager, and strategic planning and marketing director are responsible for conducting a needs assessment. The members responsible for formation of an advisory committee are the client satisfaction director, physician champion, vice president of client care services, orthopedic staff across the continuum of care, director of rehabilitation services, and vice president of medical affairs.

Which type of leadership theory explains the effectiveness of leadership and depends on the match between a leader's style and the demands of a situation?

Contingency Model Fiedler developed the Contingency Model, which explains that the effectiveness of the group depends on an appropriate match between a leader's style and the demands of a situation. Path-Goal theory was developed by House and Mitchell and explains the personal characteristics of followers and environmental demands. The Two-factor theory was developed by Herzberg for motivation in leadership. Normative-Decision Making Model is a problem solving approach developed by Vroom and Yetton.

Four nurse leaders are performing different tasks. Which nurse leader's action indicates the role of the community nurse leader?

D The nurse as a community leader has the unique opportunity to work with schools, city or county governments, and other community entities. The nurse as a community leader formulates a vision for improving the health of the community through disease prevention and health promotion. Therefore administering vaccines by Nurse leader D to the children in school to prevent disease indicates that the nurse is performing the role of the community nurse leader. Scheduling the client for a surgery may not be done in a community; therefore this action of Nurse leader A does not indicate the role of the community nurse leader. Assisting the client in positioning him or her on a bed can be done wherever possible, such as in client's home or healthcare facility. Therefore this action by Nurse leader B does not indicate the role of the community nurse leader. Teaching the student nurse to administer an intramuscular medication can be done in a healthcare facility also, therefore this action by Nurse leader C does not indicate the role of the community nurse leader.

A hospital's emergency power generators were accidentally destroyed. The hospital management has decided to move the clients to another hospital. Which staff interventions are appropriate to ensure client safety? Select all that apply.

Damage to power generators is an example of an internal disaster that can pose danger to clients. Shifting clients to another hospital can help reduce the risk. Hospital staff should carry flashlights to ensure adequate lighting during the move and avoid injuries to clients and themselves. The hospital staff should use staircases to shift clients as the elevators would be non-functional due to power loss. The hospital staff would ideally wear headlamps if they are available as these can provide hands-free lighting. Glow sticks provide lighting and can be used while shifting clients. As previously mentioned, elevators are nonfunctional in the event of power loss and would not be used.

The registered nurse is assessing four members of the health care team before assigning a task. Which person is best suited for delegation of the task?

Delegatee D Delegatee D is best suited for delegation of the task because he or she has an established relationship and expertise and can perform the task with little guidance from the delegator. Delegatee A has limited knowledge and ability to perform the task may require more guidance and explanation. Delegatee B has an established relationship; however, the task is new and the delegatee may require explanation. Delegatee C is willing and able, but the relationship is new, which may require the delegator and delegatee to create mutual expectations and conditions for performing the task.

The National Council of State Boards of Nursing (NCSBN) committee has realized that the job descriptions of some healthcare professionals are inconsistent. Which healthcare member is the NCSBN referring to?

Delegation can be challenging because UNPs are educated in a formal program of study but the educational preparation and job descriptions of UNPs are not consistent. Therefore, the NCSBN has expressed concern and recommended that these educational programs have greater public authority. The registered nurses' job descriptions are not inconsistent. Chief nursing officers have well-defined job descriptions. Licensed vocational nurses also do not have inconsistent job descriptions.

Which statement is correct regarding delegation? Select all that apply.

Delegation involves two people—delegator and delegatee—with the transfer of authority to perform the task. The delegator retains accountability for the outcome of the task delegated. The delegatee holds responsibility but not accountability for the task. Assignment involves the transfer of both responsibility and accountability of the work to the delegatee. Principles of delegation outline what nurses need to know and do in relation to completing the task

Which beliefs may be associated with a registered nurse's failure to delegate tasks? Select all that apply.

Delegation is too time consuming. More energy is required to delegate others. The registered nurse will not receive credit for total client care.

Which group discussion technique involves a large number of respondents who may be participating in the discussion remotely?

Delphi technique The Delphi technique includes the feedback of anonymous people who may not physically convene. These participants may be located throughout the country or the world. In the case of focus groups, the interaction is face to face. Brainstorming involves listing all ideas without critique or discussion. In the nominal group technique, participants are asked to not talk to each other as they write down their ideas to solve a predefined problem or issue.

Which description of accountability is correct?

Determination of appropriate actions and provide detailed explanations of the actions

Newly hired UAP expresses fear to collect a sputum from HIV patient

Determine the UAP's knowledge about HIV transmission.

Which are the priority nursing actions after the completion of the secondary survey when providing care for a trauma client with a penetrating wound? Select all that apply.

Documenting the client's care Administering tetanus prophylaxis to the client

How can registered nurses develop delegation and supervisory strategies to adapt to their changing roles? Select all that apply.

Engaging a nurse mentor helps provide guidance and facilitate problem-solving related to delegation and supervision. Reinforcing delegation knowledge through continuing education helps nurses become familiar with the changing trends in health care delivery in context of delegation. Seeking high-quality clinical delegation experience early in a nurse's career helps nurses gain confidence in delegation skills. Practicing the nursing care process in various clinical settings helps the nurses to improve patient outcomes, but would not specifically help develop delegation and supervisory strategies. Becoming familiar with the hierarchy of authority in the health care organization may help nurses understand management-related issues. However, this knowledge would not directly help nurses develop delegation and supervisory strategies.

Which care settings are more suitable for unlicensed nursing personnel (UNP)? Select all that apply.

