Leadership Test 2

10. A verdict of suspension or loss of licensure represents what type of law? A) Criminal B) Civil C) Administrative D) Judicial

Ans: C Feedback: A verdict of suspension or loss of licensure represents administrative law. This type of law is not based on any of the other options.

16. What is the basic argument for the use of rational nempirical change strategies? A) Information supports change B) Peer influence brings about change C) Reward-based incentives influence change D) Punishment supports the acceptance of change

Feedback: The change agent using this set of strategies assumes that resistance to change comes from a lack of knowledge and that humans are rational beings who will change when given factual information documenting the need for change. Normativenreeducative strategies use group norms and peer pressure to socialize and influence people so that change will occur. Powerncoercive strategies, features the application of power by legitimate authority, economic sanctions or rewards, or political clout of the change agent.

13. What component of professional negligence is represented when a nurse fails to look up an unfamiliar medication before administering it? A) B) C) D)

Ans: Duty to use due care Failure to meet standard of care Foreseeability of harm A direct relationship between failure to meet the standard of care (breach) and injury can be proved C Feedback: The nurse must have reasonable access to information about whether the possibility of harm exists not fulfilling this responsibility may result in a foreseeable harm to the client. None of the remaining options are relevant to this criterion.

23. Which statement is true concerning the refreezing phase of the change process? Select all that apply. A) B) C) D)

Ans: Feedback: During the refreezing phase, the change agent assists in stabilizing the system change so that it becomes integrated into the status quo. If refreezing is incomplete, the change will be ineffective and the prechange behaviors will be resumed. For refreezing to occur, the change agent must be supportive and reinforce the individual adaptive efforts of those affected by the change. Because change needs at least 3 to 6 months before it will be accepted as part of the system, the change agent must be sure that he or she will remain involved until the change is completed. The successfulness of the refreezing stage is dependent about the acceptance of change by all staff. The focus of this phase is to integrate the change into the status quo Stabilization of change requires a 6- to 9-month period of time If refreezing is incomplete, prechange behavior will be resumed The change agent must remain involved until the refreeze stage is complete A, C, D

25. Which activity best demonstrates a nursing unit managers attention to the ethics standards of practice required of that position? A) Membership on the institutions ethic board B) Terminates a staff member for absenteeism C) Assures staff and patients that unit decisions are ethically sound D) Holds membership in the local and state American Nurses Association (ANA)

Ans: A Feedback: ANA standards for ethics related to nurse administrators identifies participants on multidisciplinary and interdisciplinary teams that address ethical risks, benefits, and outcomes as a criteria measurement. The remaining options while addressing ethical behaviors on the administrators part are not as directly identified by the ANA.

What does the morale principle of autonomy govern? A) A persons right to make his or her own decision B) The obligation to do good and prevent harm C) Doing what is right and fair D) Truth telling

Ans: A Feedback: Autonomy, or self-determination, is also referred to as freedom of choice and accepting the responsibility for ones choice. None of the other options addresses this concept.

7. Which would be a normal and expected behavioral response during the unfreezing phase of change? A) Anger B) Withdrawal and acceptance C) Open acceptance D) Active collaboration

Ans: A Feedback: During the unfreezing stage, people become discontented, and even angry, with the status quo. Ironically, they may also become angry that change is needed, because of the resistance that is a normal and expected part of the change process. The other options are not usually associated with the unfreezing phase of change.

9. Which behavior/attitude makes it likely that a planned change will be unsuccessful? A) The suggested change is brought forward after the plan has been formalized B) Individuals affected by the change are involved in planning for the change C) The change agent is aware of the organizations internal and external environment D) An assessment of resources to carry out the plan is completed before unfreezing

Ans: A Feedback: Employees should be involved in the change process. When information and decision making are shared, subordinates will be more accepting of the change. The other options support the change.

What document permits a registered nurse to offer special skills and knowledge to the public in a particular jurisdiction when such practice would otherwise be unlawful? A) A state nursing license B) Institutional licensure C) ANA certificate D) ANA practice standards

Ans: A Feedback: In general, a license is a legal document that permits a person to offer special skills and knowledge to the public in a particular jurisdiction when such practice would otherwise be unlawful. A state nursing license allows for the practice of nursing in a specific state. Some professionals have advocated shifting the burden of licensure, and thus accountability, from individual practitioners to an institution or agency. Proponents for this move believe that institutional licensure would provide more effective use of personnel and greater flexibility. The ANA is not capable of permitting a person to practice nursing.

4. The nurse witnesses a patient sign an operative permit form. Legally, what does the nurses signature imply? A) Observed the client sign the consent form B) Is certain the client understands the proposed procedure C) Believe the client is capable of understanding the proposed procedure D) Assumes the client has had an adequate evaluation to agree to the procedure

Ans: A Feedback: Informed consent is obtained by a physician; therefore, a nurse is not legally responsible for informed consent but is confirming that the client signed the consent form. The other options are the responsibilities of the professional performing the procedure.

17. Which change is easier to make? A) Personal behavior B) Group behavior C) Group knowledge D) Personal attitudes

Ans: A Feedback: It is much easier to change a persons behavior than it is to change an entire groups behavior. It is easier to change knowledge levels than attitudes.

22. Which action is reflective of the leadership role necessary for a successful planned change to occur? A) Demonstrates flexibility in goal setting B) Recognizing the need for a planned change C) Identifying the resources that are available to support a change D) Support the staff during the implementation of a planned change

Ans: A Feedback: Leaders demonstrate flexibility in goal setting in a rapidly changing health-care system. The other options are associated with management functions associated with change.

5. Refusing to work with a staff member who dresses unprofessionally most closely represents which change strategy? A) Powerncoercive B) Normativenreeducative C) Rationalnempirical D) Resistancenwithdrawal

Ans: A Feedback: The powerncoercive strategy assumes that people are often set in their ways and will change only when faced by negative sanctions or some other method that demonstrates power and/or coercion. This is not the principle guiding any of the other options.

14. Collecting data about the ethical problem and identifying who should be involved in the decision-making process is accomplished in which phase of the MORAL decision- making model? A) Massage the dilemma B) Outline options C) Review criteria and resolve D) Affirm position and act

Ans: A Feedback: Massage the dilemma: Collect data about the ethical problem and who should be involved in the decision-making process. Outline options: Identify alternatives, and analyze the causes and consequences of each. Review criteria and resolve: Weigh the options against the values of those involved in the decision. This may be done through a weighting or grid. Affirm position and act: Develop the implementation strategy.

20. There are many terms used to describe moral issues faced by nurses, including moral uncertainty, moral conflict, moral distress, moral outrage, and ethical dilemmas. Which statement describes how moral uncertainty occurs? A) Occurs when an individual is unsure which moral principles or values apply andmay even include uncertainty as to what the moral problem is B) Occurs when the individual knows the right thing to do but organizationalconstraints make it difficult to take the right course of action C) Occurs when an individual witnesses the immoral act of another but feelspowerless to stop it D) Occurs when being forced to choose between two or more undesirable alternatives

Ans: A Feedback: Moral uncertainty occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is. Moral distress occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action. Moral outrage occurs when an individual witnesses the immoral act of another but feels powerless to stop it. Ethical dilemma is being forced to choose between two or more undesirable alternatives.

What is one way to promote open communication between patients and practitioners? A) Involving health-care consumers as active members of the health-care team B) Promoting the creation of cultures of patient safety in health-care organizations C) Establishing a federal leadership locus for advocacy of patient safety and health- care quality D) Building an evidence-based information and technology system that impacts patient safety and pursue proposals to offset implementation costs

Ans: A Feedback: One way to promote open communication between patients and practitioners is involving health-care consumers as active members of the health-care team. Pursing patient safety initiatives prevent medical injury by promoting the creation of cultures of patient safety in health-care organizations; establishing a federal leadership locus for advocacy of patient safety and health-care quality; and building an evidence-based information and technology system that impacts patient safety and pursue proposals to offset implementation costs.

What is one way to promote open communication between patients and practitioners? A) Involving health-care consumers as active members of the health-care team B) Promoting the creation of cultures of patient safety in health-care organizations C) Establishing a federal leadership locus for advocacy of patient safety and health- care quality D) Building an evidence-based information and technology system that impacts patient safety and pursue proposals to offset implementation costs

Ans: A Feedback: One way to promote open communication between patients and practitioners is involving health-care consumers as active members of the health-care team. Pursing patient safety initiatives prevent medical injury by promoting the creation of cultures of patient safety in health-care organizations; establishing a federal leadership locus for advocacy of patient safety and health-care quality; and building an evidence-based information and technology system that impacts patient safety and pursue proposals to offset implementation costs.

9. A state Nurse Practice Act is an example of which source of law? A) Statutes B) Constitution C) Administrative D) Judicial

Ans: A Feedback: Statutes are the only laws made by official enactment by the legislative body.

12. In planning strategies to prevent stagnation and promote renewal, which action would most likely result in the desired outcome? A) Developing a program for recruitment of young talent B) Rewarding employees by promoting from within C) Having set pay increases mandated annually D) Using longevity to determine committee selection

Ans: A Feedback: The constant influx of young talent brings new ideas to the organization. The other options are not as relevant to the prevention of stagnation and promotion of renewal.

How is the question of whether a nurse acted with reasonable care generally proven? A) The expert testimony of nursing witnesses B) The defendants explanation of what the nurse did C) The trial judge, after checking the outcome of prior similar court cases D) The testimony of expert medical witnesses

Ans: A Feedback: The testimony of other nurses in the same specialty as the defendant may be used to prove breach of duty. The other options are not considered qualified to testify to this matter.