Extended care and long-term care settings are more suitable for unlicensed nursing personnel (UNP). Acute care, surgical care, and emergency care settings require highly qualified and licensed nursing professionals. Acute care, surgical care, and emergency care are not suitable for UNPs because the clients are less stable compared to those in extended care and long-term care. Since acute care, surgical care, and emergency care settings require highly qualified and licensed nursing professionals, the UNP's role is very limited.

Which behavior of the nurse as a leader would be considered a smart trust action according to Covey?

Focusing first on developing character Covey's smart trust actions help leaders develop high trust in a low-trust world. Focusing first on developing one's character is a smart trust action of a leader. Leading a balanced life, engaging in self-renewal, and seeing life as an adventure are Covey's characteristics of leadership.

Which aspect relates to the quality of relationships while assessing the degree of conflict resolution in nursing leadership? Select all that apply.

Generation of empathy Understanding being created

No heroic measures

Give detailed report to accepting nurse.

Which activity performed by the registered nurse (RN) indicates effective supervision of the delegatee?

Guiding the delegatee while he or she is performing the task

What is discussed in Hersey's 2006 model related to delegation?

Hersey's model describes situational leadership, which include the core competencies of a situational leader. Anthony and Vidal described the five rights of delegation. Hersey's model does not include the legal authorities for delegation. Anthony and Vidal described characteristics of communication, such as information decay and information salience.

While performing a secondary emergency assessment survey, the nurse uses the mnemonic AMPLE to determine the client's condition after a natural disaster. Which type of assessment is performed in this scenario?

History and head-to-toe assessment involves use of the mnemonic AMPLE that includes Allergies, Medication history, Past health history, Last meal, and Events preceding illness/injury to determine the history of the client. Giving comfort measures is an emergency assessment that is used to assess, treat, and reassess for pain and anxiety. Posterior surfaces are inspected to determine bleeding, bruises, and lacerations. Facilitating family presence includes determining the caregiver's desire to be present during invasive procedures.

The nurse administrator for a long-term care facility is implementing a disaster response plan for staff and residents. Which staff member statements indicate correct understanding of the plan? Select all that apply.

Hospitals are not the only health care agencies that are required to practice disaster drills. Long-term care (LTC) facilities are also mandated to have annual drills to prepare for mass casualty events. Part of the response plan must include a method for evacuation of residents from the facility in a timely and safe manner. Nursing homes are also required to have a disaster response plan. Long-term care facilities are not held to the same standards as hospital facilities. Insurance payment for medical care is not contingent on the implementation of a disaster response plan.

The hospital administration promotes a nurse leader to the role of nurse manager and provides the opportunity to participate in a quality improvement plan. Which statements made by the new nurse manager indicate there is a need for revising the responsibilities in the quality improvement plan? Select all that apply.

I will build infrastructure and remove the barriers for improvement." "I will implement the systems for internal and external reporting of information." "I will define the procedures for immediate responses to errors that involve care.

The leader teaches the student nurse about the way to make caring visible to a client who has undergone a hip replacement surgery. Which statements made by the student nurse to the client indicate ineffective learning? Select all that apply.

I'll call your daughter, did you take your medication this morning It is important as a nurse to show visible caring to the client. When the student says "I will call your daughter" and "Did you take your medicine this morning when I was late" there is no indication of visible caring, therefore these statements indicate ineffective learning. The student nurse should say "I will call your daughter for you" and "I hope that someone assisted you with your medications this morning; I am sorry that I was late." By saying "I really admire your courage," the nurse expresses appreciation, which shows caring. "I can imagine this might feel scary for you" shows that the nurse is listening to the client actively, which also reflects care. By saying "I want to make you comfortable. Here's a blanket," the nurse shows his/her clear communication and positive intention, which also reflects visible caring for the client.

A patient care associate (PCA) is delegated a task that can be completed in 2 hours. The PCA has limited knowledge and willingness regarding that particular task. Which leadership style should be implemented by the delegator in this situation?

If the ability and willingness of the delegatee is low and the work assigned to the delegatee can be completed in 2 hours, it means the nature of relationship between delegator and delegatee is limited. In such situation, the leadership style of the delegator should be telling, because it provides a fair amount of guidance and also limits the time spent on the interactions. The selling style of leadership should be used when the relationship is ongoing; that is, individuals who usually work together continue to work together. The monitoring style should be used when the delegatee has the ability and willingness, and has an established relationship with the delegator. The participating style can be implemented when the delegatee is willing to perform the task. Tip: Hershey's Model of leadership provides solid foundation for delegation

The registered nurse (RN) delegates a task to the licensed practical nurse (LPN). If the LPN fails to perform the task within acceptable standards, what would happen? Select all that apply.

If the delegated task is not performed within acceptable standards, a potential for nursing malpractice emerges. Failure to delegate and supervise within acceptable standards may extend to direct corporate liability for the institution. Whenever care is provided by staff other than a registered nurse (RN), the accountability for care remains with the delegator who is an RN. The licensure of the licensed practical nurse (LPN) would not be cancelled because the LPN is not held accountable for the situation. When the work is assigned to the LPN, only responsibility of the task is transferred.

Which drawback indicates an improper follow-through on the part of a delegatee?

Improper follow-through on the part of a delegatee is failure to report results and findings. Improper follow-through occurs when the delegator does not understand the skills and abilities of the delegatee and does not provide clear and concise directions to the delegatee. The lack of cooperation with team members may be improved by educating, guiding, and monitoring the delegatee.

The nurse is hired to work in a Magnet hospital. What should the nurse expect when providing care in this organization?

In Magnet hospitals, staff have autonomy and control over nursing practice. This would include attending care conferences to discuss client care needs. Salaries planned according to education level and assignments made according to years of experience would be expected in an environment with differentiated nursing practice. There is no care delivery method that utilizes physician input for annual performance appraisals.