4. Distributing flyers that charge arbitrary action on the part of an employer in an effort to garner interest in employee unionization would be a part of what phase of planned change? A) Unfreezing B) Movement C) Refreezing D) Resistance

Ans: A Feedback: Unfreezing occurs when the change agent coerces members of the group to change, or when guilt, anxiety, or concern can be elicited. This is not observed in the other options.

19. What A) Professional negligence B) Assault C) Battery D) False imprisonment

Ans: A Feedback: While professional negligence is considered to be an unintentional tort, assault, battery, false imprisonment, invasion of privacy, defamation, and slander are intentional torts.

13. Which factor should be considered when assessing the quality of ethical problem solving? Select all that apply. A) Outcomes B) Decision-making process C) Multiple alternatives D) Data gathering

Ans: A, B Feedback: Outcomes should never be used as the sole criterion for assessing the quality of ethical problem solving, because many variables affect outcomes that have no reflection on whether the problem solving was appropriate. Quality, instead, should be evaluated both by the outcome and the process used to make the decision. If a structured approach to problem solving is used, multiple alternatives are analyzed, and data gathering is adequate, then, regardless of the outcome, the manager should feel comfortable that the best possible decision was made at that time with the information and resources available. The satisfaction of the involved parties is not a reliable factor.

21. Which statement is true regarding criminal law cases? Select all that apply. A) Incarceration is a likely consequence of being found guilty of a criminal offense B) Intentionally giving an overdose of a potent narcotic is a criminal offense C) A guilty verdict requires evidence beyond a reasonable doubt D) Most malpractice cases are tried in criminal court

Ans: A, B, C Feedback: In criminal cases, the individual faces charges generally filed by the state or federal attorney general for crimes committed against an individual or society. In criminal cases, the individual is always presumed to be innocent unless the state can prove his or her guilt beyond a reasonable doubt. Incarceration and even death are possible consequences for being found guilty in criminal matters. Nurses found guilty of intentionally administering fatal doses of drugs to patients would be charged in a criminal court. Most malpractice cases are tried in civil court.

24. Which action demonstrates appropriate management regarding legal issues? Select all that apply. A) Remains current on all institutional policies and procedures B) Delegates with consideration to appropriate scopes of practice C) Requires physical proof of appropriate professional licensure each year D) Provides yearly in-services on the operation of newly acquired equipment

Ans: A, B, C Feedback: Sound management functions regarding legal issues include understanding and adhering to institutional policies and procedures delegating to subordinates wisely, looking at the managers scope of practice and that of the individuals he or she supervises, and monitoring subordinates to ensure they have a valid, current, and appropriate license to practice nursing. In-services should be held frequently especially when related to issues that affect care delivery. The reliance on peers for advice in such matters is not prudent; the institutions legal advisor is much better prepared for this task.

21. Which characteristic of an organization has influence on the ethical decisions its managers make? Select all that apply. A) Purpose B) Societal role C) Societal constraints D) Values

Ans: A, B, C Feedback: The managers ethical obligation is tied to the organizations purpose, and the purpose of the organization is linked to the function that it fills in society and the constraints society places on it. So, the responsibilities of the nurse-manager emerge from a complex set of interactions. Society helps to define the purposes of various institutions, and the purposes, in turn, help to ensure that the institution fulfills specific functions. However, the specific values and norms in any particular institution determine the focus of its resources and shape its organizational life. The values of people within institutions influence actual management practice. The organizations societal status should not be considered when making ethical decisions.

24. Which statement concerning autonomy and the employee is true? Select all that apply. A) It is a form of personal liberty B) Its legal equivalent is self determination C) It is based on a persons right to make a choice D) It is supported by the process of progressive employee discipline

Ans: A, B, C, D Feedback: A form of personal liberty, autonomy is also called freedom of choice or accepting the responsibility for ones choice. The legal right of self-determination supports this moral principle. The use of progressive discipline recognizes the autonomy of the employee. The employee, in essence, has the choice to meet organizational expectations or to be disciplined further. If the employees continued behavior warrants termination, the principle of autonomy says that the employee has made the choice to be terminated by virtue of his or her actions, not by that of the manager. Therefore, nurse-managers must be cognizant of the ethical component present whenever an individuals decisional capacity is in question. To take away a persons right to self-determination is a serious but sometimes necessary action.

11. A lawsuit pertaining to professional negligence must include duty, breach of duty, injury, and a causal relationship between breach of duty and injury. What else must be included? Which element is necessary to prove professional negligence? Select all that apply. A) Breach of duty B) Presence of injury C) Ability to foresee harm D) Causal relationship

Ans: A, B, C, D Feedback: A lawsuit pertaining to professional negligence must include duty, breach of duty, injury, a causal relationship between breach of duty and injury, and the ability to foresee harm. Intent to cause injury is not a requirement.

It is appropriate to make a change for which reason? Select all that apply. A) To solve an existing problem B) To increase staff efficiency C) To reduce unnecessary workload D) To improve staff productivity

Ans: A, B, C, D Feedback: Change should be implemented only for good reasons such as the solution of an existing problem, increasing staff efficiency, eliminating unnecessary workload and improving productivity. Boredom alone is not a sufficient reason to institute change.

15. Which situations is a nurse-manager illegally responsible for reporting? Select all that apply. A) Suspected incidents of elder abuse B) Examples of substandard medical care C) Client-reported incidents of child abuse D) Confirmed case of a communicable disease

Ans: A, B, C, D Feedback: In addition, the manager, like all professional nurses, is responsible for reporting improper or substandard medical care, child and elder abuse, and communicable diseases, as specified by the Centers for Disease Control and Prevention. Disagreements are not mandated reportable situations. element must be included in the process of securing informed consent?

21. Which force is driving change in todays health-care environment? Select all that apply. A) Increased cost of health-care services B) Decrease in health-care professionals and providers C) Decreased third-party reimburse of health-care services D) Increased need to update health-carenrelated technologies

Ans: A, B, C, D Feedback: Many forces are driving change in contemporary health care, including rising health- care costs, declining reimbursement, workforce shortages, increasing technology, the dynamic nature of knowledge, and a growing elderly population. Contemporary health- care agencies then must continually institute change to upgrade their structure, promote greater quality, and keep their workers. Wages for health-care professions and providers have not contributed significantly to the changes in todays health-care environment.

17. To make appropriate ethical decisions the nurse-manager must have knowledge of what items to assist in making decisions? Select all that apply: 1, 2, 3, 4. A) Organizational processes 1, 2 B) Proven decision-making models 1, 2, and 3 C) Professional approach that eliminates trial and error D) Ethical principles and frameworks

Ans: A, B, C, D Feedback: To make appropriate ethical decisions then, the manager must have knowledge of ethical principles and frameworks, use a professional approach that eliminates trial and error and focuses on proven decision-making models, and use available organizational processes to assist in making such decisions. Knowledge of the involved parties wishes is not a focus of the decision-making process.

14. Which statement is true regarding planned change? Select all that apply. A) Resistance to change should be expected as a natural part of the change process B) Change should be viewed as a chance to do something innovative C) Technical changes are more resisted by staff than social changes are D) Change affects the homeostasis of a group

Ans: A, B, D Feedback: Change should not be viewed as a threat but as a challenge and a chance to do something new and innovative. Change should be implemented only for good reason. Because change disrupts the homeostasis or balance of the group, resistance should be expected as a natural part of the change process. The level of resistance to change generally depends on the type of change proposed not the age of the staff affected by the change. Technological changes encounter less resistance than changes that are perceived as social or that are contrary to established customs or norms.

18. Professional organizations generally espouse standards of care that have what relationship to those required by law? Select all that apply. A) Higher than those required by law B) The same as those required by law C) Are established after those required by law D) Are established prior to those required by law

Ans: A, D Feedback: Professional organizations generally espouse standards of care that are higher than those required by law. These voluntary controls often are forerunners of legal controls. The standards are written by health-care professionals while laws are written by legislatures.

18. Which statement reflects an important factor to consider when implementing a planned change? A) Change should be implemented suddenly B) Change should be implemented gradually C) Change should be implemented arbitrarily D) Change should be implemented sporadically

Ans: B Feedback: Change should be planned and thus implemented gradually, not sporadically or suddenly and certainly not arbitrarily.

20. Historically, many of the changes that have occurred in nursing or have affected the profession are the result of what type of change? A) Planned B) Change by drift C) Rationalnempirical D) Normativenreeducative

Ans: B Feedback: Historically, many of the changes that have occurred in nursing or have affected the profession are the result of change by drift. While other types of changes have occurred, change by drift accounts for most of them.

8. What characteristic is associated with organizational groups assigned to manage the change process? A) Both formulate and implement the change B) Have representation from all key stakeholders C) Are made up of quality circles D) Are teams of resistance breakers

Ans: B Feedback: In some large organizations today, multidisciplinary teams of individuals, representing all key stakeholders in the organization, are assigned the responsibility for managing the change process. In such organizations, this team manages the communication between the people leading the change effort and those who are expected to implement the new strategies.

6. What is the responsibility of a charge nurse who discovers that a medication error was made on the previous shift? A) Share that information with the charge nurse on the previous shift B) Document the incident as per hospital policy C) Write a memo to the nurse who made the error requesting incident report be written D) Write a note in the clients chart that an incident report will be completed

Ans: B Feedback: It is the responsibility as manager to immediately document the error according to hospital policy. Since policies concerning such situations vary, it is vital to know and follow established policies. It is not generally appropriate to make such a note on the clients chart.