In a long-term care facility, the care tasks for a client who is suffering with liver disease are being delegated. Which statement made by the delegator indicates the responsibility for the tasks is with the registered nurse? Select all that apply.

In a long-term care facility, the registered nurse will be responsible for supervising the licensed nursing professionals who will be the performing the delegated tasks. The registered nurse takes the responsibility of assessing alleviation of symptoms and monitoring the client on an hourly basis. Admission of the client to the ICU is the responsibility of the registered nurse. The licensed practical nurse (LPN) or the licensed vocational nurse (LVN) is responsible for taking the responsibility for the whole nursing unit. The LPN or LVN will be delegated the task of providing the treatments that are prescribed by the primary healthcare provider.

The registered nurse is caring for a client admitted with sudden paralysis in the legs and an inability to walk. Which interventions made by the registered nurse (RN) indicates correct active delegation? Select all that apply.

In active delegation, the RN assesses the situation, determines what is appropriate for client care, directs assistive personnel to perform certain tasks, and holds the individual accountable. Instructing the LPN to report the client's vital signs is an active delegation that includes directing the assistive personnel to perform the task. Instructing the unlicensed nursing personnel to administer oral vitamin D3 is beyond their scope of practice. The RN assessing the client's diagnostic and laboratory findings does not involve delegation. The RN administering an intravenous calcium gluconate injection does not involve delegation. Instructing the LPN to administer a vitamin B12 injection is within the scope of practice for the LPN.

The registered nurse delegates the tasks related to caring for a client who has undergone surgery. What are the benefits of delegation in this situation? Select all that apply.

Increased efficiency Improved quality of client care Increased professional skills of the unlicensed assistive personnel

How does the nurse leader, being in an executive position, perform Gardner's motivating task?

Inspiring the staff and community leaders to achieve desired levels of health and well-being

The registered nurse (RN) finds that a student nurse is unwilling to participate in a community health literacy program conducted for clients with diabetes mellitus . Which action of the RN portrays his or her leadership ability?

Inspiring the student nurse to take active participation

As a nurse prepares an older adult client for sleep, actions are taken to help reduce the likelihood of a fall during the night. What nursing action is most appropriate when targeting older adults' most frequent cause of falls?

Instructing the client to call the nurse before going to the bathroom

How should a student nurse be trained for implementing delegation in practice?

Interaction with highly qualified, clinically experienced nursing mentors fosters professional self-confidence in the student nurse. These experiences allow student nurses to build up their ability to be successful delegators. Delegation knowledge should also be reinforced in nursing continuing education programs. Didactic content about delegacy can be improved by pairing the education and the clinical experience from the healthcare practice site. The student nurse does not have enough knowledge to make master delegation decisions without adequate training.

While caring for clients who survived an earthquake, the nurse finds the need to free up inpatient beds for disaster victims. Which clients does the nurse plan to discharge? Select all that apply.

Medical-surgical unit nurses, in collaboration with healthcare providers, decide to recommend clients for discharge to free inpatient beds for disaster victims. Clients who can be treated in long-term care and who can be cared for in rehabilitation should be discharged. Clients who have had no critical change in condition for the past 3 days should also be discharged to free up inpatient beds for disaster victims. Clients who are admitted for observation and are not bedridden can be discharged. Clients who have diagnostic evaluations and are not bedridden can be discharged.

The legal authority has delegated the tasks according to the model of analysis type of care. Which statements are true regarding the model analysis? Select all that apply.

Model analysis is a type of care that benefits clients in terms of satisfaction of care being provided. In model analysis, the team nursing method is followed. It is a cost-effective system because it works with an expected ratio of unlicensed to licensed personnel. Organizational decision making occurs at lower levels in model analysis. Control of quality is lower in model analysis. There may be inadequate communication among staff members due to the higher potential for fragmentation of care. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.

The nurse is relating to and inspiring the client who has a psychiatric disorder to achieve the client outcomes. Which of Gardner's leadership tasks is reflected in the nurse's actions?

Motivating When the nurse relates to and inspires the client with a psychiatric disorder to achieve the client outcomes, the nurse is motivating according to Gardner's leadership tasks. Gardner's leadership task of envisioning goals involves envisioning client's outcomes for single clients/families. Gardner's leadership task of serving as symbol involves representing the nursing profession and values and beliefs of the organization to clients and families and other community groups. Gardner's leadership task of achieving workable unity involves assisting clients and families in achieving optimal functioning to benefit the transition to enhanced health functions.

Which statement is true regarding delegation? Select all that apply.

Open lines of communication between delegator and delegatee helps to eliminate any misunderstanding regarding delegated tasks. Delegation occurs only when at least two people are involved in a mutual work situation; one who has the authority to perform specific tasks and other who holds accountability for the task being performed. Delegation involves sharing activities with other appropriate authority to accomplish the work. When delegating a task to delegatee, the delegator retains accountability for effective client care by ensuring that the task is completed by the right person and that the person is supervised appropriately. The delegation potentials are significantly higher when caregivers such as UNPs are partnered.

Which behavior from the nurse leader exhibits charismatic leadership qualities?

Possesses an inspirational quality that makes team members attracted to him or her Charismatic behavior is seen in the transformational leadership style; this inspiring quality attracts team members. By sharing a vision the leader is not attracting team members; therefore this may not be a charismatic leadership behavior. Encouraging innovation and creativity in problem-solving will exhibit a quality of intellectual stimulation and is a transformational leadership behavior. Charismatic behavior is not seen in the transactional leader.

Which qualities of a leader indicate a transformational approach to leadership? Select all that apply.