6. What is the responsibility of a charge nurse who discovers that a medication error was made on the previous shift? A) Share that information with the charge nurse on the previous shift B) Document the incident as per hospital policy C) Write a memo to the nurse who made the error requesting incident report be written D) Write a note in the clients chart that an incident report will be completed

Ans: B Feedback: It is the responsibility as manager to immediately document the error according to hospital policy. Since policies concerning such situations vary, it is vital to know and follow established policies. It is not generally appropriate to make such a note on the clients chart.

23. Which term is used to identify a persons feelings of powerlessness to stop unethical behavior in another person or institution? A) Moral conflict B) Moral outrage C) Ethical relativism D) Ethical universalism

Ans: B Feedback: Moral outrage occurs when an individual witnesses the immoral act of another but feels powerless to stop it. Moral uncertainty or moral conflict occurs when an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is. Ethical relativism suggests that individuals make decisions based only on what seems right or reasonable according to their value system or culture. Ethical universalism holds that ethical principles are universal and constant and that ethical decision making should not vary as a result of individual circumstances or cultural differences.

16. Which member of the health-care team is often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting wants and goals? A) Physicians B) Nurses C) Nurse practitioners D) Social workers

Ans: B Feedback: Nurses are often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting needs, wants, and goals. The nature of the patient contact of a nurse is more direct and involves more time than the other members of the health-care team.

22. Which behavior will best minimize a nurses risk for a malpractice claim? A) Always carry a personal liability insurance policy B) Always function with the states nursing practice act C) Ask for assistance when engaged in complicated procedures D) Devote time to establishing an effective nursenpatient relationship

Ans: B Feedback: Nurses can reduce the risk of malpractice claims by practicing within the scope of the Nurse Practice Act. Nurses should purchase their own liability insurance and understand the limits of their policies. Although this will not prevent a malpractice suit, it should help to protect a nurse from financial ruin should there be a malpractice claim. While the other options present reasonable advice, they will not necessarily help in the avoidance of a malpractice claim.

25. Which statement best describes the impact that the concept of respondeat superior has on the issue of nursing liability? A) It allows for joint liability among physicians, nurses, and health-care organizations B) It supports the sharing of blame among all involved sources of health-care services C) It encourages legal intervention when health care is thought to be substandard D) It implies that the institution is responsible for the acts of its employees

Ans: B Feedback: Nurses must remember that the purpose of respondeat superior is not to shift the burden of blame from the employee to the organization but rather to share the blame, increasing the possibility of larger financial compensation to the injured party. While the other options may be true statements, the correct option describes the more nurse-related implication of the concept.

25. Which factor is the greatest contributor to the resistance encountered with organizational change? A) Poor organizational leadership B) Presence of employee mistrust C) Ineffective organizational management D) Insufficient staff involvement in the process

Ans: B Feedback: Perhaps the greatest factor contributing to the resistance encountered with change is a lack of trust between the employee and the manager or the employee and the organization. While the other options may increase resistance, employee distrust is the primary barrier to change.

What defines the legal boundaries of nursing at the state level? A) The states Attorney General B) The Nurse Practice Act C) The ANA standards of practice D) The ANA Code for Nurses

Ans: B Feedback: The 51 Nurse Practice Acts representing the 50 states and the District of Columbia are examples of statutes. These Nurse Practice Acts define and limit the practice of nursing, stating what constitutes authorized practice as well as what exceeds the scope of authority. Although Nurse Practice Acts may vary among states, all must be consistent with provisions or statutes established at the federal level. The other options lack the comprehensiveness and focus of a states Nurse Practice Act.

What defines the legal boundaries of nursing at the state level? A) The states Attorney General B) The Nurse Practice Act C) The ANA standards of practice D) The ANA Code for Nurses

Ans: B Feedback: The 51 Nurse Practice Acts representing the 50 states and the District of Columbia are examples of statutes. These Nurse Practice Acts define and limit the practice of nursing, stating what constitutes authorized practice as well as what exceeds the scope of authority. Although Nurse Practice Acts may vary among states, all must be consistent with provisions or statutes established at the federal level. The other options lack the comprehensiveness and focus of a states Nurse Practice Act.

7. What is the role of the American Nurses Association Code of Ethics and Interpretive Statements? A) Outlines minimum levels of ethical behavior that nurses must maintain B) Functions as a guide to the highest standards of ethical practice for nurses C) Is a legally binding document that directs a nurses ethical and moral behavior D) Mandates the ethical behavior prerequisite for maintaining a nursing licensure

Ans: B Feedback: The ANA Code of Ethics outlines the important general values, duties, and responsibilities that flow from the specific role of being a nurse in order to achieve and maintain the highest standards. The document is not legally binding nor is it a mandate of behavior.