Possessing charismatic behavior Possessing intellectually stimulating behavior Having inspirational and motivational behavior The leader who has a transformational approach to leadership possesses charismatic behavior, intellectually stimulating behavior, and inspirational and motivational behavior. The transformational leader follows an inspirational and motivational approach. The leader who uses the transactional leadership approach has a punitive nature and gives rewards to followers contingently

What are the various challenges related to delegation? Select all that apply.

Providing clear direction to the delegatee aids accomplishment of the specified task in the given time. Understanding the specific skill set and capabilities of the delegatee is a crucial element in the delegation process. Selecting a delegatee with the specific skill set for the particular task is more productive than just selecting a competent individual. Maintaining an open line of communication with the delegatee, without any derogatory or offensive comments, yields a collaborative and productive work environment. Providing verbal attack feedback may not produce effective change and could undermine any long-term working relationship. Creating a working environment is an essential and easy delegation task that is essential to promoting positive work output.

The registered nurse (RN) delegates a task to a licensed practical nurse (LPN) to take care of the client who underwent a tracheostomy. Which task should be performed by the LPN in this situation?

Providing tracheostomy care using sterile techniques The licensed practical nurse provides tracheostomy care using sterile techniques. Developing a plan to avoid aspiration in a client with tracheostomy is done by the registered nurse. Assessing the client's condition after tracheostomy is done by the registered nurse. Teaching a client and caregiver about home tracheostomy care is done by the registered nurse.

Which type of behavior by the registered nurse results in a low-to-stable level of commitment?

Punitive Punitive behavior is a type of transactional leadership behavior that results in a low-to-stable level of commitment as an organizational outcome. Charismatic, inspirational, and intellectual stimulation are transformational leadership behaviors that result in increased commitment as an organizational outcome.

A client with dehydration is prescribed an intravenous (IV) fluid infusion. Which healthcare professional would the nurse expect to be delegated this task?

RN

A critically injured client was brought to the hospital following a car accident and the client should be immediately triaged for determining the nature and acuity of the injuries. Who is delegated to perform the task?

RN

To improve client care, the registered nurse (RN) has delegated tasks involved in assisting the client with activities of daily life (ADLs) to a certified nursing aide, and the administration of oral medications to the licensed practical nurse. Which member of the health care team would be accountable for the final client care?

RN

Which healthcare professional would the nurse know is held accountable for the tasks performed by the patient care associate (PCA)?

RN

Which member of the health care team is accountable for initial assessment and ongoing evaluation of client care?

RN

Which team member is most accountable when delegating a task to the healthcare team?

RN

Who is accountable for the ongoing evaluation of a client's care?

RN

Who is mainly responsible for analyzing the knowledge and work of newly hired unlicensed assistive personnel (UAP) before delegating a task?

RN

Who is most accountable for an initial assessment and the ongoing evaluation of client care?

RN

Which two factors would the nurse state influence the effectiveness of the leader? Select all that apply.

Readiness and assessment are two of the factors that influence the effectiveness of the leader. Ability and willingness are the two factors that need to be assessed to determine the level of the leader's readiness. The attitude is related to the individual's willingness.

who is accountable for the ongoing evaluation of a client's care?

Registered nurses are accountable for the initial assessment and the ongoing evaluation of a client's care. CNOs are accountable for establishing systems to communicate competency requirements related to delegation. The LPN directly provides care to the client. UNPs provide client care under the supervision of a registered nurse. Test-Taking Tip: Do not worry if you select the same numbered answer repeatedly, because there is no pattern to the answers.

The nurse manager orders the direct care nurse to assist in providing tertiary care to a client. Which type of treatment would the direct care nurse be involved in?

Rehabilitation Tertiary care includes rehabilitation. Chronic care and health maintenance are considered primary care, and prevention of disease complications is classified as secondary care.

The nurse, as a leader, takes care of himself or herself to promote the nurse's ability to care for the staff. Which of Gardner's tasks of leadership is the nurse applying in practice?

Renewing Leaders generate energy within and among others. When a nurse engages in self-care to enhance his or her ability to care for the staff, the nurse is applying renewing, one of Gardner's tasks of leadership. Affirming values involves assisting the client to sort out and articulate personal values in relation to health problems. Developing trust involves keeping promises given to clients or families. Serving as symbol indicates representing the nursing profession and the values and beliefs of the organization to clients or families.

A nurse encourages employees to implement a Magnet Recognition Program in the organization. The nurses think beyond their own personal needs and are clear about the group outcomes. Which leadership quality according to Gardner's tasks is reflected in the activity of the nurse?

Representing the group According to Gardner's Tasks of Leadership, encouraging employees to implement a Magnet Recognition Program shows that the nurse is representing the group. Trust develops when leaders are clear when providing direction and refrain from misdirecting others in their thinking and actions. The leader may serve as a symbol by becoming involved in public relations events, for example. The nurse as leader can achieve workable unity between and among parties by avoiding, diminishing, or resolving conflicts.

Which component of delegation is considered a "two way process"?

Responsibility is a two way process. Authority is the ability to perform duties in a specific role. Supervision is defined as the "provision of guidance and oversight of a delegated nursing task." Accountability may not be a two-way process. It determines if the actions were appropriate and provides a detailed explanation of what occurred.

While serving as a leader, the nurse uses contingent variables recognized by the path-goal theory of leadership. Which actions of the nurse reflect the use of contingent variables? Select all that apply.

Setting clear expectations, eliminating obstacles to go achievement, increasing opportunities for follower satisfaction eliminating obstacles to go achievement, increasing opportunities for follower satisfaction The two contingent variables recognized by path-goal theory of leadership are the personal characteristics of followers and environmental needs. The nurse as a leader uses these two contingent variables to set clear expectations, eliminate obstacles to goal achievements, and increase opportunities for follower satisfaction. Empowering staff and creating enthusiasm for practice reflect the application of transformational theories.