7. What is the best reason that nurse-managers have an ongoing responsibility to be aware of legislation affecting nursing practice? A) This will prevent them from getting sued B) Laws are fluid and subject to change C) It will protect the agency from a lawsuit D) It will ensure that correct procedure is carried out

Ans: B Feedback: When using doctrines as a guide for nursing practice, the nurse must remember that all laws are fluid and subject to change. Laws are not static. It is the responsibility of each manager to keep abreast of legislation and laws affecting both nursing practice and management practice. While the other options are correct, they do not describe the most encompassing reason that nurse-managers need to keep aware of current legislature affecting nursing practice.

6. Which ethical framework would most likely be used to arrive at the nurses decision to work overtime in spite of previous social plans? A) Utilitarianism B) Duty based C) Rights based D) Intuitionism

Ans: B Feedback: The duty framework says that some things should be done just because there is a duty to do them or refrain from doing them. Utilitarianism states that the good of the many outweighs the wants or needs of the individual. The remaining options are not relevant to the situation.

19. Which characteristics are associated with change by drift changes? Select all that apply. A) They are planned B) They are accidental C) They are unplanned D) They are a result of a threat

Ans: B, C Feedback: Change by drift is unplanned or accidental. The other options are not characteristics of changes that are a result of change by drift.

3. A doctor orders a medical procedure that the staff nurse has reason to believe will harm the patient. Which statement accurately states the legal consequences of carrying out, or refusing to carry out, the procedure? A) The staff nurse cannot be held legally liable for any harm to the patient if the procedure is carried out with due care B) The nurse may lose his or her license by refusing to carry out the procedure C) The nurse can be held legally liable for any harm if the procedure is carried out without question D) The nurse can be held accountable for practicing medicine without a license

Ans: C Feedback: All nurses have personal liability, which means that every person is liable for his or her own conduct. None of the remaining options describes that liability or its outcomes accurately.

Protecting patient confidentiality respects the clients right to A) self-esteem B) self-defense C) self-determination D) self-incrimination

Ans: C Feedback: Confidentiality is a foundation of both medical and nursing ethics, and it respects the clients right to self-determination. While the other options are worthy of respect, they are not associated with confidentiality.

20. Malpractice or professional negligence is the failure of a person with professional training to act in a reasonable and prudent manner. How many components must be present for an individual to be found guilty of malpractice? A) Three B) Four C) Five D) Six

Ans: C Feedback: Five components must be present for a professional to be held liable for malpractice: duty to use care, failure to meet standard of care, foreseeability of harm, direct relationship between failure to meet the standard of care and injury can be proved, and injury. is an example of an unintentional tort?

14. What A) A timeline of when the treatment is expected to occur B) Written information on what the post procedure outcomes will be C) Information regarding the risks involved in the proposed procedure D) An explanation of the nature of all associated treatment provided by the nurse

Ans: C Feedback: Informed consent can be given only after the patient has received a complete explanation of the surgery, procedure, or treatment and indicates that he or she understands the risks and benefits related to it. Timeline and nursing responsibilities are not components that are included. Outcomes are identified as expected or desired; no guarantees are given.

5. Which statement regarding the MORAL decision-making model is true? A) It is a problem-solving model B) It does not include an evaluation step C) The identification and analysis of multiple alternatives for action is required D) The decision is arrived upon with only the involvement of the decision maker

Ans: C Feedback: MORAL is a decision-making model that is useful in clarifying ethical problems, and it requires the identification and analysis of multiple alternatives for action. The other options are not true statements regarding this decision-making model.

22. Which ethical principle associated with an adult child is legally given the right to make medical decisions for a cognitively impaired parent? A) Justice B) Fidelity C) Paternalism D) Beneficence

Ans: C Feedback: Paternalism is when one individual assumes the right to make decisions for another. Justice requires that a person seek fairness, treat iequalsi equally, and treat iunequalsi according to their differences. Fidelity involves the need to keep promises. Beneficence involves actions that are taken in an effort to promote good.

8. Which characteristics are required of a reasonable and prudent nurse? A) Years of clinically focused nursing experience B) Specialized nursing skills C) Average nursing judgment and skills D) Earned advanced nursing degree

Ans: C Feedback: Reasonable and prudent generally means the average judgment, foresight, intelligence, and skill that would be expected of a person with similar training and experience. The other options describe qualifications not required of a reasonable and prudent nurse.

12. Much of the difficulty people have in making ethical decisions results from a lack of formal education about problem solving. Research at the University of Pennsylvania found what percentage of the nurses and social workers reported having no ethics training? A) 15 B) 20 C) 25 D) 30

Ans: C Feedback: Research done at the University of Pennsylvania found that nearly 25% of the nurses and social workers reported having received no ethics training.

3. Which situation is associated with and aging organization? A) Retired staff is replaced with new graduate nurses B) State-of-the-art cardiac monitoring equipment is placed in the ICU C) The unit functions with strict adheres to institutional rules and policies D) A suggestion committee composed of staff and management meets monthly

Ans: C Feedback: The young organization is characterized by high energy, movement, and virtually constant change and adaptation. Aged organizations have established iturf boundaries,i function in an orderly and predictable fashion, and are focused on rules and regulations. Change is limited.

15. Which statement is correct regarding the distinction between legal and ethical obligations in decision making? A) Ethical controls are clearer and philosophically impartial B) Ethical controls are much clearer and individualized C) Legal controls are clearer and philosophically impartial D) Legal controls are much less clear and individualized

Ans: C Feedback: In general, legal controls are clearer and philosophically impartial; ethical controls are much less clear and individualized.

23. Which statement is true regarding the implications of a Good Samaritan law for a registered nurse? Select all that apply. A) A nurse has a legal responsibility to provide emergency services B) Such laws are universally worded so as to minimize state-to-state differences C) In order for protection to apply, the nursing care cannot be considered negligent D) A nurse who provided out-of-scope care is not protected by the Good Samaritan law

Ans: C, D Feedback: Nurses are not required to stop and provide emergency services as a matter of law, although most health-care workers feel ethically compelled to stop if they believe they can help. Good Samaritan laws suggest that health-care providers are typically protected from potential liability if they volunteer their nursing skills away from the workplace (generally limited to emergencies), provided that actions taken are not grossly negligent and if the health-care worker does not exceed his or her training or scope of practice in performing the emergency services. However, not being paid for your services alone will not provide Good Samaritan law protection. Good Samaritan laws apply only if the health-care worker does not exceed his or her training or scope of practice in performing the emergency services. Protection under Good Samaritan laws varies tremendously from state to state. In some states, the law grants immunity to RNs but does not protect LVNs or LPNs. Other states offer protection to anyone who offers assistance, even if they do not have a health-care background. Nurses should be familiar with the Good Samaritan laws in their state.

18. Using both a systematic approach and proven ethical tools and technology allows managers to make better decisions and increases the probability that they will feel confident about the decisions they have made. Leadership roles and management functions are involved in management ethics. What is an example of a leadership role? A) Uses a systematic approach to problem solving and decision making when facedwith management problems with ethical ramifications B) Identifies outcomes in ethical decision making that should always be sought oravoided C) Uses established ethical frameworks to clarify values and beliefs D) Role models ethical decision making, which is congruent with the AmericanNurses Association Code of Ethics and Interpretive Statements and Professional standard

Ans: D Feedback: A leadership role is role models ethical decision making, which is congruent with the American Nurses Association Code of Ethics and Interpretive Statements and Professional standard. Uses a systematic approach to problem solving and decision making when faced with management problems with ethical ramification, identifies outcomes in ethical decision making that should always be sought or avoided, and uses established ethical frameworks to clarify values and beliefs are examples of management functions.

15. Which activity is associated with the movement stage of the development of a plan? A) Gather data B) Accurately diagnose the problem C) Decide if change is needed D) Develop a plan

Ans: D Feedback: A responsibility of the movement stage is to develop a plan. Responsibilities of the change agent in the unfreezing stage are as follows: Gather data, accurately diagnose the problem, and decide if change is needed.

What is required to successfully implement the chaos theory of change? A) Most stakeholders accepting the need for change B) Finding solutions to resistance to change C) Changing attitudes more than increasing knowledge D) Finding underlying order in random data

Ans: D Feedback: Chaos theory requires finding underlying order in apparent random data.

8. Which statement regarding ethical decision making is true? A) Outcomes are the basic criterion for evaluating ethical decision making B) Only desirable alternatives are identified when solving ethical dilemmas C) Critical ethical decisions are made quickly so the situation does not worsen D) Accepting some ambiguity and uncertainty are a part of ethical decision making

Ans: D Feedback: Ethical decision makers choose between two or more undesirable alternatives, and because they can use only the information and resources available at the time, they must live with some ambiguity and uncertainty. The remaining options are not true statements regarding the ethical decision-making process.

1. Which statement best describes ethics? A) How our lives and relationships are led in our reality B) How people make decisions they see as legally and morally appropriate C) The conflict, power, and interdependency associated with the way we live D) What our conduct and actions should be regarding what is right and good

Ans: D Feedback: Ethics is the systematic study of what a persons conduct and actions should be with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a persons life and relationships should be, not necessarily what they are.

9. Which ethical framework involves an individualized decision-making framework? A) Duty based B) Rights based C) Utilitarian D) Intuitionist

Ans: D Feedback: Intuitionist states that each case weighed on a case-by-case basis to determine relative goals, duties, and rights. Utilitarian provides the greatest good for the greatest number of people. Duty based is a duty to do something to refrain from doing something. Rights- based individuals have basic inherent rights that should not be interfered with.

3. The practice of allocating organs for transplantation based on a persons iworth to societyi is an example of what ethical principle for decision making? A) Autonomy B) Beneficence C) Utility D) Justice

Ans: D Feedback: Justice: Seek fairness, treat iequalsi equally, and treat iunequalsi according to their differences. Autonomy: Promotes self-determination and freedom of choice. Beneficence: Actions are taken in an effort to promote good. Utility: The good of the many outweighs the wants or needs of the individual.