What are the roles and responsibilities of a senior nurse leader while implementing strategies for improving the quality of the organization? Select all that apply.

Setting priorities for staff effectiveness and client health outcomes Providing support systems for staff who have been involved in a sentinel event Building infrastructure, providing resources, and removing barriers for improvement

The care delivery committee is determining whether primary nursing would be appropriate to implement in a 500-bed acute care hospital. Which information would support the selection of another care delivery approach? Select all that apply.

Short lengths of stay do not provide enough time for the primary nurse to plan, coordinate, and implement all aspects of a primary client's needs. Nurses with limited experience may not be prepared educationally for primary nursing. Primary nursing is costly since the entire staff is made up of registered nurses. Since the organization was 120% over budget for salaries during the last quarter, the organization may not be financially able to implement primary nursing. Primary nursing does not use unlicensed assistive personnel (UAP) so only having 20 UAP for a 500-bed organization would support the implementation of primary nursing. Clients requesting one nurse to provide care would also support the implementation of primary nursing.

A nurse manager receives a complaint from a client that a particular staff member had been rude when providing care. The nurse, rather than punishing the staff member, listens to his or her side of the story and then talks to the client to clarify the misunderstanding. Which leadership theory is reflected in this scenario?

Situational-contingency theory Situational-contingency theory encourages an adaptive leadership style to focus on the issue being faced. The nurse manager understands the situation and makes a decision based on the complete information obtained. Trait theory explains a set of leadership traits that influence others toward a common goal. Two-factor theory involves application of hygiene factors and motivational factors to avoid and promote job enrichment. Expectancy theory refers to a perceived probability of fulfilling a particular need based on experience.

The nurse leader is involved in the planning of initiation of a healthcare organization. What is the correct sequence of events for strategic planning?

Strategic planning to set up an organization includes four phases. The first step is to assess the internal and external environments that include economic factors such as rates of healthcare costs and technological factors such as availability of diagnostic services. The second step is to set the goals that include developing protocols for standardizing client care. The third step is to identify the strategies to meet the goals such as preparing the budget and developing the short-term and long-term goals. The fourth step is to implement the specific plan of action prepared and evaluate the strategic plan such as developing client questionnaires regarding the care provided.

The student nurse is assisting the registered nurse (RN) in collecting feedback from superiors and peers. The questions they are asking address comments to the RN about his or her work quality that affects the environment and overall productivity. Which theory does the student nurse think the RN is applying practically as a leader?

Style theory Style theory measures the achievement of satisfactory performance. It requires supervisors to pursue an effective relationship with their followers. Therefore leaders need to obtain feedback from their followers, peers, and superiors. Trait theory involves the leader using self-awareness of his/her traits. It is useful in self-development as well as in seeking employment that matches the traits. Transformational theory includes a process in which the leader attends to the needs of the followers. This interaction raises the followers to higher levels of morality. Situational-contingency theory involves leaders considering the challenge of a situation

While delegating a specific task, the registered nurse says to the delegatee, "It is important that you measure the client's blood pressure every 15 minutes." What does this situation indicate?

Telling the delegatee that it is important to take the client's blood pressure every 15 minutes indicates that the delegatee has limited knowledge and the delegator is providing guidance. Telling a delegatee that he or she knows what to do and when to report indicates that the delegatee requires little guidance. Telling the delegatee that this is what is needed to accomplish a task indicates that the delegator is providing guidance to the delegatee. If the delegator and delegatee share mutual experiences, it indicates that the delegator and delegatee are creating mutual expectations.

The newly hired nurse is delegated the task of preparing the client care plan for a diabetic client who underwent amputation. Which task in the care plan is inappropriate according to guidelines?

The LPN's scope of practice includes monitoring vital signs in clients with a stable condition. Instructing the LPN to monitor the vital signs of a client in an acute condition is inappropriate according to the guidelines. Administering antidiabetic medications to a diabetic client who underwent amputation should be done by the RN because the condition of the client is acute. The RN is responsible for assessing the blood glucose levels of the client who underwent amputation. The LPN is instructed to change the dressing at the amputation site.

After a bomb blast in a city, why would the federal government send the Medical Reserve Corps (MRC) to the site?

The Medical Reserve Corps (MRC) helps establish first aid stations or special-needs shelters to victims of a disaster. The National Disaster Life Support Foundation renders core, basic, and advanced disaster life support training courses. International Medical Surgical Response Teams (IMSuRTs) establish fully functional field surgical facilities. A Disaster Medical Assistance Team (DMAT) is a medical relief team that is deployed to a disaster area with enough medical equipment and supplies to sustain operations for 72 hours.

The registered nurse (RN) delegates the task of caring for a client with a leg fracture to a licensed practical nurse (LPN) and asks the LPN to alert her if any issues arise. What approach is the RN taking as delegator in this instance?

The RN as delegator asks the LPN as delegatee to contact her if any issues arise while caring for the client; this approach involves the RN providing little guidance to the LPN. Supervision involves more than simply requesting that the delegatee alert the delegator if any issues arise. The delegator provides explanation when a new task is being delegated to a delegatee who has an established relationship with the delegator. The delegator and delegatee must establish mutual expectations when the delegatee has willingness and ability but the relationship is new.

A client is diagnosed with cancer and is physically weak. The delegator has delegated the healthcare team members to care for the client. Which aspects of the care are most appropriate for the registered nurse (RN)? Select all that apply.

The RN is capable of providing physical and emotional aspects of care when the client is diagnosed with life-threatening conditions. The RN should take the responsibility of helping the client be hopeful about the treatment and providing emotional support to the client's family. Vitamin supplements are administered by the licensed practical nurse. The unlicensed nursing professional can collect the medical history. Collecting urine samples is delegated to nursing assistive personnel.