19. Using both a systematic approach and proven ethical tools and technology allows managers to make better decisions and increases the probability that they will feel confident about the decisions they have made. Leadership roles and management functions are involved in management ethics. What is an example of a management function? A) Is self-aware regarding own values and basic beliefs about the rights, duties, and goals of human beings B) Accepts that some ambiguity and uncertainty must be a part of all ethical decision making C) Accepts that negative outcomes occur in ethical decision making despite high- quality problem solving and decision making D) Identifies outcomes in ethical decision making that should always be sought or avoided

Ans: D Feedback: Management function identifies outcomes in ethical decision making that should always be sought or avoided. Leadership roles include the following: Is self-aware regarding own values and basic beliefs about the rights, duties, and goals of human beings; accepts that some ambiguity and uncertainty must be a part of all ethical decision making; accepts that negative outcomes occur in ethical decision making despite high-quality problem solving and decision making.

13. Which statement is true regarding the philosophy of nonlinear change theories? A) Change occurs in sequential steps B) Change is predictable C) Change success relies on policies and hierarchies D) Change is necessary because organizational stability is brief

Ans: D Feedback: Most twenty-first-century organizations experience fairly brief periods of stability followed by intense transformation.

11. Which description best describes the theory behind nonlinear change? A) It occurs in organized steps B) It must have a logical sequence C) It results in equilibrium D) It has unpredictable outcomes

Ans: D Feedback: Nonlinear change states that the dynamics and outcomes of change are always unpredictable. Nonlinear change does not involve the other statements.

5. How is the legal expansion of nursing roles accomplished? A) The expansion of job descriptions in an agency B) Written contracts between the nurse and the client C) A written agreement between the nurse and the physician D) Revision of the Nurse Practice Act

Ans: D Feedback: RN scope of practice is always determined by the Nurse Practice Act and any expansion of roles must occur through legislated changes in that statute. None of the remaining options are sufficient to expand nursing roles legally.

6. Which action represents a management function in planned change? A) Inspiring group members to be involved in planned change B) Visionary forecasting C) Role modeling high-level interpersonal communication skills in providing support for individuals undergoing rapid or difficult change D) Recognizing the need for planned change and identifying the options and resources available to implement change

Ans: D Feedback: Recognizing the need for planned change and identifying the options and resources available to implement change are management functions; the other choices are leadership functions.

10. Which activity does a change agent make a commitment to in order to best assure a successful implementation of a change? A) Helping followers arrive at total consensus regarding the change B) Encouraging subgroup opposition to change so many viewpoints can be heard C) Using change by drift if the resistance to change is too strong D) Being available to support those affected by a change until the change is complete

Ans: D Feedback: The change agent needs to offer support to others so that the change occurs. The other options are not as impactful on a successful transition to change.

24. Which activity associated with the unfreezing state of change will have the greatest impact on the success of the movement stage of the change process? A) Accurate identification of the problem requiring change B) Effective information gathering concerning the problem C) Key personnel voicing their opinions regarding the need for change D) The need for change is perceived by all those affected by the problem

Ans: D Feedback: The change agent should not proceed to the movement stage until the status quo has been disrupted and the need for change is perceived by the others. While the other options will affect the process, perception of the need to change by all affected by the change is the most impactful of the options provided.

2. What is an ethical dilemma? A) A problem that can be solved using empirical data B) A situation that has clearly delineated facts for decision making C) A problem that when handled effectively has a mutually agreed-upon solution D) A situation that requires choosing between two or more undesirable alternatives

Ans: D Feedback: The most difficult of all moral issues is termed a moral or ethical dilemma, which may be described as being forced to choose between two or more undesirable alternatives. The problem is not generally solved with a solution that is mutually satisfying nor does it lend itself to empirical or delineated facts.

4. The only treatment alternative left for a patient diagnosed with advanced cancer is a rare, highly experimental bone marrow transfusion with a 10% success rate. The insurance company refuses to authorize payment for the $200,000 procedure, arguing that the money could be better spent providing well-baby screening for 2,000 residents in the service area. What does this decision by the insurance company reflect? A) Unethical conduct B) Maleficence C) Paternalism D) Utility

Ans: D Feedback: The principle of utility states that what is best for the common good outweighs what is best for the individual. There is no indication of unethical or maleficence behavior on the part of the insurance company. Paternalism would be characterized by the insurance company making treatment decision without the patient having input.

12. What component of professional negligence is represented when a patient experiences a seizure resulting from a medication error? A) Duty to use due care B) Failure to meet standard of care C) Foreseeability of harm D) A causal relationship

Ans: D Feedback: A direct causal relationship between failure to meet the standard of care (breach) and injury can be proved when a patient is harmed because proper care is not given. None of the remaining options are relevant to this criterion.