Which critical factors would the nurse say are associated with situational-contingency theory? Select all that apply.

The ability of the leader to reward followers The degree of trust and respect between leaders and followers The task structure about goals and the complexity of the problems being faced Situational-contingency theory considers three factors to be critical. It includes the ability of the leader to reward followers in terms of power and position. It is also comprised of the degree of trust and respect between leaders and followers. The task structure about goals and the complexity of problems faced is a critical factor. Environmental demands and the personal characteristics of followers are contingent variables.

Which critical factors would the nurse say are associated with situational-contingency theory? Select all that apply.

The ability of the leader to reward followersThe degree of trust and respect between leaders and followersThe task structure about goals and the complexity of the problems being facedSituational-contingency theory considers three factors to be critical. It includes the ability of the leader to reward followers in terms of power and position. It is also comprised of the degree of trust and respect between leaders and followers. The task structure about goals and the complexity of problems faced is a critical factor. Environmental demands and the personal characteristics of followers are contingent variables.

The nursing manager issued orders to take the utmost care of a client with myocardial infarction and expects the staff to obey and follow the rules immediately. Which type of decision making is the manager using?

The autocratic method results in rapid decision-making and is more appropriate in a crisis situation. Optimizing decision making is when the nurse considers both pros and cons of each position. Laissez-faire is a "hands-off" approach, which is taken by manager who chooses to do nothing when intervention is indicated. The bureaucratic style is focused on organizational rules and policies.

Which performance appraisal method is used by nurse managers to measure the performance of the nurse both qualitatively and quantitatively?

The behaviorally anchored rating scale is a performance appraisal method that provides an overview of nursing standards by determining performance both qualitatively and quantitatively. The narrative method requires a manager to write a statement about the nurse`s performance. The critical incidents type is a performance appraisal method in which a manager keeps a written record of positive and negative performance. The graphic rating scale form is a performance appraisal checklist on which a manager rates the nurse's performance on a continuum such as excellent, good, average, and poor.

A client is concerned about not receiving treatment due to a Medicare policy change. What is the accurate response of a nurse as a leader?

The change will not affect your treatment. A nurse leader ensures the changes made by the federal government or organization will not cause harm or financial burden to the client. Therefore a nurse leader should support the client by saying that the changes will not affect treatment. Follow-up visits are based on the client's condition, not on the changes made on the insurance policies. Increased duration and decreased effectiveness of the treatment indicates harm to the client and will not be caused by a Medicare policy change.

Which healthcare team member is familiar with all the needs of any individual client?

The charge nurse is involved in the coordination and assignment of care to individual clients. Therefore, the charge nurse is the only person familiar with all the needs of any individual client who is under care. Orderlies are unlicensed assistive personnel who are delegated to care for the client's basic needs and do not have complete knowledge of a client's condition. Nursing aides are not familiar with all client needs, but care for the client according to the tasks delegated to them. The patient care associate is an unlicensed nursing professional involved in basic care of the client.

Which priority interventions should be followed by the nurse when caring for a client with malignant hyperthermia? Select all that apply.

The client should be ventilated with 100% oxygen using the highest possible flow rate when malignant hyperthermia is evident. The client should be intubated immediately with an endotracheal tube. All inhalation anesthetic agents should be stopped immediately as the client's condition may worsen. The core body temperature should be monitored on an ongoing basis (wrong). An indwelling urinary catheter is inserted to monitor urine output, which is part of ongoing monitoring (wrong).

The registered nurse is caring for a client with dysrhythmias. Which action should the nurse perform immediately according to priority?

The client with any life-threatening complication such as dysrhythmias should be assessed for ABCs immediately because the client may suffer with airway obstruction. Oxygen saturation should be monitored during ongoing assessments and after providing the client with initial treatment. Intravenous access should be established after performing initial assessments such as vital signs. After assessing ABCs in a client with dysrhythmias, the client should be provided with oxygen via nasal cannula or nonrebreather mask to maintain oxygen levels.

Which behavior of the delegator with respect to the work delegated to a delegatee is characterized as "selling" according to the Hershey's Model?

The delegator's behavior when explaining or persuading the delegatee is characterized as " selling" according to Hershey's Model. The delegator's behavior when guiding or directing the delegatee is characterized as "telling." The delegator's behavior when observing or monitoring the delegatee is characterized as "delegating." The delegator's behavior when encouraging or problem solving is characterized as "participating."

The nurse as a leader is using a transactional leadership style. Which effect on followers often results from this style of leadership?

The followers will correct errors in a reactive manner. Transactional leadership depends on the power of the organizational position and the formal authority to reward or punish the employees. Transactional leadership often results in followers correcting errors in a reactive manner. Increased self-worth is a typical effect of transformational leadership on followers. Likewise, a transformational leadership style fosters a sense of being valued and a feeling that the work is challenging and meaningful.

The leader nurse is calculating the average daily census (ADC) in a 40-bed medical surgical unit, which accrued 679 client days in the month of July. What is the ADC on this unit? Record your answer using a whole number. ____________

The formula is client days for a given time period divided by the number of days in the time-period. There are 31 days in July, so 679/31 = 21.9. Therefore, the ADC is 21.9, rounded to 22.

What are the elements integrated into delegacy? Select all that apply.

The four elements that foster effective delegation decisions are safety, critical thinking, stability, and time. Leadership, critical thinking, communication, and clinical practice are the competency skills of a charge nurse.

A client requires emergency cardiac surgery. The leader nurse wants to make the client aware of the situation and wants the client to decide what should be done. Which ethical model does the leader nurse follow here?

The patient-benefit model uses substituted judgment, that is, what the client would want for himself or herself if capable of making these issues known. The autonomy model facilitates making decisions for competent clients. In the paternalistic model the managers decide what is best for their team. The social justice model considers broad social issues and is accountable to the overall institution.

The nurse is caring for a client with breathing difficulty and is unable to auscultate any breath sounds on one side. Which action should be implemented first by the nurse?

The priority care for clients with breathing difficulties who present with absent breath sounds is a needle thoracostomy. This procedure involves removing the fluid or abnormal air from the pleural space. Intubation is done for the client in severe respiratory distress. Supplemental oxygen should be given to the client with decreased oxygen saturation levels. Ventilation with a bag valve mask is given to clients if respirations are inadequate or absent.

The registered nurse is caring for an older client who is admitted with gastric ulcer and joint pains and is unable to perform activities of daily life (ADL). The legal authority has stated, "Provide the treatment according to the client's care sheet." Which delegatee should take up the task?

The registered nurse will delegate the task of providing medication to the client to the licensed practical nurse (LPN). The LPN's scope of practice is to administer oral medications and to provide the treatment that is prescribed in the client's case sheet. Orderlies are unlicensed assistive personnel who are delegated with tasks such as providing basic care, hygiene care, and assisting the clients in ADLs. Certified nursing aides are also unlicensed assistive personnel whose scope of practice does not allow them to perform tasks such as administering medications. A patient care associate is an unlicensed assistive personnel who can care for the client with basic needs such as ADLs

The registered nurse delegates the care of a client in the immediate postoperative period to the patient care associate (PCA). Which tasks performed are in the scope of practice of the PCA? Select all that apply.

The tasks that may be delegated to the patient care associate (PCA) for postoperative client care include providing basic comfort and hygiene. Feeding the client is basic care provided by the PCA. Assisting the client with bathing is the basic hygiene provided by the PCA. Primary ambulation of a postoperative client should be done by the registered nurse or another licensed practitioner. The PCA can monitor vital signs for stable clients but would not be delegated the task of monitoring vital signs for a postoperative client. Primary teaching of leg exercises to the client should be done by the registered nurse. Test-Taking Tip: The PCA has a limited scope of practice when delivering care to the postoperative client. When answering questions related to postoperative care, be specific about the role of PCA.

After the completion of training under the newly appointed transactional leader, the nurse manager intends to judge the performance of the new leader through interaction with the staff. What type of statements would the manager expect to receive when asking about the outcome of training? Select all that apply.

The transactional leader believes in punishment in order to accomplish a task. With the transactional leader, incentives and punishments are clearly defined for the staff. The followers might have been paid only if the work is satisfactorily completed. The followers minimize errors under a transactional leader; otherwise, it is corrected in a reactive manner. Transformational leadership may include coaching and mentoring. Challenging and meaningful assignments are part of transformational leadership.

Five victims of a shooting are identified as needing urgent care. What should the triage officer do first when these victims arrive in the emergency department?

The triage officer rapidly evaluates each person who presents to the hospital, even those who come in with triage tags in place. Client acuity is re-evaluated for appropriate disposition to the area within the ED or hospital best suited to meet the client's medical needs. The clients will need to be triaged before being sent to the operating room. The triage officer would not be responsible for conducting laboratory testing or notifying the next of kin of the victims.

Which phase in the disaster management continuum does the nurse understand as including the attempt to limit a disaster's impact on human health and community function?

There are five phases in the disaster management continuum, which include preparedness, mitigation, response, recovery, and evaluation. In mitigation, there will be plans for attempting to limit a disaster's impact on human health and community function. Recovery includes focusing on stabilizing the community and returning it to the previous status. Response includes implementation of the disaster plan. Preparedness is the preparation of a protective plan that is designed before the event has occurred.

After providing feedback to a student nurse, the registered nurse motivates the student nurse to become a leadership "tag." What does the registered nurse refer to by this statement?

To be philosophic, client-centered, and values driven

Which example would the nurse consider to be a part of systems thinking theory?

To focus on the needs of all residents in a long-term care facility The systems thinking theory would describe the need to focus on all the residents in a long-term facility care facility. Transformational theory is associated with promoting employee development. Leaders obtain feedback from peers and staff according to the style theory. Organizational behavior modification theory believes in avoiding situations that cause discomfort.

Which objective is associated with creating urgency in Kotter's eight-step model?

To generate open dialogue about external and internal realities The attribute of creating urgency is associated with generating open dialogue about external and internal realities. Short-term targets are created for creating short-term wins. Honoring the people who help complete the task anchors the changes in the culture. A culture created with continuous improvement builds on the change.

An organization having poor work flow was suffering financial losses. A team member introduced creative solutions that were publicly recognized by leadership. Which leadership theory is at work in this scenario?

Transformational theory Transformational leadership refers to a process by which the leader attends to the needs and motives of subordinates in order to motivate. A creative initiative by an employee and an optimistic attitude of a leader towards subordinates indicates successful impacts of transformational theory. Trait theory explains that a set of leadership traits influences others to work towards a common goal. Style theory involves task behaviors and relationship behaviors that determine leadership effectiveness. Situational-contingency theory considers the challenge of a situation and develops an adaptive leadership style to resolve the issues.

Which members of the healthcare team are under dependent status when a task is delegated by the registered nurse (RN)? Select all that apply.

Unlicensed nursing personnel (UNP), the licensed practical nurse (LPN), or the licensed vocational nurse (LVN) whose function is under the direction of a registered nurse are given dependent status. The client attendant and the LVN are on dependent status when a task is delegated by the RN. The unit secretary is a member of the healthcare team but is devoid of formal preparation or legal recognition. The RN is the leader of the team and has responsibility for other members of the group. The primary healthcare provider is a member of the healthcare team but may delegate tasks to those with dependent status.

The nurse resolves a conflict with another nurse by using accommodation. In what situations is accommodation appropriate for resolving conflict? Select all that apply.

When facing trivial issues When the other person's solutions appear better When harmonious relationships have to be preserved

The registered nurse (RN) who delegates work to a newly hired licensed practical nurse (LPN) says, "Please tell me how you will go about performing this procedure, and I will share my expectations with you." Which behavior strategy of Hersey's model is being applied?

When the LPN has the willingness and ability to perform a task, but the relationship is new, the RN will share his or her expectations and conditions with the LPN. This is a clinical example of participating. Participating is encouraging the delegatee to perform the task and taking an active part in problem solving, which may occur during the execution of a given task. If the LPN has limited knowledge and ability to perform a task, the RN will provide more guidance, which is an example of telling what is the task to be done and how it is to be performed. If the LPN is delegated a new task, it requires explanation from the RN. This is termed as selling in Hersey's model, which is the process of explaining and persuading; this happens if a situation involves a new task and the relationship is ongoing. If the LPN has an established relationship and experience, he or she requires a little guidance and this is called delegation.

In which situation would activation of the emergency preparedness plan be necessary? Select all that apply.

When the number of casualties exceeds the usual resource capabilities, a disaster situation exists. The pleasure boat victims are being taken to a community hospital on a Saturday night when staffing is typically lower. Likewise, the victims of a manufacturing plant explosion are being taken to an urban hospital during the time of lower staffing. The victims of a bus accident are being taken to a community hospital on a holiday, during which staffing is generally lower. The number of victims from a senior citizen's housing facility fire is large and could overwhelm available resources at the community hospital. The victims of food poisoning can easily be taken care of by existing staff and resources at an urban hospital on a weekday afternoon.

While caring for a client with severe fever, the registered nurse (RN) delegated the task to a new delegatee to assist the RN in recording the temperature. Which instruction given by the RN indicates that the delegatee is new to working with that RN?

When the work relationship is new, the registered nurse (RN) should ask the delegate to explain how he or she would perform a particular task. So, learning how the delegatee will record the temperature will help to create mutual expectations and conditions for performance. Recording the temperature every hour is the instruction given to the delegatee who has limited knowledge and limited ability to perform the task. Telling the delegatee what is necessary while recording the temperature is important to a delegatee who is new to the assigned task. A delegatee with good knowledge needs minimal guidance, but he or she should remember to report any client issues to the available RN at any time.

The registered nurse assists other registered nurses when there are no safety issues. While assisting, the registered nurse uses the strategy of asking. What is the benefit of this strategy? Select all that apply.

When there are no safety issues, the registered nurse can assist other nurses by using different strategies. The strategy of asking begins with questions related to the problem or issue regarding client care and it allows the nurse to reassess and examine the situation differently. Asking provides an opportunity to open lines of communication between the delegator and delegatee. The strategy of doing helps in demonstrating a specific task or behavior to improve client care. The strategy of offering helps in making a suggestion to facilitate the achievement of a desirable client care outcome.

The direct care nurse, as a leader, finds that there is no formalized mechanism for providing input for organizational decision making. Which strategies does the nurse use in this situation? Select all that apply.

When there is no formalized mechanism for input into organizational decision making in a hospital, the direct care nurse uses some strategies for influence. These strategies include filing official complaints, creating unit campaigns, and holding informal discussions. Mobilizing volunteers for health fairs is the role of nurse as community leader. Inspiring staff in changing the workplace is the role of the nursing manager.

Arrange the steps in the order that a nurse leader would implement while following the strategic marketing planning process.

While implementing strategic marketing planning, the first step is to analyze the mission and culture to which the strategy is contributing. The next step is to assess strengths, weaknesses, opportunities, and threats (SWOT analysis) presented by the external environment. This is followed by analyzing the future environment the marketer is likely to face. Determining the objectives and goals for the relevant planning period should be performed next. To achieve the specified goals, the core marketing strategy needs to be formulated after the objective has been determined. The final step is to establish the benchmarks to measure interim and final achievements.

A client is hospitalized with dehydration and dysphagia. Which tasks are appropriate to delegate to a licensed practical nurse? Select all that apply.

administer meds assists UAP with ambulation record vital signs

Arrange in order the series of tasks to be performed by the registered nurse (RN) to determine active delegation?

assess determines UAP monitor In active delegation, the registered nurse (RN) assesses the situation, determines which condition is appropriate for client care, makes a care plan, and then directs an unlicensed assistive personnel (UAP) to perform required tasks. When the UAP has completed the task, the RN monitors the condition of the client once again.

A registered nurse (RN) wants to delegate the task of maintaining foot hygiene in a client to anunlicensed nursing personnel (UNP). What is the sequence of events to be executed by the RN in delegating this work?

assessing determining monitoring providing Before deciding to delegate the work to the UNP, the RN should assess the UNP's skills. If the UNP is skillful, the nurse should determine which tasks may be assigned and monitor the tasks once they have been allotted. Feedback should be provided by the RN once the task has been completed.

The nurse manager finds that there is an increased infection rate in the unit due to an increased number of client visitors. The nurse believes that a change in the visitor policy could help reduce the infection rates. The leader is initiating an open dialogue about external and internal realities among the team members. Which attribute of Kotter's eight-step model is involved in this action by the nurse manager?

creating urgency

Which of these clients can be provided care safely by unlicensed nursing personnel? Select all that apply.

stable recovering

During a status meeting for a research project, the project leader asks the team members for feedback. What leadership theory is represented by the action of the leader?

style theory